Should we be free to self-medicate?

In this month's feature article, Jessica Flannigan presents a challenge to our commitment to respecting patient autonomy, arguing that argues that prescription drug laws that enable doctors to control access to medications violate what she calls a patient's rights to self-medication (see page 579, Editor's choice). She makes the bold point that the prescription drug system has bad consequences and it privileges regulators’ and physicians’ judgments about a patient's health over the patient's judgment about her overall well being, as well as violating patient autonomy. She points out that the doctrine of informed consent already affords patients the right to refuse medical treatment, and patients may not have treatments forced on them against their wishes. To do so is now regarded as unacceptably paternalistic, and an infringement of individual autonomy. Flannigan argues that the same thinking should apply to decisions about medication. Where a patient wishes to take a particular drug, she should not be prevented from doing so if the choice is informed and competent. Restricting access to medications via the prescription system is a paternalistic violation of patient autonomy. Just as we allow patients to make their own choices about which treatments to refuse, so we should allow them to choose which drugs they will take. The current system should, in Flannigan's view, be replaced by non-prohibitive policies that enable patients to access whichever available medicines patients wish while promoting informed consumer choices by making expert advice readily available.

Using the example of different approaches to managing diabetes, Flannigan teases out what she calls the ‘puzzle of self-medication’. She presents two cases of risky patient choices for comparison: the case of Debbie, who is advised by her doctor to manage her diabetes by taking insulin, but she refuses this treatment, preferring to control her condition through diet …