The Dignity of Personal Choice; Choosing Lifesaving Care - or Not - Shouldn't Be Left to Bureaucrats

Article excerpt


Much of the discussion about the Affordable Care Act (ACA) has dealt with costs, unintended effects or constitutionality, which are all crucially important. But there has not been much mention of the deeper philosophical issues the ACA raises, such as its effects on human autonomy and dignity, both of which are endangered by the usurpation of personal health care choice by a government bureaucracy.

A patient's interests in his own health, comfort and financial security as well as the well-being of his loved ones are multifaceted, complex and known only to him. As such, choices regarding health care are among the most intimately personal choices one can make, and making those choices oneself is essential to maintaining and expressing one's autonomy. Government intervention in the health care system will lessen the ability of people to make their own choices to promote their own interests and to preserve their dignity as autonomous persons.

Under the ACA, bureaucrats will play a more significant role than ever in rationing scarce medical resources. Of course, scarcity is not the fault of the government (although price controls make it worse). The market must allocate scarce medical resources, too, but it will do so according to the price mechanism, which critics say is unfair or arbitrary. While any allocation of scarce resources is likely to have tragic aspects - especially in the case of medical resources - there is no more ethical way to allocate them than the market. The price mechanism incorporates the choices of many, while bureaucracy represents the choices of few, which is truly unfair and arbitrary.

The issue is not whether choices must be made - for they must - but rather who should make them. In a market system, the patient can assess the value of different treatments compared to other uses for his resources. Perhaps he will decline the recommended treatment, even if he can afford it, in order to leave more money for his children or to take a cruise in the final months of his life. Or maybe he will sell his house to pay for another month on life support - and with his beloved grandchildren. In a market setting, he alone is responsible for the benefits, costs and other consequences; the choice is his, no matter how imprudent others may judge it to be. …