About July 2017
Libertarians commonly take self-ownership to be an important idea: If anyone owns you, you do. This idea has many implications; one of them is that individuals are presumably the ones best suited to making decisions for their own health and welfare. In particular this includes decisions about which drugs to ingest and for what reasons. At least to hear libertarians tell it, any challenges to that presumption must meet a fairly high standard if they are to succeed.
Some decisions are not merely self-regarding, of course, but for us it is seldom sufficient merely to assert that an action has an other-regarding aspect, and that therefore it may - or must - be regulated or forbidden. Others are less persuaded by the idea of self-ownership. Perhaps they do not subscribe to it at all; or perhaps they find that the presumption it creates is rather easily rebutted. This disagreement in ethics has public policy implications that may touch on exactly who lives and who dies - and when, and of what. To discuss these matters we have invited a panel of four individuals with varying perspecitves on the right to self-medicate: Jessica Flanigan of the University of Richmond, Craig Klugman of DePaul University, Alison Bateman-House of the New York University School of Medicine, and Christina Sandefur of the Goldwater Institute. Professor Flanigan will open the discussion, with each of the others responding over the coming week. We will then host a free-form discussion through the end of the month.
We also welcome readers’ comments, also through the end of the month.
Physicians are ethically bound respect patients’ medical choices whenever patients wish to refuse care. Yet both they and government regulatory agencies are altogether willing to prohibit patients from taking medical interventions into their own hands. In particular, many drugs are unavailable without prescriptions, and this impinges meaningfully on patients’ rights to self-medicate. Jessica Flanigan argues that we should take these rights more seriously. The results, she argues, will include greater respect and trust in medical settings, better health outcomes, and improved overall wellbeing for patients.
Patients’ autonomy is a key principle of bioethics, says Alison Bateman-House, and with good reason. Yet others must also be protected, including justice and benificence. These principles mean that many of the regulatory safeguards of modern American medicine are indeed justified. Bioethics must never disregard autonomy, but it is far from the only consideration at hand.
Craig Klugman argues that in the field of medicine we need a measure of paternalism to keep from hurting ourselves and others. Doctors and pharmacists train intensively for years to develop an extensive knowledge of which therapies are best for which cases, and to know when they can and cannot be used together. Patients lack this knowledge. They also commonly lack the time to acquire any of it during an illness. As a result they often risk hurting themselves and others when they self-medicate.
Christina Sandefur argues that our system of drug regulation is fundamentally unjust: While some dangerous drugs are authorized government, whether with a prescription or without, some other drugs are not available by any legal means, even when patients are informed and willing to bear the risks. Regulation even goes so far as to prohibit certain parties from discussing off-label use of prescription drugs. These are not merely theoretical impositions, either, because individuals stand to live or die in consequence.