The Certificate Option

The libertarian option poses a problem for those who are concerned about the possibility that consumers will not be adequately informed in their drug-use choices. Even competent adults may be inclined to purchase pharmaceuticals without the benefit of adequate education about the pharmacology of the agents—the evidence of their effectiveness, the data on potential undesired effects, and the evidence regarding alternatives. Lay people may be unduly influenced by lay press accounts of wonder drugs or by advertising intentionally misleading consumers about the drug’s safety and effectiveness.

The Weak Paternalism Version

This is, in effect, a concern addressed by the notion of weak paternalism. Some who are, in principle, anti-paternalists worry about dangers to people who are not acting in a mentally competent manner based on adequate knowledge. They would support a limited use of paternalism to intervene long enough to determine if the consumer is, in fact, adequately competent and informed. Once that is determined, the weak paternalist will step aside and let the actor choose a course of action, even if observers continue to believe that the consequences will be bad.

That is the policy that defenders of a “certificate option” would favor. They would restrict the purchase of legend drugs, those currently available only on prescription (or a shorter list of those that should only be available on prescription) to purchasers who have a certificate signed by a licensed physician, asserting that he or she has educated the patient adequately about the drug, its potential effects, and its alternatives.

This would look very much like the piece of paper that is currently called a prescription, but it would be very different philosophically. It would not be a written declaration that the physician believes the drug is best for the patient. It would merely be a testament that the patient is adequately informed. It would remain the patient’s decision to determine whether the drug is best. The certificate requirement would be a paternalistic attempt to make sure that the consumer is, in fact, acting in a substantially autonomous manner. Once that was determined, it would be the patient’s decision whether to use the drug and how it is used.

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