We believe vaccine mandates are important. But we also believe fighting for patient autonomy is important. So we compromise our logic.
We acknowledge that vaccines are beneficial, but we decry mandates. We acknowledge the value of science in healthcare, but we remain cautious.
When we try to articulate our hesitancy, we often say what we do not mean. We wax poetic about liberty and position it against science. We pretend as though vaccines are harmful, yet take vaccines willingly throughout our early life and elementary schooling.
In reality, our subconscious is fighting a war our conscious awareness has yet to fully grasp. We cannot yet articulate what we really think. So we posture and grandstand towards more familiar arguments.
This discrepancy is nothing new. In fact it seems to be the standard for public discourse in healthcare. We discuss abortion in terms of fetal viability yet reduce the issue into a matter of weeks of pregnancy. We discuss the need for harm reduction in treating patients with substance use dependency yet continue to stigmatize those afflicted.
We cannot help ourselves. We reduce the complex into the simple. And in healthcare, this means we reduce complex medical issues into simplified narratives. But in reducing something complex into something simple we often misunderstand the core issue at hand.
When we discuss vaccine mandates, we simplify it into a matter of individual liberties. But the issue is more visceral than liberties or rights and more complex than basic freedoms. The issue is the principle of patient autonomy.
Autonomy is independent of freedom. It is not defined by any one right or through written law. It is in the decisions we make, the subtle patterns of habit that define the essence of who we are. We value healthcare, but our implicit behaviors around healthy living balance what we know we should do against our personal preferences and tendencies.
Two patients diagnosed with diabetes may choose different courses of treatment. One may incorporate diet and exercise in an effort to stave off the need for medications. The other may maintain the same lifestyle yet adhere steadfastly to diabetic medications. And both may end up with equivalent blood sugar levels.
So who can say what the preferred course of action is? Both are compliant and both address their clinical condition through established treatment regimen. This is patient autonomy, the ability to choose how to manage one’s health. It is flexibility in the face of established protocol. It is the option to choose when the options are limited.
This is as good a definition as any of patient autonomy.
People feel threatened by vaccine mandates because they feel the mandates encroach onto patient autonomy. Yet the issue is articulated as a battle between individual liberties and trust in science. This is nothing more than simplifying a complex healthcare issue of patient autonomy into an easily digestible narrative.
The vaccines are not about trust. Most people implicitly trust science, even those who claim to be vaccine hesitant. The issue is not about trust or even science, but of a visceral sense of control. We do not mind being told to take certain medications and vaccines as long as we feel that we are in control of the decision-making.
But the moment our sense of autonomy is questioned, we retaliate. This is the root of the anti-science rhetoric we hear of these days. In 1905 the Supreme Court ruled vaccine mandates were constitutional. Now we have lower court federal judges and Senate legislators readily shooting down vaccine mandates.
This reversal has nothing to do with former President Trump or some nascent Populist sentiment. It has everything to do with patient autonomy. And it comes from the technological and economic advancements of healthcare creating a visceral sense of encroachment onto patient autonomy.
Before healthcare was a cottage industry, relegated to the town doctor. Now healthcare is an economic juggernaut, absorbing nearly a third of the country’s GDP and nearly all the federal research dollars.
So with every app, email, and digitization comes an ever growing sense of technological control over patient decision-making.
It is time we confront the issue of autonomy head on. Look beyond the contrived arguments of liberty and trust, and see the issue for what it truly is – a growing, visceral fear of healthcare technology overtaking individual patient autonomy.
