Physicians as "Little Dictators"

Wednesday, October 25, 2006

At Spiked is a chilling article by Rob Lyons that describes what can happen if we delegate to the government all control over the medical sector: Doctors in Britain are beginning to refuse certain forms of medical treatment to people who smoke, drink, or are obese.

In the latest example of this trend, health chiefs in Norfolk and Newcastle-under-Lyme have decided to refuse certain kinds of non-urgent surgery to smokers --- including hip and knee replacements. Both [National Health Service] areas are in financial crisis and are looking for ways to save money -- and the government's relentless campaigning against our bad habits have made smokers, drinkers and the overweight an easy target for these bean-counters.


Whatever happened to humane medicine? It is one thing to advise a patient that giving up smoking or losing a few pounds will aid their recovery or increase the chances of success. It is quite another to refuse treatment altogether.

There is also the small matter of patient autonomy. While rationing of one form or another has been ever-present in the NHS, there has been the general principle that patients will be treated on a first come, first served basis, regardless of their income or lifestyle. Using access to public services to modify behaviour is something more closely associated with dictatorial regimes. The result is a peculiar form of torture. Those who require hip or knee replacement operations are clearly in pain, and usually severely hampered by their condition. This is coercion through healthcare, as surely as twisting someone's arm. The defence of autonomy, our freedom to live as we choose rather than as our government or our doctors see fit, is far more important than balancing the books of a cash-strapped NHS. [bold added]
When a good is offered for "free", as medical care is in Britain, shortages occur and rationing becomes inevitable as pricing information is unavailable to consumers about the state of the demand for that good versus its supply. Furthermore, given that the government must pay for medicine there, unhealthy habits by patients therefore become the business of the government to the extent that it will attempt to remain accountable to those whose wealth it expropriates in the process of providing that "free" service. Some form of government interference in the personal habits of Britons was an inevitable consequence of this scheme.

It should be obvious that such a situation provides all the rationale needed for any " little dictators" who happen to practice medicine to refuse to treat smokers and drinkers who might be well able to afford the operations in a free market system.

As objectionable as the behavior of the physicians is, it is absurd to complain on the one hand about a loss of "personal autonomy" and yet on the other to leave the system that makes their behavior possible unchallenged. The only way to preserve personal autonomy -- be it the freedom of a doctor to run a private practice (which seem not to concern Lyons), of a patient to look for the best physician he can afford, or for a patient simply to get care at all -- is to return to the system that protects it, capitalism.

And those who want to import this hideous system to America whine that some cannot afford medical care or medical insurance! Their "cure" for poverty is clearly worse than the disease!

-- CAV


Andrew Dalton said...

Doctors are already being conscripted as informants in the United States. I can't imagine what would happen if this kind of alcohol/drug enforcement zeal were applied under a fully socialized medical system.

Gus Van Horn said...

Considering how politicized smoking and obesity have become in recent years, we're already getting a taste it here. Both drinking and eating are forwned upon by the more puritannical elements of the left, and most physicians are leftists.

And if your physician follows a religion? Well, we're getting a sneak preview of that, too, although this bird isn't even a physician.

Anonymous said...

"Using access to public services to modify behaviour is something more closely associated with dictatorial regimes. The result is a peculiar form of torture."

My partner and I faced this when we built a house in a very liberal city. Several of the most invasive regulations were not intended to achieve their stated purpose but some other item off of the city's wishlist. For example, we were required to plant nearly 9,000 native plants around our property, ostensibly to limit erosion. In fact, it had nothing to do with erosion. The city wants to see a general "greening" of the landscape because it's "good for the environment". They call it a "community value". We could also see that they wanted to teach us more about gardening with natives. I was thinking I could teach them a few things about natives, but I won't go into the details...

In both cases -- needing medical care and taking a total financial risk on a new home -- the authorities know that you'll comply. You almost have to, at least when you're in the middle of it.

Gus Van Horn said...

It is even worse in your case! You were simply attempting to exercise your property rights and the government glommed onto that as an excuse to point a gun to your head and make you garden whether you wanted to or not.

Totally reprehensible and wrong!

Anonymous said...

It gets worse, but I won't go into it. I'm afraid I'll start frothing at the mouth.

Seriously, petty bureaucrats can be much worse in some ways than a bunch of senators and presidents. The amount of rules created at the administrative level of local government can be absolutely mind-boggling, and a lot of it isn't open to appeal.

Yep, best you stay in Texas, Gus. You and your six shooter might get you into some trouble out here on the left coast. :-)

Gus Van Horn said...

Even Texas has a little bit of that, if I recall recent attempts by some of my fellow brew club members to remaodel correctly.

But your point is well taken in the sense that it shows exactly why deep cultural change is necessary. Only a culture that supports such behavior can explain why it is so widespread.