Choice is a charged word in medicine

Choice is always available to us. Choice is a charged word – fueling political debates and challenging concepts of freedom. Many would argue that there are unavoidable obligations, legal and cultural limitations that revoke choice, but at the core of human existence is free will that cannot be revoked. While there may be consequences for choices that seem undesirable, unjust, even inhumane, and ultimately unavoidable, choice remains infinitely available, and ownership is entirely within the individual domain.

Choice is clouded by “have to” and “need to” statements and queries. These are phrases of self-deceit designed by the external world to convince us that we are compelled to conform, accepted by the brain as fact through the process of social conditioning. They shift ultimate responsibility to an outside source, trade autonomy for acquiescence, and diminish the power of the person.

Participation out of obligation is compliance.

Participation out of choice is cooperation.

Participation through contract is obedience.

Participation through choice is collaboration.

Participation in response to force is submission.

Participation in response to information is freedom.

In medicine, we document the non-compliance of patients. Recommendations are made and, if not followed, this is often the designation given to the receiver of information who does not implement offered advice. This can be viewed as obstinate behavior, it can feel frustrating and even spiral into a sense of futility when considering the time spent explaining, years of education endured, and thoughtful input provided by the physician only to be unheeded.

What if the patient doesn’t understand? What if the patient disagrees with the reasoning? What if the patient feels powerless in their medical experience, and the last shred of control they experience is the right of refusal of a recommendation? What if they are exerting their power of choice in the one place they feel they can, even if it is to the detriment to their own health?

Recommendations can feel like mandates. Choice is often clouded by illness, when the fight for life and health narrows the options and shortens the timeline of decisions. Need for the right decisions, and right answers along with confusion around the appropriate assignment of responsibility for outcomes can create an unbearable pressure for follow-through.

How might this pressure be relieved if we mutually agree to be responsible for our own results – for the physician to uphold their responsibility to provide meaningful information and recommendations and the patient to uphold theirs to ultimately make the decision? With respect upheld mutually in the process, blame and futility fall away.

What if we never “had” to do anything? What if we replaced “have to” with “choose to” and revisit our assumed obligations? What would be different if this was always followed by asking ourselves why we are choosing to do (or not do) something?

When faced with a directive, our defenses can activate because we are being “told what to do” How might this soften if we receive a directive with curiosity? What if we listen for understanding rather than hear a demand without option? How might our response shift if we recognize that we always have a choice? Are we willing to accept the responsibility that comes with choice and step out of the “I’m doing this because I have to” or “I’m doing this because they told me to”?

What might our decision be if we choose to answer more clearly the “why” behind our decision?

While we can feel frustrated by the sense of disempowerment, we can also choose to stay in that space because the relationship between power and responsibility is so closely linked, and accepting a diminished capacity is a tradeoff we accept for offloading the onus of outcome.

What if receptiveness can nurture and strengthen choice?

What if we can gain confidence in ourselves to uphold the responsibility that comes with the power of choice?

How do we refine our choices when we make an informed decision from a place of personal power?

What questions might we ask?

What answers will we provide?

Responsibility can feel heavy, loss of autonomy heavier yet. Recognizing choice and reframing response to outcome can lighten these loads. Realizing we can only control our own results can shift the means of choosing. Acknowledging that we are part of a collective, and can demonstrate choice externally through our actions, broadens our perspective. Remembering that in all things we have choice and that we never “have to” or “need to” do anything changes the entire experience.

We must be willing to accept the associated consequences and results with exclusive responsibility. While we cannot control the outcomes or responses for others, we can consider how we contribute to the collective and decide how that awareness influences our choice. When projected outcomes are unknown and variable, we can choose to step into choice consciously, repeatedly, and purposefully, acknowledging all that may happen and electing to be responsive as it does.

Amelia L. Bueche is an osteopathic physician and founder, This Osteopathic Life.

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