British sociologist Julian Le Grand has noted that public policy is grounded in a conception of humans as “knights,” “knaves,” or “pawns.”1 Human beings are motivated by virtue (knights) or self-interest (knaves) or are passive respondents to their circumstances (pawns). A society's view influences whether it builds public policies that are permissive, punitive, or prescriptive.
Le Grand's original analysis applied to British citizens affected by the postwar social welfare state in Britain, and it has previously been applied to the role of physicians in the US health care system.2 In this Commentary, we describe ways in which patients might be considered knights, knaves, and pawns in public discourse and the importance of policies that match actual motivations.