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How to Regulate the Right to Self-Medicate

Joseph T F Roberts, University of Birmingham.                


Over the course of the last 50 years the doctrine of informed consent has become the bedrock of medical ethics. Whereas in the past patients were passive recipients of treatment, patients now have a right to be actively involved in making decisions about what treatment to receive.

There are two main reasons why it is important to protect people’s rights to decide what, if any, medical treatment to accept. Firstly, protecting people’s right to decide whether to accept medical care allows them to promote their wellbeing by choosing what medical care is right for them.

Secondly, the doctrine of informed consent serves to protect one of the core principles of a liberal society: the idea that people should be allowed to live their own lives in accordance with their own values (subject to the caveat that they do not harm others).

In her book Pharmaceutical Freedom Professor Flanigan argues that the same reasons that support granting people the right to give (or refuse to give) informed consent to treatment also support granting people rights to decide what drugs they wish to take.

In order to respect people’s right to self-medication, Flanigan argues, we need to: i) allow people to access recreational drugs, ii) allow people to purchase medications without a prescription and iii) allowing people to access experimental medications which have not yet been proven to work (or be safe). 

Yet this is not how we regulate pharmaceuticals. In most jurisdictions around the world people do not have a right to consume recreational drugs, experimental medications or purchase many drugs without a prescription. In order to make the way we regulate drugs consistent with the doctrine of informed consent, we need to overhaul current drug regulations to make them more permissive.

Despite being the best defence of the right to self-medication written to date, Flanigan’s Pharmaceutical Freedom leaves a number of practical questions unanswered. For example: how should information be made accessible to consumers? How should consumer’s competence be assessed for behind the counter drugs?

Answering these questions is important if we want to ensure that liberalising access to drugs doesn’t lead to people harming themselves unknowingly or due to lack of decision-making competence. In my paper, I take up these questions and argue that, in order to make drug liberalisation as safe as possible, the role of pharmacists in the overall delivery of healthcare will need to change in two ways.

Firstly, we need to ensure that pharmacists make information about the risks of drugs accessible to people at the time they are making the choice in a format they can understand.

Secondly, pharmacists need to conduct risk-sensitive competence assessments to force people to think about their decision in the company of a knowledgeable bystander before being allowed to purchase drugs, thus providing them with opportunities to inform themselves and re-consider their intended course of action.

In the 2 minute read I mainly discuss my paper ‘How to Regulate the Right to Self-Medicate’.