Are we free to choose an unhealthy life if, at the end of it, we help to bankrupt our country? Is it other people’s business what you do on a daily basis, knowing that health is a set of habits you keep? In this country, people are free to choose as they wish, but it’s often the broader community that cleans up after them.
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ACEP Now: Vol 35 – No 04 – April 2016
Often I’ve heard that “these people” should have the personal responsibility to take care of their issues. If they have primary care physicians, why don’t they try to go to them? It turns out they’re free to do whatever they choose, even if that’s make bad choices. What they’re not free from are the consequences. Every action, the saying goes, has a reaction. Every choice has an effect. Many of my colleagues have noted the choices made by patients have costs. “Your tax dollars hard at work,” I hear. As if the prescription was to simply cut them off. As if the prescription was to erect a barrier or a filter so only the “right” people get seen.
My point is this: in this country, we’re free to do as we please. Often these choices have consequences that reverberate beyond just ourselves. In fact, they often impact the community negatively. This is where our freedoms are supposed to end, but it’s never that clean. There are only so many resources out there and not enough hospital beds for the population. EDs, for example, get very crowded (albeit for many different reasons), impacting everyone who works there and everyone who comes to that ED in need. So are we then to limit everyone’s freedom to self-determine? Are we to tell people when they can and cannot decide it’s an emergency? Or are we free to self-determine?
Some of you might rightly point out that we can’t afford to let everyone utilize resources endlessly. That we all have a responsibility to the broader community to be a steward of resources and to not run our country into bankruptcy. That there are limits to freedom. You’re probably right, but maybe we in medicine should be talking about those limits. The great majority of the cost in our health care system is spent on the sickest patients. The greatest source of our long-term debt in the country is the cost of health care. Maybe we in medicine have a responsibility to our country. However, I’m pretty sure that when sick patients show up in your ED, you do what I do and try to save them.
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