Monday, April 6, 2009

Who is responsible for one's health?

A most important question behind too many health initiatives and medicrat blather is a most basic one.

Who is in charge?
Who is in charge of a person's health?

Is it the patient?
Is it the Doctor?
Is it the Medicrat?

Do you remember the old rhetorical question, "Whose body is it, anyway"?

When I was in training, I was subject to a great deal of instruction to not be "paternalistic" toward patients and to respectfully obey their autonomy. I could advise, warn, and teach, I could give them options and try to help, but ultimately the patient made the decision for him/herself.

Today, however, we are seeing the erosion of patient autonomy and a forced resurgence of paternalism as doctors are blamed when someone makes 'bad choices'. Pay-for-performance (P4P) schemes where the Medicrat decrees the Doctor is responsible for the patient's smoking, weight, exercise, etc. What happened to the patient's autonomy?

It is not the Doctor's prerogative to steal the patient's freedom.
It is not the Medicrat's right to overrule the patient's liberty.
It is a person's right and responsibility to exercise autonomy; self-rule. And to live (or not) with the consequences, whether good or bad.

“Liberty means responsibility. That is why most men dread it.”
George Bernard Shaw

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