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J Med Ethics 2005;31:187 doi:10.1136/jme.2005.011809
  • Editorial

The paradox of promoting choice in a collectivist system

  1. A Oliver1,
  2. J G Evans2
  1. 1LSE Health and Social Care, London School of Economics and Political Science
  2. 2Green College, Oxford University
  1. Correspondence to:
 Dr A Oliver
 LSE Health and Social Care, London School of Economics and Political Science, Houghton Street, London WC2A 2AE, UK; a.j.oliverlse.ac.uk
  • Received 31 January 2005
  • Accepted 8 February 2005

The notion of choice and its individualistic underpinnings is fundamentally inconsistent with the collectivist NHS ethos

In both the policy1 and academic2 literatures, the issue of extending patient choice in the UK National Health Service (NHS) is currently a much discussed issue. From December 2005—for example, general practitioners (GPs) will be required to offer patients needing elective surgery the choice of five providers at the point of referral.1 Choice is often thought of as an intrinsically good thing; that is, that people value choice in and of itself.3 A probable underlying reason for this belief is that choice is tied in with the notion of individual autonomy, or freedom, a concept that looms large in ethical theories of the good. Beauchamp and Childress—for example, classified respect for …

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