Wednesday, April 25, 2007

Why Can't I Write My Own Prescription?

How come I can tell my lawyer to take a line of defense that's almost sure to get me hung, but I can't tell my doctor to give me medicine he thinks is going to kill me?

That's the main thrust Glenn Greenwald made on his blog recently in a post titled "What is the rationale behind the prescription drug laws?". What does liberty mean if not the right to control what happens to our bodies? And yet when it comes to health care, doctors act as gatekeepers, making it impossible to make decisions about your own well-being:

Let me ask you this question: let's say I come into your office (I'm a mentally competent adult -- at least in our hypothetical) and tell you that I want to take a Schedule II drug (or Schedule III or IV) for Medical Problem X (or even just for garden-variety insomnia, depression, or anxiety). You tell me that I shouldn't, that there is a high risk of addiction, that the problem doesn't warrant that treatment. I tell you that, after listening carefully to everything you have said, I disagree with you and I want to take it anyway.

Why should your judgment prevail over mine for what I take? Why, as a competent adult, should I need your permission before I can take the substance I decide is best for me?

I ask that, in part, with reference to the attorney-client relationship. Often times in that relationship, there is as much at stake as there is in a doctor-patient relationship -- the individual's life savings, or financial security, or liberty, or even (in the rarest of cases), their life.

Yet the decision about what to do always remains the client's. The lawyer can advise them, warn them, urge them in the strongest possible terms not to opt for Choice X because Choice X is stupid, self-destructive, risky, irrational, etc. But it is always an advisory role, never a parental role where the lawyer can override the client's choice for his own interests. In fact, whether to have or listen to a lawyer at all is completely optional. The client can always proceed purely on his own, even in the weightiest of matters.

Why should the doctor have the ability to override the decisions of the patient? Why should the doctor's permission be required before the patient undergoes the pharmaceutical treatment he chooses?

This resonated with me in part because of our recent experience trying to get Annie's hypothyroidism diagnosed and treated. She kept telling her doctors that something was wrong, but they blew her off again and again. Eventually they even removed her thyroid, in what we now think was an entirely unnecessary procedure, because they didn't want to listen to what she was saying about her own health.

Finally, after lots of investigation online and trying several new doctors, she found some who would listen. And she demanded that they give her the medicine she knew she needed. They didn't want to, they argued against it and kept throwing out the scare tactics we figured they would from our Internet reading. But ultimately they gave in, and since she's been on Armour (a natural thyroid hormone replacement) the difference in her health and energy has been staggering.

That she had to beg -- literally beg -- her doctors to take her seriously, that she had to churn through so many health care professionals before finding someone to take her seriously, that this intelligent, motivated, informed, insightful, successful woman was put in the position of being a child, and that she was so let down by those we're required by law to submit to -- well, it makes my blood boil.

Greenwald's point is a good one. As free people we should be able to take charge of our own health care, even if sometimes that goes against what the professionals would advise us to do. It should be no different than an attorney-client relationship, with the expert offering guidance, advice, and support, but the ultimate decision absolutely should rest with the client.

I have GOT to stop reading things that change my perspective. Can't I get a good set of dogma around here that I can just follow blindly? Sheesh.


Anonymous said...

because this is too fundamental a change in the culture to be allowed.
but i tend to agree with you, doctors should not be gatekeepers, but trusted advisors.

it does get sticky when dealing with people who have inclinations toward self-harm or mental instability though.

Anonymous said...

doctors SHOULD be gatekeepers. There is a reason why they go to school for 8+ years. Also there are people who abuse prescription drugs. You may ver well be able to make educated decisions on what medicine to prescribe yourself, and it may very well work better than what your doctor would prescribe, but one thing to keep in mind is there is no way on earth that the government would be able to regulate something like this.