Friday, September 6, 2013


Sarah (The Healthy Home Economist) reports on the ongoing saga of Sarah Hershberger, an Amish girl with leukemia. In breve, the 10 year old patient begged her parents to keep her off another round of chemotherapy. Her folks agreed, the hospital did not. Hospital administration sought custody and so spawned a court struggle.

This story reminds me strongly of a case that was plastered all over the New Zealand news while I was visiting for a month in 1999. Maori parents took their son out of chemo to pursue alternative treatments and the hospital turned to the state to reel the patient back in.

Okay, so let's get the red herrings out of the way. Appeals to religious liberty and the shades of medical ethics codes are top notes played over a foundation of conflicting virtue. The care ethic pulls in both directions here. What we've really got is a question of the appropriate role of coercion.

I think the thing that confuses me is why a hospital would want to risk being painted as a bully. It seems to me that jawboning little girls is a pretty surefire way to make future patients all the more pee-shy, particularly for outgroup members. Think about the message this sends: "you'll take your goddamn medicine whether you like it or not, citizen." This is meant to inspire confidence in a medical system already well-plagued by, well, let's call it "rent-seeking and preservation" rather than the ever so slightly more confrontational "institutionalized corruption" that might also be accurate on a certain reading?

Patients (and even doctors) tend to be terrible Bayesians. Should this impute to a common moral intuition that consumer sovereignty in medicine be revoked? There's already a lot to suggest that the typical response to this question is "yes". I have a friend who lives in Germany who has been threatened on more than one occasion that her son would be (read: permanently) taken into state custody because she refused to administer his prescribed dose of ADHD medication before she sent him off to school in the morning. The key measure of the ACA is that every citizen is compelled to participate in the market (I'll leave off the scare quotes this time) for medicine. Coercion, my boy. Coercion as far as the eye can see.

How euvoluntary is medicine? How euvoluntary should it be?

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Do you have suggestions on where we could find more examples of this phenomenon?