The parking lot was not just full when my wife Sandra and I pulled in for dinner—its main arteries were clogged with emergency vehicles conspicuously flashing their lights and warning us that something of consequence was going on inside. Our wait for a table left us perched on two barstools, and we had gallery seats for the little drama that was unfolding 10 feet away.

An elderly gentleman and his female companion sat in a booth across the aisle from us. He was already surrounded by a police officer, the restaurant manager, and three emergency personnel. One of the EMTs was holding an IV bag aloft and, incongruously, the manager had just placed on the table in front of the customer a steak fresh off the grill but encased in a white Styrofoam take-home container, complete with plastic fork and knife.

My drink arrived, and I asked the barkeep what was going on. "Oh," he said, "The old man mentioned to the waitress that he had recently had open-heart surgery and that he wasn't feeling too well, so we called 911 for him."

There was just one problem. The old man didn't seem to want them there. 

We could see him pick up his plastic knife and fork and try to start his dinner—an effort constrained by the IV tubing the EMTs had apparently convinced him he must have. He tried explaining his condition (or lack thereof), but the EMTs were insistent that an examination must take place. 

Stethoscopes, sphygnomometers, and other diagnostic instruments were being placed on his body while he tried in vain to cut his steak with the flimsy plastic knife. We heard him say, again and again, "I'm fine. I just want to eat my dinner, please." 

The scene played out over the next half hour or so—with the medical team even wheeling a stretcher into the restaurant to remove the man to an ambulance. Finally, in exasperation, we saw the police officer consult with one of the paramedics, and the man was presented with a metal clipboard and a form to sign. "Here," he was told, "You have to sign this refusing our treatment." Another argument. No recourse. The man signed and the team finally removed themselves. The steak remained in its Styrofoam shell, cold by now, and restaurant personnel offered no replacement—or even metal cutlery.

I looked at the man with sympathy. 

* * *

Little did I know that within three weeks I’d be in the same position. Though I had just run a several-day gauntlet of passing four kidney stones (a problem that has plagued me for 13 years), I had to fly to West Palm Beach for a critical business meeting. 

Sandra, a family nurse practitioner, was in Chicago visiting our son. I called to let her know I’d be going to the meeting. She knows me well enough to know I would not be stopped, so she gave me instructions on how to load up from the family medicine cabinet.

Halfway through the rocky flight, a fifth stone started dropping. I knew from experience the pain cycle would last another two hours or so, but the nausea and the bumpy ride worked me over. My fellow passengers were sympathetic, but there was nothing they could do. I was the last one left on the plane when we landed, continuing my dry heaves on a now-empty stomach, in kidney-stone agony. My critical meeting was three hours away.

The flight attendants were also sympathetic, but had a plane to turn around and get back in the air. I asked if I could be assisted to the airport aid station to lie down and rest for a bit. "I'm sorry, sir. This airport has no such facility. We can call 911 if you like."

"No," I replied with my head between my legs. “I just need to rest, please. Is there somewhere I can just be alone and not bother anyone?" 

I had Sandra on a surprisingly loud speakerphone by this point. She asked them to find me a wheelchair and someplace quiet—and I was wheeled to a remote corner of baggage claim. 

I sat there with my head between my knees, gazing at my ankles, bothering nobody and being bothered by no one, for 45 minutes. The cycle was working as it usually does, with the pain gradually receding, though my stomach settled only gradually. God bless Sandra and lithium batteries: she coached me through the whole thing.

And then they came. I remember five voices: the manager, the cop, EMT1, EMT2, and the security guy. Our dramatis personae also included "the citizen" (yours truly) and Sandra, over the mobile speakerphone.

SECURITY (gruffly): Hey, buddy— whatcha doin' there? What's your name?

CITIZEN (sotto voce, head down): I had some stomach problems on the plane. They're gradually getting better. I just need to be left alone a little longer.

SECURITY: Can't do that, bud. We've got 911 here and they're gonna hafta look you over.

CITIZEN (politely): No. I just need to be left alone, please.

SECURITY: Gotta have your name, bud. What flight did you come in on? What's your name?

CITIZEN (politely): Unless I have broken some law by sitting here in this wheelchair, I think I don't have to provide you with anything. I just want to be left alone.

EMT1: Let's just have a look at you a moment. Raise your head for me? (to EMT2): Get a line going.

CITIZEN: Please, I just want to be left alone. I do not want you to start an IV.

EMT1: Sorry, we're here now and have to look you over and get you to some medical help.

SANDRA: Gentlemen . . .

CITIZEN: Please, I just need to be left alone. This really is my problem.

MANAGER: Like hell it is. It's damn well my problem if you die in my airport.

COP (aside to Manager): We'll handle this, sir.

EMT1: Okay, I'm just going to examine him here. But we've got to start an IV.

CITIZEN (head still down): No, I just want to be left alone. You do not have my permission to touch me or to treat me in any way.

EMT1 (less polite now): This isn't a choice, sir—we're here and have to examine you. We'll decide whether you need to be taken in for treatment.

SANDRA: Gentlemen—May I speak to someone there, please?

CITIZEN: I really don't need any help—I just need to be left alone for a little longer.

EMT1: That's what we're here to determine. Sir, I must examine you. There really is no choice.

SANDRA: Gentlemen, please . . .

CITIZEN: No, you do not have my permission. Please just leave me alone. It's getting better.

SANDRA: Hon, hand the phone to one of these guys so I can talk with them.

(phone handed up to someone who takes it)

SANDRA: Gentlemen, I am this man's medical provider. He is sick to his stomach, but that is all. There is nothing life-threatening going on. 

EMT2: Ma'am, we have to determine whether he is disoriented. (To Citizen): Sir, what's your name? You need to give us your name.

SANDRA: If you want to determine whether he is rational or disoriented, why not ask him something he's willing to answer? Ask him, "Who is the President of the United States?" or "What day is it?"

EMT2: Okay, buddy—Who is President of the United States?

CITIZEN: (Thinking fuzzily, Oh hell—who's President?) Uh—George W. . . . no, no. Obama.

EMT2: Okay, what day is it?

CITIZEN: (furiously trying to remember) It's . . . uh . . . the 23rd. Uh. Uh. Saturday.

EMT1: That doesn't mean anything. We've still got to examine him and make a determination.

CITIZEN (head still bowed): The last time I looked, this was still the United States of America and we still have a Constitution. I want to be left alone. Please just leave me alone.

(perhaps 10 seconds of silence)

COP (quietly to someone): Actually . . . I think he may be right about that.

EMT1 (fumbling with some papers): Well, he's gonna have to sign a waiver for me, then. I've gotta have his name and a signature on this release form.

COP: Right.

CITIZEN (politely): I didn't ask for help. I didn't call you. I am a private citizen who has broken no law. I am in a public space. I am refusing your assistance. And I will not sign anything. Please just leave me alone.

SANDRA (phone back in Citizen's hands now): Gentlemen, this situation is under control. Please do as my patient and I ask.

EMT1: No. We have to have this form signed. 

COP (low, to EMT): Just write down "assistance refused" and sign it yourself. I'll countersign it.

(rustle of papers being handled)

EMT2 (leaning over and placing his hand gently on the Citizen's shoulder): Buddy—is there anything we can do to help you anyway? Anything at all?

SANDRA: Yes. Do you have any saltine crackers or plain bread? That would help him settle his stomach.

EMT1: No. Haven't got anything like that. 

EMT2 (receding): Hold on. There's a vending machine over there a ways. (Returning.) There are some animal crackers in there. Would those do?

SANDRA: Yes. Nice and bland.

CITIZEN: Please reach in my left pocket and you'll find some money. I would appreciate the crackers.

(EMT2 does so, purchases the crackers, and places the change in the Citizen's shirt pocket. EMT1 packs up gear. Exit noises; the Citizen is alone again.)

* * *

The above scene actually took close to half an hour to play out. It took about another 20 minutes until I could raise my head. The kidney stone pain was now a dull ache, and my stomach was no longer heaving. I got up shakily and made my way to the bathroom. I drank some fresh water. I washed my face. Then I made my way to the rental car counter. I made my meeting about 90 minutes later.

The parallels between the old man in the restaurant and my experience on the plane and in the airport are pretty obvious. It is tempting to conclude simply, "Well, of course we should have the right to be left alone if that's our choice!" But is it really that simple?

Certainly the legal issues involved are anything but simple. 

Most of us in a modern society don't have any real desire to be Jedediah Smith or Robinson Crusoe. But at least some of us, some of the time, would like to be free to work out our problems on our own. Sometimes we really do know more about what is better for us than do strangers who are unfamiliar with our history and circumstances. 

But surely we also owe our fellow citizens the courtesy of not imposing our problems on them (even if it’s only that I expect my condition might arouse concern among my fellow passengers, for example). And we owe ourselves the recognition that we may not always be capable of making rational decisions on our own behalf. My right to swing my arm extends to where your nose begins; but just where my arm ends and your nose begins is sometimes difficult to determine.

In the final analysis, do we, in fact, have the right to be left alone? The philosopher and the lawyer may have subtly or starkly different answers to that question. But in the real world of day-to-day affairs, the lawyer's answer determines our practical ability to demand independence. That is, it’s the lawyer’s answer that matters in the short term. The sorting out of conflicting rights and obligations is at the heart of what a democratic society is all about, and I know that my own libertarian tendencies leave me with a strong preference for self-reliance and a willingness to err on the side of independence—even when being left alone to solve my own problems may not be an optimal choice. But it is probably safe to say that the trajectory of both majority opinion and public policy in the United States today leaves an individual with such philosophies to fight some lonely battles with an increasingly insistent "helping" State.


Left Alone: Some Lingering Questions

The Old Man in the Restaurant

In the case of the old man in the restaurant:

  • What rights did he give up the moment he allowed them to start an IV?
  • Was that tacit consent for further treatment?
  • Did he then become responsible for any invoices that might be presented for medical services, including the entire 911 service call?
  • Should the restaurant manager have called 911 under the circumstances at all?
  • Did the old man have to sign the waiver to get them to leave?
  • Did it make a difference that he hadn't called them or asked for their help himself?
  • Did it make a difference that he was in a private business establishment?
  • Did it matter that he was in a very public setting with other customers being potentially impacted by witnessing someone with a heart attack, or that they were inconvenienced by the 911 personnel themselves?

In the Airplane / At the Airport

In my circumstances:

  • Did I have the right to get on the plane in the first place without alerting airline personnel to my recent medical condition?
  • What obligations and rights did the airline personnel have under those circumstances?
  • Did my rights change when I exited the plane into the airport, and again when I was moved from the secure area of the facility and left in the non-secure baggage area, in a location outside the view of other members of the public?
  • Would it have mattered if I had wheeled myself out into the street or onto a shuttle bus?
  • Was the airport manager right that the problem was also his in a public facility such as an airport?
  • Did the EMT have a right to start the IV even over my refusal?
  • Could they have employed police force to move me to a medical facility against my will?
  • Did it matter that a licensed medical practitioner was providing me direct advice at the time?
  • Did they have probable cause to check my briefcase for ID, subsequently finding prescription drugs not issued in my name but provided by a medical professional with a DEA license to prescribe?
  • Did I have to provide my name and other identifying information to either the cop or the EMTs?
  • Did the EMT err in finally backing down about the treatment refusal form?
  • Was I right in referencing any Constitutional rights to privacy?


Karl Borden
Karl Borden is professor of financial economics at the University of Nebraska-Kearney and a serial entrepreneur with 11 successful business start-ups to his credit.