Who wants choice?
So, paternalism is out, choose-and-book is in: the doctor tapping in a few parameters offering a screenful of options as to what, when and how precisely the patient is to be treated. Choice of any hospital in the UK by 2008, subject to waiting lists. Stern advice, based on expertise and education? Not anymore. The patient, like the customer, is always right.
The new NHS, if it works, might be the democrat’s dream, but will choice actually involve better patient care? Not according to a recent report in the Journal of Internal General medicine.
Suppose a deadly influenza moves across the world, arriving in Europe. There is no cure, but a 10% chance of dying of the flu. However there is a vaccine – but with a potential side effect: there is a 5% chance of dying of the less dangerous variant of the ailment that the vaccine might induce. What would you take? A no brainer, one would have thought.
Apparently not: less than half the population would take the vaccine themselves if given the choice. It seems people are fundamentally not rational when it comes to assign risk regards themselves. When dealing with others, however, understanding of the probabilities – hardly taxing – take over, and the more distant the personal relation the more rational the guinea pigs in this hypothetical scenario carried out by psychologists for the journal.
But 57 percent said they would give it to their children; 63 percent said that if they were doctors they would give it to patients; and 73 percent said that if they were the medical director of a hospital they would recommend the vaccine for all patients.
In other words, people are more rational at making decisions for others than for themselves – a fortiori this applies to doctors making choices on behalf of patients, rather than the patients choosing their own treatments. Doctors have expertise, too, not just that essential objective standpoint. You might be better of, for that matter, if your friend made your choice for treatment Aristocratic socialists – who combine paternalism with equality - such as Allyson Pollock and Colin Leys have decried patient choice as a chimera: “People don’t choice, they just want care: it is like the fore brigade, not the supermarket,” they say. And they could well be right. At least if the choices they have to make are their own. Perhaps the best combination would be not patients’ choice, but doctors’ choice. The paternalists are right after all.
