Mandatory Seat Belts (Reprise)
Leaving aside the practical question of whether those ‘extra’ deaths really do impose financial costs (because injuries are more severe) or not (because we don’t spend as much money healing the dead as we do healing the injured) both arguments lack any substantive moral foundation.
As the Foster’s staff graciously allowed me to point out in their pages the last time this issue arose a little more than a year ago (“Mandatory seat belt use crosses the line of our right to choose”, 24 Nov 2003), there are many personal behaviors – say smoking or drinking, or racing cars, or bicycling on the roads, or scuba diving, or playing a contact sport – that increase our risk of disease, or of injury, or even of death. When counted as statistics across the whole population these all result in some amount of ‘extra’ misery and death each year, and at various times most of these have been the subject of more or less serious efforts by some compassionate souls to protect us from ourselves by prohibiting them. But most of us value our freedom to choose such activities despite (or even because of) their risks, not just because they also offer benefits and pleasures that their detractors simply can’t appreciate, but more fundamentally because the freedom to choose our own fates is the only true freedom. Just as the freedom to say only what everyone else agrees is true is not “freedom of speech”, the freedom to do only what everyone else agrees is good for you is not “freedom of action”. If we grant society generally, and the government specifically, the authority to circumscribe our actions solely because they are potentially self-destructive we have sold our freedom for a false security.
The other argument – that our financial exposure gives us the right to dictate behavior that minimizes the exposure – is appealing, and might be legitimate if we had made a covenant with the recipients of our largesse rather than simply imposing our compassion as a policy – if we had said up front, for instance, that we would not pay their medical bills if their behavior contributed to their injuries, allowed them to make decisions based on that, and then enforced that policy even when compassion told us to do otherwise; or alternatively, if the recipients had specifically asked for our help and we had imposed our restrictions as a condition of providing it. But we did not do either. As a matter of policy we have promised as a society to cover the medical needs of the severely injured no matter how those injuries are sustained, either indirectly through the risk pool of insurance or directly through public and private subsidies for emergency medical care. In such circumstances we in fact take great pains to circumvent the normal mechanisms by which the costs of individual choices would be borne by the individual.
Such a policy is certainly compassionate and arguably pragmatic, and some would contend that doing anything else would be immoral. But however well-justified that policy may be it is also voluntary: as a society we have assumed that burden by our own choice and for our own moral and practical purposes; and having volunteered for our own reasons to take on that responsibility (and for all practical purposes denied all opportunities to refuse our generosity) we have no moral claim on those we choose to help.
Imagine that your parents or in-laws, because they are both wealthy and care about the welfare of their children and their grandchildren, volunteer to cover all your family medical bills. You certainly appreciate their help, but you didn’t ask for it and didn’t negotiate any conditions for its provision; they just arranged to pay for your insurance premiums and doctor’s visits – and family dynamics didn’t give you the realistic option of refusing. Do they now have carte blanche to tell you how to run your life? Can they demand that you exercise for some number of hours per week? Can they dictate the menus for your meals? The hobbies you pursue? The vices you indulge or renounce? Does accepting help from someone who is adamant about giving it obligate you to indulge their notions of what is good for you? Does the fact that your choices determine the extent of their self-imposed obligation give them a moral authority over your behavior?