The Shackles of Paternalism

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.”

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2 thoughts on “The Shackles of Paternalism

  1. Alice Sussman

    This is so very true. My own mother, nearing the end of her life, had her moderate prescription of narcotic pain reliever (Norco) cut by her physician shortly before her death. It provided relief and mobility to her in the short time she had left. Today, I have to ride a bus with “recovering” opioid addicts, on their way to “dose,” as they call it, at the local methadone clinic. They are loud..laughing, shouting, braying like donkeys…on their way to “dose.” There is a slyness to them. It is as if they are aware of the social power they have acquired as they crowd out standards and replace it with their own personal stink. There is no relationship between their “disease” of addiction, and the agonies my parent endured following a botched vascular operation. I am not without compassion for personal weaknesses (far from it) but, their arrogance–my goodness, this is what is new and it comes from a society whose mores they have the joy of disfiguring, since they cannot do anything else. Thank you so much for writing this article — this issue has been on my mind.

  2. Ken Lavoie

    This exactly describes the state of our Union- It has become the status-quo for all levels of our society. Sad but true.


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