Government Control of Health Care Is a Threat to Freedom

(Sylvia Engdahl's background information for her novel Stewards of the Flame)

In 2006 New York began checking the blood sugar levels of residents with diabetes by requiring medical labs to report test results to the city -- the first time any American government has monitored individuals with a non-contagious disease. The program is justified by its supporters on grounds that money and lives could be saved through intervention in the care of those whose diabetes is poorly controlled. There have been surprisingly few opponents. On the other hand, that's not really surprising; it's strong evidence for the assumption in Stewards of the Flame that most people will voluntarily give up freedom and privacy, and willingly deprive others of it, if told that government action will "save lives" or even simply have "health benefits." I fear this premise of the story is not an exaggeration.

But surely Americans cannot be forced to submit to unwanted medical care; doesn't the law require informed consent? Yes, and the Supreme Court has ruled that competent adults cannot be treated against their will. But not everyone is aware of this fact. (It was, for instance, ignored in the Academy-Award winning movie Million Dollar Baby, the ending of which depended on the assumed inability of a conscious heroine to reject treatment.) Arrested criminals must be read their rights, but in medical situations people are generally simply handed a consent form and told to sign it. Except for surgery, they often must sign a blanket consent before even being permitted to see a doctor.

Moreover, the law is unclear when it comes to screening, as opposed to treatment; screening programs don't always provide for opting out. In any case, the vast amount of government indoctrination on health matters goes unchallenged and indeed, meets with widespread approval. One of the reasons I make a point of Stewards of the Flame not being suitable for the same readership as my YA novels is that I don't want parents and librarians to think I'm using my position as a well-lnown YA author to undermine this indoctrination among kids. To adults, however, I am quite open about the fact that I disapprove of most of it. What's best for the health of individuals is not a matter for the goverment to decide. It wouldn't be even if it weren't controversial -- and it is; medical experts don't always agree. Such decisions depend on personal factors, both physical and with regard people's differing priorities, and should not be made by anyone merely on the basis of statistics.

Although in America the government cannot force adults to be treated medically (unless they are deemed incompetent to make decisions), it can and does force the treatment of children against their parents' wishes. The most common example is childhood vaccination, from which exemption is often granted, although recently some states have eliminated religious exemptions and allow them only for medical reasons. Actually, vaccination is not truly compulsory as U.S. laws requiring it do not involve force. Parents cannot be jailed or fined for failure to comply (as they can in some countries) and their children are not forcibly injected; they are merely barred from attending school -- home-schooled children are not affected. So there is a choice, albeit one not often practical. After all, eligibility for many adult pursuits depends on medical action, such as physical exams for pilots, flu vaccination for health care workers, and inoculation for foreign travel; and where the aim is to protect the public, these requirements have some justification.

Intervention where only a particular child is involved falls in a different category. In my opinion there is no justification for this violation of individual rights unless the parents are mentally ill or uncaring. Courts often order treatments that the parents believe will be damaging, and these unfortunate parents must choose between betraying their child's trust and losing custody. This happens not only in cases of religious objection to treatment -- where, tragically, well-meaning parents have too often been convicted of neglect or even murder for avoiding government-approved care -- but in an increasing number of cases of disagreement based on medical controversy. It is not even limited to life-threatening situtions; children have been locked up simply because of obesity. Teenagers old enough to make up their own minds are denied any say in what is done to their bodies. And in addition, millions of children are now being given dangerous psychoactive drugs with their parents' full cooperation, merely because schools and school-approved therapists demand it..

It goes without saying that government control over prescription drugs is a serious restriction on freedom, not only in the sense of freedom from government interference with individual choice, but because it makes those who require medication continuously dependent on the officially-licensed medical establishment. Yet so accustomed are we to this control that most of us aren't even aware that it did not exist until 1938. Before that, Americans could buy whatever drugs they wished, except narcotics; doctors' prescriptions were mere advice, not legal authorization. There are a few people today (and I am one of them) who believe that the present law is wrong -- that the government has no right to dictate what citizens may or may not consume -- and that its power with regard to drugs should be limited to ensuring truth in labeling. But the vast majority are concerned only with whether or not presently-illegal drugs should be legalized, an issue that obscures the real problem. By declaring some drugs too dangerous for public consumption (which indeed they are) the current law promotes the idea that others are both safe and desirable. Yet no drug is "safe"; with few if any exceptions, all have "side" effects that are either risky or downright damaging -- though many are the lesser of evils compared to serious illness. The public is urged to take authorized drugs to relieve every conceivable condition, potential future condition, or discontent -- and then society wonders why some turn to unauthorized ones in pursuit of the same goal.

It should be noted that some opponents of government involvement in health care decisions are organized into what is known as the Health Freedom movement, which champions the freedom to choose one's own medical providers and treatments but is focused on -- and financed by -- promoters of nutritional supplements and other "natural" health remedies, along with practitioners of alternative medicine. I certainly support people's right to use these without restriction by the government, but the association of the term "health freedom" with lobbying for that specific agenda is unfortunate. By no means all advocates of freedom believe such products are beneficial, and the commercial and/or ideological arguments for them distract from the fundamental issue, which is that the pursuit of health is a person's own business, entirely apart from the question of whether or not a particular form of health care is efficacious.

As C. D. Herrera has written, "The state's close involvement with medical research, education and certification prevents it from being a disinterested spectator . . . [its] close involvement with medicine dictates a particular interpretation of what is in the child's best interests." I might add that political considerations, not to mention lobbying by the pharmaceutical industry, strongly influence its interpretation of what is in anybody's best interests. Furthermore, as Peter says in Stewards of the Flame, "Whenever health authorities succeed in overcoming some actual problem, such as contagion, they are left with a bureaucracy that must justify its existence by medicalizing more and more aspects of simply being human." Those of us who care about medical autonomy cannot afford to be complacent.

Update, July 2012: This page was written in 2007, before the debate about the Affordable Care Act. It goes without saying that there is now vastly more commentary on the Web about government compulsion in health care. But the so-called compulsion to buy health insurance, which the Supreme Court has rightly called unconstitutional while upholding the power of the government to tax, is not the real issue. As the Court's opinion states, there is individual choice about buying insurance because it is cheaper to pay the tax than to do so. But there will be no choice about the nature of the health care available, and the allegedly "preventative" steps the goverment may eventually require of citizens, if this law is not repealed.

What government pays for, it controls. This is proper, which is one of the reasons why government should have no part in paying for health care beyond emergency care for seriously-ill people who cannot afford treatment. If promoters of tests, drugs, and even procedures -- both bureaucrats and companies with a financial interest in them -- convince the government that the use of these things will save money (which in fact it won't, but that's another story) then a law will require people to submit as a condition of receiving any care at all. It cannot make refusal illegal because the Supreme Court ruled long ago that there is a right to refuse medical treatment, but for all practical purposes compliance will be compelled. Doctors will be required to insist on compliance as a condition of receiving government payment, perhaps even of retaining their licenses to practice. Many opponents of the Affordable Care Act worry about "rationing" of health care, but the opposite is a greater danger to liberty. If you doubt this, read Stewards of the Flame.

Some links to some material dealing with government involvement in health care that either constitutes, or verges upon, compulsion.

This list does not include articles about compulsory treatment of mentally ill patients, which is dealt with on my psychiatry page, or the lack of choice offered to the dying, which is discussed on my page about prolonged dying. Nor does it cover the immense threat to health care freedom -- and even to job security -- posed by new monitoring technolgies (see my remote health monitoring and implanted microchips pages).

Do Patients Have the Right to Refuse Medical Treatment? by Trisha Torrey. Verywell Health, March 27, 2019. "It is unethical to physically force or coerce a patient into treatment against his will if he is of sound mind and is mentally capable of making an informed decision."

Can I Be Legally Forced to Accept Medical Treatment? by Benjy Schirm. Super Lawyers, 2019. "Adults have the constitutional right to privacy, which by court rulings has been interpreted to include the right to refuse medical treatments. Adults also have the protections of tort law, in that any unwanted medical procedure is considered an unwanted touch, or even assault or battery."

Taking No for an Answer: Refusal of Life-Sustaining Treatment by Stephanie Cooper. AMA Journal of Ethics, June 2010. "The 'emergency privilege' does not permit physicians to treat competent patients with emergency conditions who refuse treatment; but how does one assess an injured patient’s decision-making capacity?"

Treating competent patients by force: the limits and lessons of Israel’s Patient’s Rights Act by M. L. Gross. British Medical Journal, 2005. "Coercing a patient for his own good (welfare) may be justified, but compelling a patient to conform to a good (worthwhile values) one thinks one should hold is presumptuous."

The Nanny State vs. the Family, Liberty Papers, July 12, 2006. By Doug Mataconis. "Abraham is 16 and technically a minor, but if it's clear that his decision is really his, then what right does the government have to stick a needle in his arm and pump toxic chemicals into his body?" [Later another judge ruled that this boy does have the right to refuse chemotherapy; however, he still must be monitored by a court-appointed doctor.]

The Case of Starchild Abraham Cherrix by Arthur L. Caplan. AMA Journal of Ethics, 2007. "Autonomy is perfectly compatible with demanding a justification before legal authorities when a minor refuses recommended life-saving medical treatment."

Cassandra's Chemo Fight: 'This Is My Life And My Body' by Cassandra C. Hartford Courant, January 8, 2015. "Whether I live 17 years or 100 years should not be anyone's choice but mine. . . . I care about the quality of my life, not just the quantity.

The Detention and Forced Medical Treatment of Pregnant Women: A Human Rights Perspective by Cynthia Soohoo and Risa E. Kaufman. American Constitution Society for Law and Policy, March 2018. "Civil commitment laws authorizing states to detain pregnant women to prevent future substance use improperly and unconstitutionally restrict a woman’s right to liberty, privacy, personal autonomy,and non-discrimination."

Arguments Against the Compulsory Treatment of Opioid Dependence by Ruth Birgin. Bulletin of the World Health Organization, April 2013. "“Many countries provide long-term residential treatment for drug dependence without the consent of the patient that is in reality a type of low security imprisonment."

Buzzkillers by David Malmo-Levine. Hemp Info, April 26, 2005. 'We do not want to live in a world where our diet and medicine is dictated to us by the state--a dark and horrible future if ever there was one."

Torture in Healthcare Settings, Washington College of Law Center for Human Rights & Humanitarian Law, 2013. "Medical treatments of an intrusive and irreversible nature, if they lack a therapeutic purpose, constitute torture or ill-treatment when enforced or administered without the free and informed consent of the person concerned. This is particularly the case when . . . performed on patients from marginalized groups, such as persons with disabilities, notwithstanding claims of good intentions or medical necessity."

New York City Starts To Monitor Diabetics, Washington Post, January 11, 2006. By Rob Stein. "Government concern often shifts to government coercion. . . . Today we're telling people what you should do voluntarily. Tomorrow it may be we're telling you what to do or you'll be penalized."

Mayor Bloomberg, M.D., New York Sun, April 4, 2006. By Elizabeth M. Whelan. "Given the complete lack of protest in response to the new mandated diabetes reporting and tracking scheme ... it is highly likely that we will see proposals to mandate reporting of serum cholesterol levels, high blood pressure, and body mass indices, followed by city interventions to prod us into changing our behavior to reduce the risks of heart attack, stroke, and the spectrum of maladies associated with obesity. This new diabetes regulation is, in short, a harbinger of more intrusive legislation to come -- all in the name of 'public health.'"

Is Diabetes a Plague? Eroding the Distinction Between Public and Private Health, Reason, March 17, 2006. By Ronald Bailey. "Given the trend toward ever more intrusive government intervention in health care, New York's proposed cure may well turn out to be worse than the disease."

The Model State Emergency Health Powers Act: An Assault on Civil Liberties in the Name of Homeland Security, Heritage Foundation, June 10, 2002. By Sue Blevins. "Although this model legislation was recommended as a means to help states protect citizens against bioterrorist attacks and deal with national defense issues, the draft bill goes much, much further. It calls for giving state public health officials broad, new police powers." (The draft bill aroused a storm of protest and was never passed anywhere in its original form -- but the mere fact that the government proposed it says a lot.)

Health Police Gone Crazy, The Lantern, Ohio State University, October 11, 2006. By Sandeep Rao. "Firearms, fat and alcohol have all been the targets of medical analysis identifying possible health risks and accompanying recommended legislative action. This untamed tyranny of the medical community will continue as long as the lay public greets the health community's legislative pronouncements with tacit acceptance. . . . Americans would do best to avoid the politicization of medicine and reject the government’s automatic use of health concerns as edicts for immediate government intervention, absent of concern for private rights."

Prevention Better than Cure in Cuban Healthcare System by Fiona Hill. Health Check, BBC World Service, December 13, 2015. "'My nurse knows where they live,' Dr Quevas Hill jokes. 'They can run, but they can't hide!' The data from this check-up allows the family doctor to put her patients into categories according their 'risk.' If they're healthy, the annual check-up is enough. But if they're showing signs of ill-health, if they drink too much, smoke or have a continuing health condition, they're seen much more regularly. It's an integrated, whole-person approach to healthcare, perhaps too intrusive for some, but widely accepted within Cuba."

Health Care’s Brave New World of Compulsory Wellness, Bloomberg, October 12, 2011. By Ezra Klein. "Are we really ready to let employers -- much less the government -- tell us to quit smoking, skip the junk food and lose weight?"

The Perils of "Health Care", Association of American Physicians and Surgeons, December 12, 2006. By Richard E, Ralston. "Increasingly, approved providers are backed up with the police powers of the state. The FDA and Codex may ban home remedies, while mental health screening, disease registries, and mandatory vaccines and psychoactive drugs proliferate."

Kidcare: Socialized Medicine Through Government Schools, Institute for Health Freedom, January 20, 1998. "With more health care personnel in schools looking to justify their positions, parental control over children will continue to slip away. Worse still, parents and families could find themselves subject to Orwellian oversight."

Doctor's Orders: Parents Battle Medical Authorities for Control of Their Children, Reason, February 2001. By Brian Doherty. "Legal conflicts between child services agents who are convinced they know best and parents who insist on their rights to raise their children as they see fit run the gamut. Representatives of local and state governments have enforced unwanted treatment plans or taken children away from parents in cases involving conditions ranging from hyperactivity to obesity to hepatitis B to ulcerative colitis."

Health Visitors or Health Police? AIMS (Association for Improvements in the Maternity Services, a British organization), 2004. By Jean Robinson. "A young woman, expecting her first baby, hears a knock at the door. She opens it, and the woman standing there says she is a health visitor, and can she come in? The woman asks why, and the health visitor says, "Just to see how you are." The woman says she's fine and doesn't need a health visitor, thank you. The health visitor replies, 'If you don't let me in, I shall report you to Social Services.'"

Zero Tolerance Vaccine Laws in America: Will You Defend Vaccine Freedom? by Barbara Loe Fisher. National Vaccine Information Center. July 1, 2918. "There should be limits placed on the authority that public health officials and their physician colleagues exercise in a constitutional democracy."

Forced Vaccinations and the Death of Health Freedom, The Corbett Report, July 18, 2012. By James Corbett. "This fight is not about anyone’s personal beliefs over the efficacy or inefficacy of any particular vaccine. It is about the right to say no to enforced medical treatment."

Compulsory Medical Treatment Is Un-American by Phyllis Schlafly. Eagle Forum, October 1998. "Freedom in America should include allowing parents to make their own informed choice about injecting their babies with a potentially dangerous vaccine."

Hands Off Our Kids, Association of American Physicians and Surgeons, March 2007. "The [Texas governor's] Order states: 'Rules. The Health and Human Services Executive Commissioner shall adopt rules that mandate the age appropriate vaccination of all female children for HPV [human papilloma virus] prior to admission to the sixth grade.'" Outraged parents protested that "Parents should not have to get permission from the state to make informed consent medical decisions for their own children.'"

Shots in the Dark, Reason, July 1999. By Sue Blevins. "Even when exemptions are available, parents are rarely told that they can turn down vaccinations for their children without repercussions. Some public health officials argue that parents who refuse to vaccinate their children should be held legally accountable for child neglect. The justification for mandatory vaccination, which used to be protecting the general public from disease carriers, has thus shifted to protecting children from parents who fail to take precautions recommended by the government's experts."

Should Mandatory HIV Testing Be the Norm?, CBS, August 16, 2009. By Priya David. "A few hospitals, like one in the Bronx borough of New York have found a way to work within the current rules. . . . A bill to eliminate written informed consent was recently introduced in the New York State legislature."

Mandatory Vaccination of Health Care Workers by Alexandra M. Stewart New England Journal of Medicine, November 4, 2009. "The workers argue, first, that compulsory vaccination violates the Fourteenth Amendment in depriving them of liberty without due process. But in 1905, in deciding the smallpox-vaccination case Jacobson v. Commonwealth of Massachusetts, the U.S. Supreme Court recognized that the “police powers” granted to states under the Tenth Amendment authorize them to require immunization."

New York City Is Requiring Vaccinations Against Measles. Can Officials Do That? by Donald G. McNeil Jr. New York Times, April 9, 2019. "Forced vaccination . . . is more politically sensitive than quarantines or forced treatment. Vaccines are given to healthy persons -- sometimes infants -- instead of to those who are sick and clearly endangering others."

The Issue Is Freedom, Not Soft Drinks, Commentary, May 31, 2013. By Jonathan S. Tobin. "The purpose of government is to protect freedom, not to heedlessly infringe upon it merely for the sake of what some people may believe is doing good. Like the city’s ban on the use of trans fats and draconian restrictions on smoking, the new soda regulations are an intolerable intrusion into the private sphere."

Government Control of Your Diet: Threats to “Freedom to Eat”, Heritage Foundation, September 3, 2013. By Daren Bakst. "If the government can control what the public eats, it is difficult to imagine what it could not do."

Well-Intentioned Food Police May Create Havoc With Children's Diets, New York Times, May 30, 2006. "The schools are overreacting to the so-called obesity epidemic, and in the process are doing our children more harm than good.... These food wars go beyond good sense and good science. They're misguided and red herrings, based more in conjecture and politics than on solid research-based solutions."

Control Freak Society: Government To Monitor School Lunches With Cameras, Infowars, May 12, 2011. By Steve Watson, Paul Joseph Watson and Alex Jones. "Where does this end? . . . Will the government move to ration your child’s calorie intake? Will the government issue fines to parents whose children’s eating habits do not match up to a predetermined definition of a “balanced diet”?

The Government War on the American Diet, Center for Individual Freedom, May 5, 2010. By Joseph Groff. " Ultimately we should be taking responsibility for our actions (and our children’s actions) and rejecting the rise of the nanny state and its war on our diet . . . Our waistlines may not be shrinking, but our freedoms surely are."

Death Is Inevitable, from a Canadian organization called Stop the Health Fanatics which appears to be inactive. This page sums up one of the main points of Stewards of the Flame very nicely. "What a tragic irony it would be, if nations where millions of citizens were willing to sacrifice their lives in the struggle to ensure liberty and freedom for all, ended up sacrificing that very liberty and freedom in cowardly and futile attempts to run away from the inevitablity of death, by forcing minimal-risk lifestyles on all of their citizens."