Today, the “nanny-state” is omnipresent. Its latest pernicious intrusion pertains to pain-relief medication. Doctors are being told to restrict their prescriptions of opioids, the drugs (such as Percocet and Vicodin) used to reduce extreme pain. Why? Because the government is concerned about patients who overuse the drugs, leading to addiction and sometimes death.
The idea of a paternalistic government, deciding what is best for each of us, rests ultimately on the ethics of self-sacrifice. It rests on the altruistic premise that you have a moral duty to surrender your self-interest for the sake of others, that you must subordinate yourself to the needs of your neighbor. Thus, those who genuinely require strong pain medication must suffer, so that their neighbors not be able to use the drugs irresponsibly.
A story in today’s NY Times describes the effects of these new controls on one doctor’s patients. “ ’I have a patient with inoperable spinal stenosis who needs to keep chopping wood to heat his home,’ said Dr. [Robert] Wergin, 61, the only physician in this rural town. ‘A one-size-fits-all algorithm just doesn’t fit him. But I have to comply.’ ” Another patient, a 55-year-old woman, “had three rotated vertebrae in her lower back, migraines and a mastectomy for breast cancer this fall. . . . Her fibromyalgia was flaring up, she told Dr. Wergin. Pain was aggravating her insomnia. ‘And you have to cut my pills again?’ she asked. Dr. Wergin nodded. ‘It will be very difficult to get an override for your dose.’ . . . ‘It’s rough cutting back when I’m at a level that almost works,’ she said to Dr. Wergin. A rare flicker of frustration crossed his face. ‘I’m sorry,’ Dr. Wergin said.” He could do no more for her.
As I wrote in IN DEFENSE OF SELFISHNESS (p. 165): “[T]he government regulates the medicine you may use, because other people might be tempted to take it when they shouldn’t; it regulates your retirement program, because of those who might squander their savings; it regulates your educational choices, because of those who might make foolish decisions about the schools to which they send their children; and it regulates your intake of food, because of those who might be oblivious to their health requirements. You are forbidden to choose—because of those who do not wish to be burdened by the onus of choice. You must sacrifice your freedom—because of those who are indifferent to freedom. Everyone must be dragged down to the level of the worst, and be shackled to their needs. This is how the individual becomes subservient to society.”