Should Community Rights
Individual Rights to Privacy?
A Book Review
By Sheldon Richman
January 22, 2001
Amitai Etzioni, professor of sociology at George Washington
University, is the leading popularizer of the philosophy
he calls "responsive communitarianism." As he writes
in The Limits of Privacy, "responsive communitarianism
seeks to balance individual rights with social responsibilities,
and individuality with community." In this volume he
applies his philosophy to the matter of privacy. Unsurprisingly,
he sees a "basic tension between our profound desire
for privacy and our deep concern for public safety and
public health." He concludes, "We need to treat privacy
as an individual right that is to be balanced with concerns
for the common good--or as one good among others, without
a priori privileging any of them."
Time to Swing the Pendulum?
Etzioni believes that privacy in many areas (including
HIV testing, e-mail encryption, national identity cards
and biometric identifiers) is overemphasized to the detriment
of public health and safety. It's time, he writes, to
swing the pendulum back to a more reasonable position.
Later I will show that Etzioni's approach to privacy
rests on an act of fundamental question-begging. But
first let's consider his views on privacy with regard
to medical issues.
Readers will be pleased to learn that Etzioni thinks
there is insufficient consideration for privacy in the
matter of medical records. He decries the unauthorized
and, more important, abusive authorized access
to people's medical information. He calls for more protection
of privacy and thinks it can be done without sacrificing
such "common goods" as research, quality control, and
cost containment. He outlines several methods to guard
medical privacy, including self-regulation, sophisticated
computer applications, smart cards, and the like. These
would permit wide "legitimate" access to anonymous data,
while restricting access to information in which patients
can be identified.
Who is a Bigger Threat?
We can applaud Etzioni for worrying about threats to medical
privacy, but beware. He believes the private sector (that
is, people who want to sell you things) is a bigger threat
than the government! For him, government is a big part
of the solution. He seems to favor the unique health identifier
authorized by Congress. Significantly, he rejects the
principle of informed consent as rooted in individualism,
inferior to his communitarian approach, and impractical.
Indeed, he thinks it is neither informed nor consent because
to obtain health insurance, people must sign standard
blanket consent forms that "impose no limits on what is
to be disclosed or to whom, or on the release of personal
health information to third parties or the sale of such
information to all comers."
Etzioni commits a fallacy here. Simply because the
principle of informed consent is imperfectly implemented
is no proof that it is defective. He takes no notice
of the fact that most medical care is paid for by third
parties, either the government or insurance companies.
Of those who rely on insurance for even the most routine
medical attention, most have their coverage through
their employers. That paternalistic practice is the
result of wartime wage controls and a tax policy that
penalizes those who buy their own insurance. This results
in a crippled medical marketplace that lacks what John
Goodman calls patient power, or cost-consciousness.
If people were responsible for finding their own coverage,
they would scrutinize the terms more closely and a truly
competitive market would push companies to offer consent
agreements that conform to the preferences of consumers.
Instead of favoring free markets and contracting for
confidentiality, which cannot be matched for sensitivity
to individual preferences, Etzioni prefers the state--which
is notorious for its one-size-fits-all approach to things.
In the end, Etzioni's solutions are unsatisfactory
for a simple reason: he is trying to shoehorn solutions
into a flawed philosophical framework. The premise that
individual rights must be balanced with the common good
begs the main questions: What rights do individuals
begin with? How can "society" determine the extent of
those rights when society is a collection of individuals?
There is the crux: Etzioni treats the community as an
organism that makes decisions and has interests that
can override those of individuals.
But only individuals choose, act, and pursue interests.
Thus the principle that "the community" should balance
individual rights and the common good is a euphemism
for mob rule.
Once the individual's preeminent place is recognized,
his natural rights, especially property rights, are
up to the task of distinguishing legitimate from illegitimate
is editor of Ideas on Liberty, published
by the Foundation for Economic Education.
The Limits of Privacy by Amitai Etzioni was published
by Basic Books in 1999 (215 pages plus notes and index).
This article was originally published in the November/December
2000 issue of Health