A wolf in sheep's clothing: a critical look at the ethics of drug taking

The Department of Health's Medicines Partnership is encouraging a shift away from the concept of drug compliance, with its tacit assumption of obedience and coercion, to one of concordance. However, Iona Heath argues that this is, at best, misguided and, at worst, simply window dressing

In 1997 a report of a working party of the Royal Pharmaceutical Society of Great Britain acknowledged that prescribing is “a technically difficult, and morally complex, problem” and that compliance is an ethically dubious aspiration.1 The report proposed the use of a new term—concordance—which was intended to describe the creation, during the process of prescribing, of an agreement that respected the beliefs and wishes of the patient.2 The intention of the working party was to foster a distinct change in culture in the relation between prescribing and drug taking and between patient and prescriber. The intention was honourable, but the initiative seems to be foundering.