Medical Practice Without Consent – Econlib

• While informed consent and respect for autonomy govern how health care practitioners interact with their patients, this new ethos is absent when it comes to the government asserting authority over adults’ health decisions. The government dictates what kinds of health professionals adults may consult. It determines what medicines adults may purchase and under which circumstances they may consume them. It bans adults from ingesting substances or engaging in activities that the government decides are unhealthful, regardless of individual risk-benefit priorities.

• I want to point out roads leading to a future where the government respects the autonomy and rights of all adults.

• –Jeffrey A. Singer, Your Body, Your Health Care, (pages 2-3)

Jeffrey A. Singer, a physician, argues for deregulation in health care to empower individuals to make their own health care decisions. His book’s title, Your Body, Your Health Care, harkens back—consciously or otherwise—to a 1970 volume Our Bodies, Our Selves, which was dedicated to female empowerment in that era’s feminist movement. While not focused on healthcare alone, the popular book radically shifted the conversation around women’s health, empowering women to understand, manage, and advocate for their own bodies and medical care.

Except under dire circumstances, we would be offended if a doctor gave us no choice concerning the manner of treatment. Dr. Singer is at least as offended by the government presuming to be dictatorial regarding treatment.

Today, we are accustomed to only being able to consume medications that have been approved by the government. In many cases, a doctor’s prescription is necessary. But we can imagine a regime in which you can decide on your own, with institutions, including the Food and Drug Administration, playing only an advisory role. Singer asserts:

• If one supports the doctrine of informed consent, then one must logically respect the right to self-medicate. (page 13)

But later Singer writes,

• The complexity, sophistication, and risks posed by many modern pharmaceuticals and the threat of tort liability would lead manufacturers to continue to market many drugs as prescription-only. p. 60

I am afraid that “the threat of tort liability” imposes costs while providing uncertain benefits. In that regard is not necessarily better than regulation. I would prefer to see the FDA lose its monopoly on drug certification. One can imagine that the function of drug certification would be privatized and advisory-only. Consumers should be informed about what private certification bodies recommend concerning the drugs that they are considering taking. But I can imagine that to have the resources and the incentives to test thoroughly, private certification organizations might require government subsidies.

Singer argues that the government should not tell us who we can or cannot consult regarding our health.

• Ideally, states should repeal all health professional licensing laws. Licensing laws do little to protect the public from poor quality care and serve as barriers to new entrants and innovations in the health care professions. States could accredit third-party certification organizations to perform licensing boards’ functions. Such organizations could review the credentials, education, and real-world experience of domestic and international applicants and certify them as competent to provide various health care services. (page 39)

The trick will be to make sure that consumers are represented by such certification organizations. Otherwise, there might not be much change from the current situation, where rent-seeking by providers is predominant.

Singer opposes the War on Drugs.

• If the government ended its war on drugs, people would be able to purchase them from legal suppliers. They would comparison shop. They would know with confidence the drugs they are buying, the dosage, and the purity. (page 151)

With marijuana legalization, it does not appear to me that consumers have become so well informed and protected. Purity and dosage are more reliable in the case of alcohol, which is heavily regulated.

For libertarians, the phenomenon of drug addiction represents a challenge. There is not a unitary self. There is the self that is addicted, and there is also the self that would prefer not to be addicted. Perhaps a solution is for an individual to designate someone else with something comparable to “power of attorney” when it comes to potential drug addiction. My designee would be allowed to take steps to block my access to addictive substances.

Your Body, Your Health is a bracing challenge to the status quo regarding health care regulation. Although along the way I have expressed quibbles regarding Dr. Singer’s recommendations, I certainly endorse re-thinking public policy in these areas to try to enhance consumer autonomy.