Digest №20: The Banal Dangers of Medical Prescriptivism

Bless!

Isn't it odd, that you are allowed to buy hundredfold lethal amounts of alcoholic beverages, but are disallowed from purchasing pharmaceuticals in any amount for your own use, should you care to?

The logic behind this is obviously well-meaning, if misguided. A patient allowed to purchase pharmaceuticals at his own leisure could very well harm or even kill himself with their consumption. It follows thus – in this well-meaning logic –, that the patient should be disallowed from purchasing such pharmaceuticals, simply for his own protection.

Whilst I understand, that this logic is well-meaning, it's also infinitely demeaning, infantilising, and disrespectful to the patients. Mind you, no proponent of such medical prescriptivism – i. e. that patients must have doctoral approval to purchase pharmaceuticals – is actively or consciously being demeaning toward the common patient, and yet in effect, the patient is being infantilised and made out to be unworthy of trust for his own health and safety.

Such prescriptivism isn't only at home in the medical field, but pervades every echelon and constituent field of our modern societies. It's a somewhat natural consequence of the authoritarian societal structures we live in. Whether we live in 'democracies' or 'dictatorships', the elite – respectively voted into power or attaining power by force – decide what's acceptable and good.

Even in democracies, beyond casting our vote every few years, we have no say in the matter, even when it comes to such personal matters as our own health.

Maybe the medical authority – a board, institution, or doctor – knows better than its subjugates, and I reckon, that in quite a lot of situations it may indeed know better. Nonetheless, taking such an authoritarian approach to treating such patients – an approach of 'doctor says, patient does' – carries wide-reaching and catastrophic consequences.

To treat an infantilised patient, the doctor needs to have direct contact to the patient, must use valuable time on simple-to-solve problems, which divert his attention from more pressing cases. To treat an army of infantilised patients, the sickcare system needs to have direct contact to every single patient, no matter how little and easily taken-care-of his ails.

The result is as tragic as it is predictable from simple system dynamics.

As patients become increasingly infantilised and less allowed to take ownership of their own welfare, they become more and more dependent on constant attention from the sickcare system. This dependence conditions them to give their own health and wellbeing out of hand, and to let others worry about it, because they can't do anything about it anyway.

Take millions of such dependence-conditioned patients, who are disempowered of their own health, and you get a overladen medical system, which can no longer appropriately care for its constituents.

To resolve such a strain, there are multiple solutions.

The solution we've stumbled into within modern states is to partially or fully privatise the medical system and resolve the strain by progressively barring the poor from appropriate care. I happen to think, that this is inhumane and not a very good way to go. So, what alternative do we have?

Getting rid of medical prescriptivism in its entirety and empower doctors to educate and empower the communities they serve to make intelligent choices for their individual health and wellbeing would be one such alternative. This way simple issues can be taken care off by communal efforts of empowered individuals, whilst doctors would have more time and headspace to deal with the more complex health issues requiring the help of specifically trained experts.

We'd thus be able to return to a more natural and healthy relationship between empowered patients and no longer overworked medical professionals, based on mutual respect and appreciation, instead of distrust, infantilisation, and derision. Paradoxically, taking coercive power away from authority figures and levelling hierarchies seems to give them more, not less, influence and respect with their community in their field of expertise and wisdom in the long term.¹

It'll be a long way to dispense with the corruptive effects of medical prescriptivism, as we've been so deeply conditioned to abide by it, but there is a surprisingly simple solution: Don't abide by it.

Freedom needn't be – and seldom is – granted. Rather, it must be demanded, taken, and defended with force in righteousness.

You needn't wait for anyone to deem you worthy of taking interested in, and ownership of, your own health, for you already are; you needn't wait for anyone to grant you permission to take care of yourself, for God already has.

It is your body, your health, your life. No one can help you or stand up for you, if not you.

Toward a freer, healthier, and more prosperous future.

God bless,
Merlin L. Marquard