‘Life, Liberty and The Pursuit of Happiness’: The Unalienable Rights of Diabetes Care

Written by Thomas Jefferson and colleagues, ‘life, liberty and the pursuit of happiness,’ is a phrase cited within the United States Declaration of Independence.¹ The statement outlines three ‘unalienable’ rights (i.e., rights that are incapable of being transferred to another), that ‘all men’ are endowed with. The simple seven-word phrase serves as a moral compass to be followed; to ensure all human beings are in receipt of these three basic provisions. The United States Declaration of Independence has inspired similar political philosophy in other countries as well. Here, we assess its relevance to diabetes care.

Modern medicine endeavours to provide patient-centred care (PCC) to all. This is especially true in chronic disease management, which requires the patient to play an important role in self-care. PCC is defined as, “providing care that is respectful of, and responsive to, individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions.”2 Building on this, responsible PCC is a novel concept that suggests, “the physician or health care team take on the responsibility of ensuring that the person with diabetes is offered all relevant information, in an understandable manner, so that he or she can take part in a shared decision-making process, which offers the potential for achieving optimal therapeutic outcomes, without ignoring his or her biopsychosocial context.”³

Although PCC may seem a modern concept to some, the Declaration of Independence, first published in 1776, suggests otherwise, as ‘life, liberty and pursuit of happiness,’ are “person-centred” goals.

Life

Respect for life is the raison d’etre of the medical profession, which strives to protect and preserve human health. In this context, diabetes care professionals respond to the potential threat of dysglycaemia, its complications and its comorbid conditions.

Liberty

PCC involves crafting therapeutic plans that keep the preferences, needs and values of patients in mind. This allows as much flexibility, or ‘liberty,’ as possible. In diabetes management, although absolute liberty (in terms of permitting potentially harmful lifestyle choices) may not be possible, many different monitoring and treatment options are available that allow the patient to play an active role in therapy, based on the principles of informed decision making. Responsible PCC reminds us that it is our duty to inform the person with diabetes about relevant aspects of his or her condition, so that appropriate decisions can be taken, to achieve optimal health.

The pursuit of happiness

As is the case with liberty, happiness cannot be achieved without responding to the individual’s preferences, need and values. Happiness, termed as ‘euthymia’ in diabetes care, is not only a target, but a tool as well. Euthymia should be considered in patients, the physician, and the patient-provider relationship.⁴

How can the United States Declaration of Independence help guide diabetes care professionals?

Diabetes care is often characterised by frustration on both sides of the consulting table. While a person with diabetes may feel that their needs and preferences are not considered, the diabetes care professional may complain that the patient is not doing enough to take care of themselves. In such cases, it may be useful to remind ourselves of all three of the ‘unalienable’ rights inscribed by the Founding Fathers of the United States. Thus, in diabetes care, we should aim to preserve ‘life’ (health), while offering the maximum degree of ‘liberty’ (choice) possible, with the target of ensuring ‘happiness’ (patient satisfaction).

The troika of rights also overlaps with the biopsychosocial model of health. While ‘life’ corresponds to biomedical health, ‘liberty’ can be taken to represent social health and the ‘pursuit of happiness’ is an apt synonym for psychological health. Thus, the Declaration reminds us to pay equal attention to biomedical and psychosocial wellbeing and to aim for a comprehensive, holistic approach to managing diabetes.

REFERENCES

1. The Declaration of Independence, 1776. Available at: http://www.ushistory.org/declaration/. Last accessed on 9 August 2019.
2. Committee on Quality of Health Care in America Crossing the Quality Chasm: Institute of Medicine (U.S.). A New Health System for the 21st Century. Washington, DC: The National Academies Press; 2001.
3. Kalra S, Baruah MP, Unnikrishnan A G. Responsible patient-centered care. Indian J Endocr Metab. 2017;21:365–6.
4. Kalra S, Balhara YP, Bathla M. Euthymia in diabetes. European Endocrinology. 2018 Sep;14(2):18.