Conflicting Goods?

I've often been suspicious of the starring role played by the principle of autonomy in most medical ethics treatises.

So it's interesting--to say the least--to hear a presidential candidate propose a solution to our country's health care dilemmas that proposes limiting patient autonomy in a substantial way--or at least penalizing the irresponsible exercise thereof.

John Edwards (Does anybody else keep accidentally calling him Jonathan Edwards?) recently proposed health care policy that would mandate certain preventative measures, including annual checkups and mammogram screens.

Now, this is a very interesting proposal. In many ways, it naturally follows from the combination of the logic of the market and the logic of liberalism, both of which also depend on autonomy as their chief good. Medicine has been almost completely subsumed into both--it has become an enterprise almost completely dominated by its economic side, and government intervention into and regulation of the practice of medicine is taken as normative. (Ask even the most ardent libertarian whether he'd like his son to be operated on by a doctor who was not board-certified.)

So, assuming medicine to be a predominantly economic enterprise, and assuming government responsibility to make this economic enterprise run well, it makes sense for the government to exercise its authority by incentivising and disincentivising behaviors that have economic consequences within the system.

This means you have three disciplines or systems which derive their internal logic from a primary commitment to autonomy, combining in such a way that virtually demands a limitation of individual autonomy. Fascinating.

In all honesty, though, as much as I loathe Edwards' proposal, I think he is the first candidate whose proposals show that he understands the complexities of the health care problem. Few of the other proposals I've seen seem to take seriously the complex interplay of economics, psychology, law, and biology that comprises health care. I'm not sure he adequately addresses the dynamics of the patent system or litigiousness, but he has covered more bases than most people.

The only bit of utter cluelessness came when he said, in response to the question of whether people would find this too invasive, "We mandate public education—public or private—and no one minds that."

Now, I know he's only homeschooling his kids this year so that they can spend time together as a family while he's campaigning. So he's not a hard-core homeschooler. But still, you'd think he'd have heard of a movement of a couple million people who decidedly "mind that." Or maybe have read of the violent resistance that attended the introduction of compulsory schooling?