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Freedom of Choice

Arthur Kemp, Ph.D., is Director of the Eco­nomic Research Department of the American Medical Association. This article is reprinted by permission from the February 27, 1960 issue of The Journal of the American Medical Association.

At Atlantic city in June, and again at Dallas in December, the American Medical Association’s House of Delegates proclaimed and reaffirmed the belief that the "free choice of physician is the right of every individual" and that such freedom of choice, together with free competition among physi­cians, constitute prerequisites to "optimal medical care." In so do­ing the House of Delegates, by in­ference, took a position in favor of individual freedom of choice in general and expressed a preference for maintaining a social, political, and economic framework in our so­ciety conducive to the preservation of such freedom of choice.

All too frequently the term free­dom has been misused or abused. Perhaps this is inevitable when the concept of freedom is capable of stirring up considerable emotion in the human breast; indeed, some men have died for it, and many others have proclaimed their willingness to do so. Less often, how­ever, have men had the patience to devote attention to the less emo­tional and more mundane restric­tions on freedom when these do not directly affect them. Certainly it behooves members of the medical profession to give attention to the broader meaning of the term "free­dom of choice" and to its implica­tions.

If freedom of choice were to re­late merely to the number of courses of action open to a person, it would be more accurately de­scribed as power of choice. But freedom of choice represents some­thing more fundamental than power; it represents the right of the individual person to be a free agent in his interhuman relation­ships, to make his own decisions, to be free from the arbitrary author­ity of others, and to be able to choose how he wishes to use his services or property rather than to be subject to coercion by others. Freedom of choice means that the the person is able to choose his own course of action and his own pat­tern of living, subject to the requirement that he shall not act so as to violate the freedom of choice of others.

Freedom in this sense, it should be noted, is freedom of, not free­dom from or freedom to; the prep­osition is of great importance, for the latter represent not different aspects of the same thing but en­tirely different conditions. This calls to mind the famous four free­doms enunciated by President Franklin D. Roosevelt during World War II—freedom of speech, of worship, from want, and from fear—later called "a noble pun" by the British economist, Joan Robin­son. The two pairs of freedoms were, in fact, of entirely different character. Mr. Roosevelt meant se­curity from want and fear, not freedom or liberty. Many philoso­phers, including Franklin and Jef­ferson, have pointed out that free­dom and security are inconsistent human conditions. Indeed, make freedom of choice into freedom from choice and one comes close to a definition of slavery.

A Vital Distinction

The struggle and debate of our time is intimately related to this difference between freedom of choice and from choice. Such a dif­ference relates to the alternative methods of organizing human ac­tivity and is not simply a struggle between the United States and the

Soviet Union or between the free world and the unfree world. Hu­man activity can be organized so that the individual person has freedom of choice or so that he has little or no choice. The latter is the technique of the totalitarian state while the former is the mechanism of the market place with limited government and the separation of political powers.

A freedom-of-choice society in the economic sphere is a market society. Individual economic trans­actions are conducted through the voluntary cooperation of reason­ably well-informed persons in such a way that both parties benefit from them. A free-choice society provides a mechanism for bringing about coordination with a mini­mum of coercion. Human activi­ties, so far as possible, are con­ducted in the market, not in the political sphere. In this way coer­cion of individual persons to con­form is minimized and freedom of individual choice is maximized. Each person can choose the color of tie he wants, the architecture of his house, and the cut of his clothes. He does not have to submit to what the majority wants; he may make his own choice and get it.

This is, of course, exactly the opposite from that organization of society where decisions which could be made by the market are made on a political yes or no basis. Even if these decisions are reached by the expedient of democratic majority rule (which may be transitory) rather than by dicta­torial fiat, the political decisions are the results of group pressures instead of individual choices.

We live in a society still essen­tially free, one that gives to the in­dividual person the right not only to choose his physician but to make other choices as well. Indeed, we have even permitted the individual person to choose to use his capital and his services to advocate the abolition of freedom of choice it­self. Throughout the history of mankind this sort of society has not been the general rule but the exception. Perhaps this is inevi­table. The totalitarian collectivist principle is simple and straight­forward; it appeals to those who say, "Do something now." The ne­cessity of restraint, group and in­dividual, the recognition of ignor­ance and the imperfection of hu­man knowledge, and the denial of a millennium and the aim of estab­lishing conditions that make life not perfect but workable—all these attributes of a free-choice society constitute a highly sophisticated doctrine.

It is sobering to see the growing number of so-called leaders of po­litical thought or politicians who advocate an ever-growing govern­mental assumption of responsi­bility for all sorts of complex eco­nomic and social problems—full-employment, care for the aged, care for the indigent, government health services, subsidized hous­ing, and so on and on. Yet the moral ethic on which our civiliza­tion rests emphasizes individual responsibility. Can such a civiliza­tion survive? Perhaps, but only if it recognizes the difference be­tween freedom of choice and free­dom from choice.



Ideas on Liberty

"Freedom" From Responsibility

WHEN the Athenians finally wanted not to give to the State, but the State to give to them, when the freedom they wished most for was freedom from responsibility, then Athens ceased to be free and was never free again.


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