More problems with patient choice

Response to Simon Clark of campaign group Forest after he argued in favour of freedom to smoke and against government bullying on BBC radio 4 You and Yours 25.8.2008

Dear Simon,

You seem to be saying that choosing to smoke is a solipsistic, subjective, rational decision and that any form of government coercion is an infringement of liberty. People smoke for a lot of reasons, but one of the most significant (at least for my patients) is that (like alcohol and junk food) it is a potent stress reliever. Since deprivation leads to stress and cigarettes and cheap booze are the most easily available, culturally familiar stress relievers in deprived areas, don’t you think that deprivation amounts to a coercion to smoke?August 25, 2009 at 16:31 | Unregistered CommenterJonathon Tomlinson

Perhaps Jonathan. But in that case, the deprivation should be tackled to restrict new entrants to smoking.Bullying those who choose not to quit is exactly that, coercion and bullying.August 25, 2009 at 16:39 | Unregistered CommenterDick Puddlecote

Whilst I share your libertarian principles, and despair of state bullying of individuals, my concern is that it takes a lot of confidence, knowledge, and money to be sufficiently autonomous to freely choose to do risky things. I believe we need different standards for someone choosing to sell a kidney, another standard for someone choosing to take ecstacy and another for smoking and so on. The world is packed full of coercive forces, governements certainly don’t have a monopoly. By reducing coercive forces (not merely governmental) we can increase automony and the freedoms associated. It would require a massive cultural shift.

Tackling coercion, as you suggest, doen’t restrict new entrants to smoking, it leads to greater autonomy, so that people may still choose to smoke, they just do so with less social coercion. Until we’re all equally free and autonomous (impossible except in an anarchist utopia), freedom to choose will lead to a widening of inequalities which will result in increasing government interference in order to reign in the bad habits of the deprived.

We will of course never all be equally free and autonomous, but we can certainly be more equal and more autonomous, and this results in freedom. Freedom as an end in itself, pursued, for example, by giving everyone more choice results in widening inequalities, as those already with the greatest freedoms become more free.

“I am truly free only when all human beings, men and women, are equally free, ‘only in society and by the strictest equality'”  Michael Bakunin.

See also:  ‘What Matters. Walter Benn Michaels review of

2 responses to “More problems with patient choice

  1. Pingback: DH consultation on greater choice and control: a sham. | Abetternhs's Blog

  2. Pingback: Consultation or charade..? « Launchpad: By and for mental health service users

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s