From cycling helmets to vapes: where does the line between personal freedom and government intervention lie?

Vaccination, bicycle helmets, tobacco, alcohol, healthy eating, abortion, preconception care and an open-door policy in care homes: all hot issues in the Netherlands where the balance between health and freedom comes into play. Professor of Health Law Brigit Toebes has written a book on the subject: 'Dat bepaal ik zelf wel - reflecties op gezondheid, vrijheid en recht'. ‘’The government does not so much have the right as the duty to promote and protect the health of citizens.”

_{By Esther van der Meer}

Where does the line lie between individual autonomy and government intervention when it comes to health?
‘’There is no clear line, and that has led to a great deal of confusion in the past. For example, during the coronavirus pandemic: was the government allowed to make wearing face masks compulsory? This book is about how we determine that line. It differs for every issue. Human rights play an important role in this.

When it comes to vaping among young people, you want to draw a firm line. That also stems from the Convention on the Rights of the Child. Conversely, you want to give people with dementia in care homes as much freedom of movement as possible so that you provide them with optimal autonomy.”

Following on from this: when, in your view, does the government not only have the right, but even the duty to intervene in citizens’ health choices?
‘’The government does not so much have a right as a duty to promote the health of its citizens and protect them from harm to their health. This stems directly from Article 22-1 of the Constitution (‘the government shall take measures to promote public health’), and from international and European human rights conventions.”

What do you hope policymakers, healthcare professionals or citizens will take away from this book?
“That they are aware of the risks associated with certain products and situations. That the need for frameworks is clear. I also want to show what the balance between health protection and self-determination looks like, and how this relates to a human rights assessment. And I hope I can dispel the fear of being ‘paternalistic’: sometimes self-determination takes precedence, but there is certainly scope for greater intervention.”

If you could introduce or abolish one health measure in the Netherlands, which would it be and why?
‘’Gosh, I can think of plenty. But if I had to choose: a ban on alcohol at sports clubs would, in my view, be a good, concrete measure. Alcohol and sport don’t mix well. And I would also introduce a healthy lunch in schools. That does require a major cultural shift, in a country where freedom of education is enshrined in the Constitution. Within that context, it is difficult for the government to implement such concrete measures.”

Dat maak ik zelf wel uit – reflecties over gezondheid, vrijheid en recht will be published on 1 April by Boom Publishers. From 10 to 30 April: €26.96, thereafter €29.95. The book launch will take place on 20 April.