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.