What happened to self-determination?

I am astounded more and more every day how much weight people as a whole put on governments to have healthy lives. To most people, I am sure this would seem like, “well, yea.” But no… not really from my point of view. Get sick? Government will pay! Need new teeth? You pay! Sorry… what happened there? There are now lobbyists who do lobby for universal dental coverage. Don’t get me wrong, I love the theory and ideology of relying on the government for my health expenses, truly. I mean, I have been blessed to have gotten the bill for my eye surgery to prepare my eye for the prosthetic when it was done in Halifax but thankfully I was only a student at the time, so my home province covered the surgery but not the artificial eye. Nowadays, New Brunswick will also cover the prosthetic and cleanings because of a big article in the newspaper out of Fredericton many years ago. Lobbying does work. But… I see gaps and a constant push for government to pay for more and more healthcare. Why?

In middle and upper classes, there is a bias of health because of a lovely thing called medical coverage. It often covers allied health up to 80% of appointments (usually up to a maximum of $1200–$1800), hearing aids $300–$500, usually only the first prosthetic at only 60%-80%, some orthotics and additional items. The Canadian Revenue Agency allows a person to claim the medical coverage cost and out of pocket expenses for items above and beyond. For both the CRA and private insurers, I advise you to pay attention as some require doctor’s notes and others don’t — its about as bad as figuring out which referrals require a doctor’s send off and which ones you can self-refer. Also, many places that have coverage assume having some time off for such appointments. However… not all jobs have this kind of coverage if any at all. Not everyone has the ability to attend appointments due transportation, childcare and time. Only a fraction of working population hold full-time, benefit entitled jobs. So what happens to the rest of the people? It is out of pocket or paid by the government through a series of lucky loopholes. Either way, it is up to you, the patient, to advocate and attend the appointments.

So back to self-determination. Remember times when every household had a home remedy book on their shelves? Where there was usually a grandparent of sorts who knew remedies to the oddest things? The remedies oddly worked and you learned how to take better care of yourself. There was a time not that long ago where people could not rely on doctors, ambulances and hospitals. Nowadays, somehow, there is a message that only a doctor knows best. An example of this stems from a few years ago when I used a bunch several systematic review articles in one of my exercises that highlighted a classic example: Can a mother’s touch accurately assess a child for fever? The answer was actually yes, mothers do know. Unintentionally, the article also highlighted to me how often a mother’s instinct was disregarded at the price of the health of the child. Do doctor’s even believe that a patient can self-determine? When did the health of a person become removed from one’s own care and reliant on an external system? Oh, the questions that go beyond this article… I am determined to stay on track here.

What is self-determination? In my opinion, it is the ability to determine by yourself what are your needs and the desire to achieve those needs. It requires great awareness, inherent understanding, and assertiveness. It also requires you to be truthful in your needs and abilities. But what does self-determination mean if it is so easily dismissed by those who are expected to listen and be able to help? The answer does not matter because I cannot think of the rejections, only of the chances of success. The weight is on me to be healthy.

Self-determination also has elements of self-efficacy (the belief that yourself that you will get your shit together to succeed), self-care (the ability to take care of yourself), autonomy (act based on your own values and interests and self-culture) and resilience (the ability to pick yourself up again and again to get to where you want to go). The wealthiest are often stereotyped as being self-determined. Those with disabilities who are happily functioning in society are self-determined. If people at the the lowest and at the highest rungs of society have self-determination in common to doing well, imagine what you can determine for yourself at any place in your life.

So where is your self-determination? Your ability to self-regulate, self-care, and self-manage? Who takes responsibility for you when you are sick? I realize that responsibility in a world of entitlement is a bit of an oxymoron: can the two co-exist? Self-determination is taking responsibility for your own shit along with having a strong will to live. Personally, I am determined to have confidence in what I determine for myself, as long as the 5 tenants are in play (be nice, respectful, kind, assert boundaries and ask questions). How about you?

Here is a list of articles that inspired this post:

Morgan, S., Bixler, E., & McNamara, J. (2002). Self-Determination for Children and Young Adults Who Are Deaf-Blind. NTAC Briefing Paper.

Betz, C. L., Redcay, G., & Tan, S. (2003). Self-reported health care self-care needs of transition-age youth: a pilot study. Issues in comprehensive pediatric nursing, 26(3), 159.

Kesselring, J. (2017). Values in medicine: A neurologist’s perspective. Clinical and Translational Neuroscience, 1(1), 2514183X17714122.