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PT and the Greater Good

Personal Accountability

Published March 19, 2013 10:38 AM by Dean Metz

In response to my blog from last week, one Facebook reader suggested that laws such as Mayor Bloomberg's ban on super-sized drinks started a slide down a slippery slope into a nanny state. Simultaneously fellow ADVANCE blogger, Toni Patt, DPT, reflected on the priorities patients choose when in rehab facilities. Both seem to focus on the idea of personal responsibility and/or accountability. This made me recall a lesson from my "Public Health Law and Ethics" course.

The question presented to us was whether or not motorcycle helmet laws should exist. My initial response was, "If people wanted to risk splattering their brains all over I-95, that was their choice, so long as they don't hurt anyone else." That last phrase was the key to my undoing. The professor rightly pointed out that I assumed said rider would die in the accident, but what if he didn't? What if he lived? What if in addition to multiple fractures, he suffered a TBI? What would that cost? Who would pay?

If the person had private insurance, that might cover for a while. What if he had no insurance? What if he was out of work for sufficient time to lose coverage? What about the cost of rehab, home care, adaptive devices and environmental adaptations required? What if this person never left a nursing home? The impact on those of us paying insurance premiums and taxes toward Medicaid would be significant as we pay this rider's bills.

Now multiply this incident times many more people. Now would you say it was in the public's best interest to have helmet laws? Should we just leave the rider in the middle of the high-occupancy vehicle lane to die like road kill because riding without a helmet was his choice? How should we penalize the family of this person who may or may not have advocated his riding without a helmet? This person's desire to feel the wind in his hair while riding actually hurts a lot of other people.

This is one reason why I believe PTs should play a role in the development of public health guidelines. Fellow blogger Dr. Patt works with brain-injured individuals. Who could be better to describe the potential impact of a TBI to lawmakers? Who could be better to voice opinions about whether legal influence or perhaps other public health measures could have an impact on this problem?

The decision to limit personal freedoms should never be "capricious and arbitrary" as Mayor Bloomberg's was. If it turns out to be necessary, it should only be when absolutely nothing else will work and all other options have been exhausted. PTs should be part of these discussions.

2 comments

Dean,

You make a good point. Rarely does any one person's actions only affect that person.

I wrote a series of posts a while back that talked about leading a team out of dysfunction. One of the principles discussed is that the need to have consensus is dysfunctional. Healthy team members don't have to agree on a decision to buy in to that decision. In order for that to work, the healthy team has to be able to identify when they have made a mistake and be willing to change course. This type of healthy team work is rarely seen in an organization. I'm not sure it is possible in a society at large.

Therein lies the problem with your last paragraph:

"The decision to limit personal freedoms should never be "capricious and arbitrary" as Mayor Bloomberg's was. If it turns out to be necessary, it should only be when absolutely nothing else will work and all other options have been exhausted. PTs should be part of these discussions."

Without doubt PTs should be a part of those discussions.

However, within those discussions, who gets to decide when it is necessary, define whether or not something works or doesn't work, and definitively declare all other options have been exhausted?

The leader. In this case that was Bloomberg. I agree with your adjectival description of his actions. However I would hazard a guess that at the time he felt his decision was necessary. The key is to be responsible in selecting our leaders, when that is in our control. I would argue that, as a society, we are failing in that objective.

Just my two cents.

Janey Goude March 26, 2013 6:20 PM
Lexington SC

Here is another editorial on the issue of personal accountability. Posting this doesn't necessarily mean that I agree with the point of view, just that I think it is an interesting point of view.

http://www.nytimes.com/2013/03/25/opinion/three-cheers-for-the-nanny-state.html?pagewanted=1&_r=0&hp

Dean Metz March 25, 2013 11:26 AM

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About this Blog


    Dean Metz
    Occupation: Staff Development Specialist
    Setting: New York, NY – Newcastle Upon Tyne, Great Britain
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