Give Me Liberty or Give Me the ER

Happy 4th Everyone!

Here’s my rumination in Independence Day…

There is only type of medical care in the country where providers are legally-obligated to provide care to patients – ER medicine.  Given the American penchant for liberty, this is a strange encroachment on individual freedom that provokes little outcry from ER docs.  It would be great to hear the likes of Shadowfax over at Movin’ Meat or the White Coat Rants doc weigh in on this topic, since they work in the ER every day (and write great blogs).

Imagine if the contents of your head were generally the “property” of pretty much every person in society.  Socialist thinking dictates that medical care is a “right” of humanity.  In fact, that right is considered by some – like Al Gore – to be universal (which calls into question whether newly-discovered alien life forms are, in fact, also entitled to the services of a humanoid physician…not that they’d be interested).

But to say that everyone has a right to this system also then demands that those who provide the system are ethically-obligated to those nameless “everyones”.  This is a strange concept in liberty-obsessed America.  I once worked with a Chinese doctor who recounted that when working in her homeland, she was conscripted into the population-control arm of the Chinese medical system.  She was forced to travel to rural villages and surgically sterilize women against their will.  You might be thinking “he used poor grammar there…SW101’s use of ‘their will’ is obscure and I don’t know to whom he’s referring…the village women or the doctors”.  If you were thinking this, then you get one E. B. White star-point.  And to answer your question, in this case, the bad grammar makes my point.  The answer is both.  Nobody wanted to be in on the sterilization procedure…patient or provider.  Talk about quashing human liberty!

Although nobody’s forced to go to ER’s (not yet, but could happen some day), ER docs are required to treat everyone who does show up at the door.  All other doctors can refuse to provide care for any reason they like (except, perhaps, the medicare thing).  I suppose because ER docs are paid so well, they don’t mind the encroachment on their individual liberties.  Or perhaps they also believe in the universal health ethic and would be first in line to intubate the martian in B-11 who appears to have 3 tracheae.

If, on the other hand, you ascribe to strict libertarian belief in personal freedom, the notion of an ethical requirement to provide care to anyone who asks for it is revolting.  There are many times in my work in the ER where the right thing to do, the flat-out correct thing to say to the “patient” sitting in the room is to go home because they don’t need care or don’t deserve care because they are combattive, assualtive or only seeking narcotic drugs.  Furthermore, medicine is knowledge embedded in neurons scattered around the inside of an individual cranium.  No government should be able to “own” something that ill-defined or intimate.  It’s akin to saying the government has a right to asses, tax, penalize, order, quantify and qualify every aspect of their human populace, such as their sighs, yawns, sneezes, urinations, orgasms and defecations.  “Soo, Mr. Cassanova, we see that you quite enjoyed yourself last night with Ms. Sultry…please deposit your pleasure-tax in the mail before April 15th.

Don’t get me wrong, I spent 3 years using the Israeli socialist medical system and I believe it to be far superior to the disaster we have in the U.S.  But one thing I never could settle, in principle, was the notion that all the work I did to learn medicine, all the sacrifices I made financially, emotionally and relationally, occurred so I could provide to society something they rightfully own.  It’s as if I’m being done a favor by being allowed to suffer through medical training.  From a strict socialist theory perspective, patients shouldn’t even thank their ER doc.  It should be the other way around.  I can sit on my couch for 30 years, smoking and spreading STD’s and unwanted babies and clogging up my arteries with pork rinds, and when the physiological reckoning comes…the ER doc better THANK me for the medical castrophy I bring through the sliding doors.  Doctors are required to take care of these things.  Don’t thank them for doing their jobs.

And THAT’s the biggest problem with socialism – there’s no liberty.  You owe everybody.  Your life – your very mind – is not your own when someone else has a right to it.  But although our individual freedoms are severely limited compared to 1776, and with the exception of more citizens imprisoned than in any industrialized nation in the world, most Americans are still free to keep most of what they have, and strive to make their own lives better.  This is liberty, and it is precious.  Even the ER docs don’t have it so bad.

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