Socrates vs. Callicles: Informed Consent

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Inspired by Plato’s Gorgias.

CALLICLES: Now, my dear Socrates, let us return to your rather embarrassing stance against water fluoridation.

SOCRATES: Certainly, Callicles, but in relation to which part of my stance do you seek to embarrass me further?

CALLICLES: This silly business of informed consent to medication.

SOCRATES: You mean informed consent to treatment?

CALLICLES: Socrates, be warned, I shall not allow you to play your silly games, as you did with that meats, drinks and physicians nonsense earlier.

SOCRATES: My good friend, I merely seek, in this instance, to protect you from any embarrassment in the presence of this fine company here today. In this spirit, you should know there is a difference between informed consent to treatment and informed consent to medication.

CALLICLES: Oh, Socrates, if it means that much to you, please, enlighten us.

SOCRATES: I would never presume to do so, Callicles, and certainly not in the presence of these fine gentlemen, with yourself being the most distinguished among us, but in the interests of moving forward on this matter, I will offer the humble footnote that informed consent to treatment is accepted as a universal human right. Medication is merely one possible form of treatment and therefore only falls within the scope of a human right in the context of being a treatment.

CALLICLES: I’ll sleep better at night knowing that, Socrates. Thank you. Your point is noted. Let us move on.

SOCRATES: Certainly. Callicles, correct me if I am wrong, but in our previous exchange you said the following: “… men who act according to nature; yes, by Heaven, and according to the law of nature: not, perhaps, according to that artificial law, which we invent and impose upon our fellows, of whom we take the best and strongest from their youth upwards, and tame them like young lions, charming them with the sound of the voice, and saying to them, that with equality they must be content, and that the equal is the honourable and the just”.

CALLICLES: You are not wrong.

SOCRATES: Would I be correct, then, in saying that you value individual autonomy as a general principle in life, that a man should decide his own destiny and that artificial laws are in a sense a restriction on such individualistic principles?

CALLICLES: You could say that, yes.

SOCRATES: Let us assume that one of these ‘young lions,’ to which you refer, had the strength of character to demand his right to choose which treatments for disease he undergoes, for how long these treatments shall last and who oversees this treatment. Would you consider that he is exercising some form of natural, autonomous right, as a man?

CALLICLES: I would, of course. He would be exercising his strength and personal power.

SOCRATES: But what if I then told you that artificial laws were created to ‘tame’ this young lion of yours, to deny him this choice. Would this not fall under the category of “artificial law, which we invent and impose upon our fellows” to ultimately undermine their individual strength?

CALLICLES: It would depend on the treatment.

SOCRATES: Would it?

CALLICLES: Yes.

SOCRATES: How so?

CALLICLES: If the treatment was obviously for his own good, to support his strength.

SOCRATES: Then his strength does not lie within his ability to choose for himself, as a general principle of autonomy?

CALLICLES: Yes, of course it does.

SOCRATES: Then how could an external, artificial imposition do anything but undermine his strength in the very fact of removal of choice?

CALLICLES: I guess so.

SOCRATES: Then you would agree that the only option here is full and free choice, for this principle to be upheld?

CALLICLES: Yes.

SOCRATES: So tell us again, why does the nature of the treatment matter?

CALLICLES: I suppose, when you put it that way, it doesn’t. But what is your point in all this wrangling, Socrates? Let’s get back to this absurd opposition of yours to water fluoridation.

SOCRATES: My dear friend, we are already engaged in that discussion.

CALLICLES: Enough of your games, Socrates, speak straight man.

SOCRATES: As you wish. Just to recap, you have agreed that individual choice in regards to treatment supersedes the nature of treatment itself, and that artificial imposition of treatment upon the individual would class as an attempt to undermine this natural principle. Correct?

CALLICLES: Correct.

SOCRATES: Surely you have heard of a condition called dental caries, or tooth decay.

CALLICLES: Of course.

SOCRATES: This is a disease?

CALLICLES: Yes.

SOCRATES: And what do we call a measure put in place to prevent or alleviate a disease?

CALLICLES: A treatment.

SOCRATES: As you mentioned earlier, Callicles, you feel I have already embarrassed myself in my opposition to water fluoridation; and in turn, I stated that I did not wish for you to suffer the same fate as me. So in this spirit, please demonstrate to our guests that you have mastered the basics of the issue, so there can be no doubt.

CALLICLES: My pleasure. Where shall I begin?

SOCRATES: Since this issue is so broad, I propose that we remain with this issue of informed consent, which you earlier dismissed as “silly business”. To extend this discussion, I respectfully ask that you give us your understanding of why fluoride compunds are added to public water supplies.

CALLICLES: Certainly. They are added to fight tooth decay in people of all ages.

SOCRATES: So, the disease of dental caries?

CALLICLES: Yes.

SOCRATES: I’m sorry to sound like a stuck record, Callicles, but for us humble folk, what was the term we agreed upon for a measure that purports the alleviation or prevention of a disease?

CALLICLES: I believe it was ‘treatment.’

SOCRATES: So the disease of dental caries is treated by adding fluoride compounds to public water supplies, which are consumed by all in society? Is that your understanding of the practice?

CALLICLES: Yes.

SOCRATES: So the nature of this treatment is both preventative and alleviative?

CALLICLES: Yes, my dentist has assured me that these compounds act as a constant ‘repair kit’ for vulnerable teeth, and that forming teeth are made stronger by it to resist decay.

SOCRATES: So we are clear that fluoride compounds are added to public drinking water supplies ostensibly to prevent or alleviate the disease of dental caries?

CALLICLES: For once, I can’t argue with you, old friend. But please, get to the point.

SOCRATES: Is the point not obvious?

CALLICLES: You have not proposed one, Socrates.

SOCRATES: But you have, Callicles.

CALLICLES: I warned you from the outset, none of your games.

SOCRATES: And I accepted your warning, but I assure you, this is no game. Do we have time for a few more basic questions?

CALLICLES: If it makes you feel better, sure.

SOCRATES: Okay. Well, this one is only a simple question, but have all these people who are being treated for the disease of dental caries via public water supplies given their informed consent to said treatment?

CALLICLES: Don’t be ridiculous. How could consent be given by so many people all at once?

SOCRATES: I thought we agreed that consent was paramount.

CALLICLES: Yes, to individuals. Not groups.

SOCRATES: Are not all the recipients of this daily treatment individuals?

CALLICLES: Yes, of course!

SOCRATES: Then what circumstance or argument waives their right to informed consent to treatment?

CALLICLES: The nature of the treatment, it is good for them. And it is safe.

SOCRATES: But did we not agree, my friend, that the nature of treatment is irrelevant in the context of informed consent as a natural principle?

CALLICLES: Yes we did, but this is another matter.

SOCRATES: Please explain, again, for us humble folk.

CALLICLES: Fluoride compounds are not medications.

SOCRATES: Once again, Callicles, I hate to sound like a stuck record, but I seem to recall you also conceded earlier that medication is merely a type of treatment among many and that the process of treatment itself is the enshrined right in question.

CALLICLES: Oh, by Zeus!

SOCRATES: Dear friend, tell me, if you visited your physician and he told you that you had something wrong with your nose and that he was going to break it and reset it, to alleviate the problem and prevent future problems, but that it was very likely that other forms of damage to your nose would occur and create potentially worse future problems. Would you class this procedure as medication or treatment?

CALLICLES: Treatment, of course.

SOCRATES: So, if you said “no” to the treatment and the doctor made you have it regardless, you wouldn’t mind?

CALLICLES: Of course I would mind! It’s my body, my choice.

SOCRATES: But you said informed consent only applies to medication. This is not a medication, so what’s your problem?

CALLICLES: Return to fluoridation, for the sake of the Gods.

SOCRATES: Gladly so. I would like you, for the benefit of our audience, to help us understand why fluoridation – as a treatment for the disease of dental caries – does not require informed consent to treatment from all the individuals upon whom it is administered. Will you re-concede, then, that informed consent to treatment and not informed consent to medication is the most logical terminology.

CALLICLES: Yes, yes, okay, I re-concede.

SOCRATES: Then we should return to the central point. What makes the treatment of water fluoridation exempt from the informed consent paradigm which we have established? Perhaps I could ask you another question?

CALLICLES: Granted. But please make this the final one.

SOCRATES: Certainly, Callicles, as you wish. Final question: Given that water fluoridation policy is crafted by artificial laws and overrides natural laws of autonomy, would you not in turn make one final concession – that this is a violation of your own beliefs regarding artificial law, which, as you claim, “we invent and impose upon our fellows, of whom we take the best and strongest from their youth upwards, and tame them like young lions, charming them with the sound of the voice, and saying to them, that with equality they must be content, and that the equal is the honourable and the just”?

CALLICLES: And this relates to water fluoridation, how exactly?

SOCRATES: Water fluoridation policy is artificial law that contradicts, by its very nature, the principle of informed consent to treatment, which, as we have established, is a fundamental principle of individual sanctity regardless of the nature of treatment. It claims an equality from the treatment that supposedly overrides the natural principle. So, I ask again, how are your “young lions” not disempowered by this artificial imposition upon their freedom of choice regarding treatment of their own bodies?

CALLICLES: For the second time, Socrates, I can’t argue with you.

SOCRATES: Any other points of “silly business” you wish to discuss, Callicles?

CALLICLES: No, I need a doctor.

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Author: AFA Mildura

Administrator, Anti-Fluoridation Association of Mildura

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