Recently, the popular press has reported on the seriousness of preventable deaths due to injury and the lack of effectiveness that certain states have had on reducing such deaths.MIAMI, FL – APRIL 30: Dr. Robert L. Levine, M.D., Chief of the Miller School’s Division of Emergency Medicine and Director of the Emergency Department at University of Miami Hospital, looks in on a patient on April 30, 2012 in Miami, Florida. (Image credit: Getty Images via @daylife)
Heart disease, stroke and cancer certainly result in many tragic deaths every day. Although an argument can be made that some lifestyle choices contribute to the development of the aforementioned diseases, the association to choice is fairly remote in many cases. In fact, heredity and other uncontrollable factors are likely to play at least as important a role as lifestyle choices in many of these cases.
Making Bad Choices
What seems more tragic than a death from something one has little control over is a death directly and immediately related to bad judgment. As harsh as it may sound, it is human nature to assume that bad things happen to other people, minimizing the risks we take and absolving ourselves from our responsibility to take care of ourselves. Particularly, in the United States, we place civil liberty and personal autonomy above good common sense. In other words, we preserve, and fight valiantly, for the right to make bad choices.
Traveling the road of harsh rhetoric, it is important to recognize that many bad personal choices have far reaching implications, far beyond those making them. On a personal note, families of victims have their lives devastated by those making bad choices (e.g. texting and driving), and they were never consulted in the decision making process. Economically, those making bad choices may be digging into our collective pocket book to preserve their right to choose.
A good example is traumatic brain injury from motorcycle accidents and not wearing a helmet. Many motorcyclists have made the choice that freedom supersedes safety. As an avid motorcyclist, I am amazed at the cavalier approach to one’s own safety. From my perspective, a DOT approved motorcycle helmet is required equipment for getting on a motorcycle. However, I can respect another’s decision to go helmetless up to the point that society is expected to pay for the decades of long-term care needed to treat and provide rehabilitation from a preventable head injury. Riders should recognize their responsibility to protect themselves from injury.
As many as 31 states don’t require helmets for all riders. Don’t we have a societal obligation to prevent death and serious injury? I think we do, and our history suggests that we are willing to restrict personal autonomy when the evidence is clear that the benefit outweighs such limitation in personal freedom.
Seatbelt legislation is an excellent example of “big brother” stepping in when autonomy exceeds one’s ability to make reasonable choices. Although the helmet debate has raged for years, newer examples of poor choice that are amenable to legislative remedy have recently come to light. To name a few are texting while driving and most recently, hitting epidemic proportions, is recreational use and misuse of prescription narcotics.
Finding the Right Solutions
Bloomberg News recently reported that from 2007-2009, 13.3 per 100,000 Americans died from poisonings, and more than 90 percent of unintentional poisoning deaths in 2007 were from drugs and prescriptions. By comparison, only 12.4 per 100,000 died from motor vehicle crashes in the 2007-2009 time period. It seems clear that the prescription narcotic drug problem even is a bigger societal threat to death and injury than the safety of our roadways. Surprising?
Although action should be taken, the question is, “What are the right actions?” While many states drag their feet on well-understood threats with obvious solutions, such as texting while driving and lack of helmet use, many have reacted, perhaps prematurely, with respect to our nation’s prescription drug problem. This issue is far more complex than seat belts, helmets and texting, and thus, it requires careful consideration of the issues, contributing factors and potential solutions. Good data, misapplied, has resulted in bad policy decisions.
As an emergency room physician, I am very sensitive to the issue of chronic pain patients in our nation’s emergency departments and the skyrocketing incidence of emergency room visits associated with unintentional overdose, secondary to prescription narcotic use and abuse. Although these patients present to the emergency room for treatment, this does not mean that the emergency room is the source of the problem.
I believe Ohio has misinterpreted this data, resulting in bad policy is Ohio House Bill 93. While aimed at shutting down “Pill Mills,” it has also resulted in limitations of office dispensing of narcotics and has restricted emergency department dispensing so that it is unlikely that any Ohioan will receive any after-hours narcotics, regardless of their complaint (i.e. fracture or burns, etc.)
It’s time to demand more personal responsibility, legislate what we know will improve safety and further study what we don’t understand. I would favor limiting personal autonomy to save lives, but not at the expense of providing appropriate pain management for those in need.
Kevin Klauer, D.O., EJD
Summa Health Center at Lake Medina Emergency Department