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The Right to Self-Treatment

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Over the last year or so, much has been said about the right to health care. The advocates of government management of the health-care system believe that everyone should be able to obtain the services of doctors and related practitioners regardless of ability to pay. That is what has fueled the push by the Clinton Administration and others for so-called universal coverage.

Truth be told, there is no right to health care as the advocates of socialized medicine conceive it. In their view, anyone who needs medical attention ought to be able to count on the government to force others to provide or pay for it. But no one can have a right to the services or money of unwilling providers. One has a right to buy services from willing providers. One has a right to request free services or financial donations. But one has no right to use the threat of physical force-directly or indirectly (i.e., through the state)-to obtain those things. The right to health care in that sense is a counterfeit right.

There is, however, an authentic right to health care, which was recognized in the United States until 1914. It is typical of our age that while nearly everyone embraces the counterfeit right, almost no one accepts the authentic right. Even worse, few realize they are denied an important freedom. That authentic right may be called, as the noted psychiatrist Thomas S. Szasz has called it, the right to self-medication. It is the right to care for one’s own health without prior permission from the state.

At first glance, many people will believe we already have that right. They are wrong. For example, one may not seek treatment from a practitioner who is not licensed by the state. Although one may be perfectly content with the treatment provided by an unlicensed practitioner, the state will prohibit that therapeutic relationship; it will even jail the practitioner if it wishes. True, it will not jail the patient. It will merely prevent a consenting adult from engaging in the medical acts of his choice.

Another way that the government interferes with the authentic right to health care is through the system of prescription medicines. Citizens of this theoretically free country may not use certain medicines without the written permission of an officer of the state. Yes, doctors are officers of the state by virtue of their having been deputized by the state to grant, or withhold, such permission. That was not true before 1914. Until then, adult citizens could enter a pharmacy and buy any drug they wished, from headache powders to opium. They needed no one’s permission. They were, in a phrase, pharmacologically free.

That freedom was abolished as the paternalist ethic gained currency. People had to be protected from their own unwise choices. For their own good, they could not be allowed to prescribe medicines for themselves. At least, that is what they were told. In fact, we know otherwise. When Americans were pharmacologically free, they managed not to kill themselves with overdoses or inappropriate medicines. When they felt it necessary, they sought advice from physicians or others who had greater experience than themselves. Americans somehow knew not to swallow purported medicines without wondering about the consequences. (We know this because population and life expectancy grew all during the period.)

Then they lost this right. They were told they were no longer able to make those kinds of decisions. For some unfathomable reason, they surrendered their authentic right to health care without a bloody struggle.

They were lied to, of course. The doctors and the politicians did not really believe that Americans had suddenly become too benighted to medicate themselves. No, the doctors and politicians wanted power. The prescription law was just one piece of a larger conspiracy against the public. At about this time, the United States got its first laws to license doctors and accredit medical schools. The same paternalistic rationalizations were fed to the public. But the minutes of the medical societies’ meetings tell another story. Historian Ronald Hamowy has documented what was really on the minds of the doctors: income. They were concerned that free entry, and hence unrestricted competition, into the medical profession was driving down fees. Only government regulation could keep the doctors living in the manner to which they had become accustomed.

That regulation took several forms. Accreditation of medical schools regulated how many doctors would graduate each year. Licensing similarly metered the number of practitioners and prohibited competitors, such as nurses and paramedics, from performing services they were perfectly capable of performing. Finally, prescription laws guaranteed that people would have to see a doctor to obtain medicines they had previously been able to get on their own. The doctors and politicians succeeded in supporting the medical profession’s income; they also contributed to the infantilization of the American people. We have never recovered.

The same laws have also subverted the medical profession, since doctors can be-and have been-prosecuted for prescribing drugs “in amounts that exceed a legitimate medical purpose.” In some states, doctors must send a copy of prescriptions for certain drugs to a government bureaucracy. Government thus reserves the power to decide what is legitimate.

Some will say, things were simpler before 1914. Surely in our complex age, people cannot be expected to make those decisions for themselves. This is fallacious. Despite all the purported protection against self-treatment, the one thing that is supposed to activate the system for the individual is left entirely to his own discretion: the visit to the doctor. What protects a person against his decision not to see a doctor? Even the most extreme proponents of socialized medicine do not advocate compelling people to see a doctor against their will. The freedom to do without medical care, at least, is respected. If the paternalists were truly consistent, they would call for protecting us from that dangerous freedom by requiring periodic visits to the doctor. But perhaps that would bare their totalitarian talons a little too much.

However, if we can be trusted to make such a basic decision, why can’t we be trusted with other decision-making related to health care? The reason cannot be that people are ignorant in these matters. We are ignorant in lots of matters in which the consequences of unwise decisions can be great. Most of us know little about automobiles. An improperly serviced auto can be dangerous to others. Yet, there is no law against my servicing my own auto. The law does not stop me from working on my own furnace, though a mistake could kill me and others. If I am spiritually distressed, I am free to console myself or seek comfort from a bartender, friend, or anyone else. If I can work on my car, my furnace, and my mind, why can’t I work on my own body?

But surely no medicine should be allowed on the market before it is approved by the government, right? Wrong. The right to self-treatment means just that–the right to choose and administer (or have administered) any treatment. Each individual should be free to determine his own level of confidence about a medicine. A desperately sick person quite reasonably may be willing to seize on a new, untested drug. He may not survive the years of testing required by the Food and Drug Administration. (That systemic delay kills thousands of people each year.) Someone less ill or more risk averse may be more selective. A third person may only want medicines that have stood the test of time. The key question is, who should decide one’s level of confidence? Should the government impose one level on everyone? Or should each decide for himself? In a free society, there can be only one answer.

It is certainly wise to know what one is doing before treating oneself. And that is why the free market provides an abundance of medical information to the layman. It would provide even more in a free medical marketplace. Sources of information would include doctors, medical societies, insurance companies, Prevention magazine, Consumer Reports , newspapers, and more. Competition and the civil law against fraud and malpractice are the best assurances of quality in both information and services. But in the end, people must have the right to enter into any mutually agreed-on contracts for medical services that they choose. Anything less makes a mockery of the idea that we are free.

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    Sheldon Richman is vice president of The Future of Freedom Foundation and editor of FFF's monthly journal, Future of Freedom. For 15 years he was editor of The Freeman, published by the Foundation for Economic Education in Irvington, New York. He is the author of FFF's award-winning book Separating School & State: How to Liberate America's Families; Your Money or Your Life: Why We Must Abolish the Income Tax; and Tethered Citizens: Time to Repeal the Welfare State. Calling for the abolition, not the reform, of public schooling. Separating School & State has become a landmark book in both libertarian and educational circles. In his column in the Financial Times, Michael Prowse wrote: "I recommend a subversive tract, Separating School & State by Sheldon Richman of the Cato Institute, a Washington think tank... . I also think that Mr. Richman is right to fear that state education undermines personal responsibility..." Sheldon's articles on economic policy, education, civil liberties, American history, foreign policy, and the Middle East have appeared in the Washington Post, Wall Street Journal, American Scholar, Chicago Tribune, USA Today, Washington Times, The American Conservative, Insight, Cato Policy Report, Journal of Economic Development, The Freeman, The World & I, Reason, Washington Report on Middle East Affairs, Middle East Policy, Liberty magazine, and other publications. He is a contributor to the The Concise Encyclopedia of Economics. A former newspaper reporter and senior editor at the Cato Institute and the Institute for Humane Studies, Sheldon is a graduate of Temple University in Philadelphia. He blogs at Free Association. Send him e-mail.