Extract

Choice in health is a triangle of forces and a compromise of constituencies. This chapter identifies the body-holder as the first of the three discussion partners. It says that the entity variously known as the patient, the client, the shopper or the customer is the bedrock initiator who harbours the preference. Reductionists and individualists will like it that way: ‘Only the slave has needs; the free man has demands’ (Boulding, 1966: 202). Paternalists and perfectionists think that excellence can be imposed without consultation. Believers in autonomy defend the irreducible self in the language of equal rights and respect for persons. The individual is in pursuit of better health. Section 5.1, ‘Needs and wants’, suggests that revealed preference may not be the best way to improve the health outcomes. Section 5.2, ‘Knowledge and ignorance’, says that even the compos mentis, neither lunatics nor children, might not have the focused expertise that they require. Section 5.3, ‘Information asymmetry’, explains that the principal must sometimes turn to an agent to fill in the gaps. Section 5.4, ‘The freedom to become’, is about personhood. Personhood is more than the freedom from a sneeze or a cough. At the base there are the physical needs: ‘Human beings need vitamins, and did so before they had any notion of vitamins’ (Braybrooke, 1987: 91). Survival is the precondition. Dead people do not need a doctor. Physiology is a part but it is not the whole.