Self-Medication as a Codified Right

The reader who takes the argument of this resource seriously arrives at a practical question the resource has, until now, avoided. If medicine is under-equipped, if the market is compromised, if the law is not yet in place, if the state passes responsibility, what are they entitled to do with their own body in the meantime? The answer this piece defends is that they are entitled to a great deal, and that the entitlement is not new. It is already codified.

The empty room the reader has walked into

The reader of No One Is Coming and The Store That Sells the Right has been told, twice, that no institution is going to arrive with a solution. The clinical mainstream will not order the tests that would name the deficit. The supplement store will monetize the substrates the mainstream declines to prescribe, at inflated prices and around novelty compounds. The physiological-rights framework this resource argues for does not yet exist as an enforceable instrument. The reader who has taken those pieces seriously is, having finished them, in a room with no visible door.

This piece is about the door.

It is about the fact that the reader, contrary to a certain modern mythology of medical authority, is not obliged to wait for a system that is not coming. They are entitled to act. That entitlement has a name in international health instruments, a name in bioethics, a name in constitutional law in several jurisdictions, and a name in the ordinary doctrine of informed consent. It is called, variously, auto-soin, self-care, self-medication, or, in the ethical-legal register, the exercise of bodily autonomy in a health context.

The right already exists

The Alma-Ata Declaration (1978). The founding international declaration on primary health care states, in its Article IV, that “the people have the right and duty to participate individually and collectively in the planning and implementation of their health care.” That participation is not decorative. The Declaration describes primary health care, in Article VII, as care that “requires and promotes maximum community and individual self-reliance and participation in the planning, organization, operation and control of primary health care.” Alma-Ata did not invent self-care. It named it as constitutive of what primary health care is.

The WHO Self-Care Interventions programme. In 2019 the World Health Organization published its first Consolidated Guideline on Self-Care Interventions for Health, subsequently expanded in 2021 and 2022. The Guideline defines self-care as “the ability of individuals, families and communities to promote health, prevent disease, maintain health, and to cope with illness and disability with or without the support of a healthcare provider.” The initial focus was sexual and reproductive health; the framework has since extended to a broader set of conditions. The WHO does not present self-care as a substitute for insufficient services in low-resource settings. It presents it as an autonomous mode of health provision to be recognized and supported in every setting. It does not treat self-medication as a marginal case of self-care; it treats it as one of its ordinary components, alongside self-testing and self-management.

The right to health (ICESCR, Article 12). The International Covenant on Economic, Social and Cultural Rights recognizes “the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.” General Comment 14 of the Committee on Economic, Social and Cultural Rights (2000) reads that right through the AAAQ framework: availability, accessibility, acceptability, quality. The Comment names the individual’s participation in health decisions as constitutive of the right itself. To claim a right to the highest attainable standard of one’s own health, without simultaneously claiming the right to act on it in the absence of adequate provision, would be incoherent.

The Oviedo Convention (1997) and the doctrine of informed consent. The Council of Europe’s Convention on Human Rights and Biomedicine states in Article 5 that “an intervention in the health field may only be carried out after the person concerned has given free and informed consent to it.” The mirror of that principle, which follows immediately from it, is that the person is entitled to withhold consent to an intervention proposed to them, and to substitute an alternative. Bioethics has recognized this for half a century. It is what the ordinary right of refusal implies: not only the right to say no to a specific treatment, but the right to act otherwise. The subject who refuses a course of statins and elects instead to address their apolipoprotein B by dietary and micronutrient means is exercising a right that the doctrine of consent has already granted them.

National frameworks. These international instruments are received in national law in various forms. The French Code de la santé publique, following the 2002 loi Kouchner on patient rights, recognizes the patient’s right to participate in decisions concerning their own health, including the right to refuse a proposed treatment and to seek an alternative. The United States’ Dietary Supplement Health and Education Act (1994) presupposes, in its architecture, an adult population entitled to obtain and consume supplements without prescription. Canada’s Natural Health Products Regulations (2004) do the same for its own market. Most Western jurisdictions have equivalent provisions.

The right, in short, is not something that has to be invented. It is something that has been named, and named again, over the past half-century, in the very instruments the medical profession invokes when it wishes to be perceived as rights-respecting.

The distinction that matters

The word “self-medication” carries, in ordinary usage, an ambivalence that this piece needs to resolve. It is used to describe two very different things, and the failure to distinguish them has served the interests of both the medical mainstream (which uses the ambivalence to disparage self-medication as a category) and the supplement industry (which uses the same ambivalence to sell whatever novelty its formulator has decided to brand).

Informed self-medication is what the WHO Guideline describes. It presupposes access to reliable information about the substrate, its role in the physiology, its expected effect, its known interactions, and its verifiable markers of adequacy. It presupposes, where testing is technically feasible, access to that testing. It presupposes a clinician who is willing to receive the results and read them, or its documented absence. It is a mode of health action for which the subject is the responsible party and the information is the substrate.

Adventurous self-diagnosis is what happens when the informational infrastructure is not provided. It is the reader guessing at the meaning of a symptom, selecting a product from a shelf on the basis of its packaging, and titrating dose on the basis of nothing. It is not a mode of health action to be valorized. It is the symptom of an institutional failure: the failure to provide the information, the testing, and the clinical reception that informed self-medication requires.

The distinction has a consequence this resource wants to name plainly. Informed self-medication is a right. Adventurous self-diagnosis is a burden imposed on the subject by the absence of the infrastructure the right presupposes. The two are often described as if they were the same thing. They are not. Conflating them serves the interest of the parties whose failures produce the second.

The pragmatic economy of the substrate

Where does the everyday practice of nutrient supplementation fit into this framework? It fits at the intersection of the two distinctions above: it is an exercise of the codified right, in its informed version, when the reader has done the work of reading the biology.

The physiological substrates this resource documents in its Rights pages are the ordinary objects of informed self-medication. Magnesium, potassium, iron, folate, riboflavin, choline, the substrates of glutathione, the vitamins Pauling recommended taking in large quantities and inexpensively. These are not novelty compounds. They are the substrates the body has been using for as long as the species has existed. The right to intervene on one’s own body with such substrates, when the medical system has declined to test whether the intervention is needed, is not a controversial position. It is the ordinary application of the doctrine of consent to a situation in which the standard of care has failed to be a standard.

The economy of this exercise is not the economy of the supplement store. It is the economy of the substrate: the cheapest reliable form, at a dose calibrated to the biology, and where possible verified by a test. It is what The Store That Sells the Right argues the market does not provide, and it is what Pauling spent his last decades correcting the market for having failed to provide.

What this piece is not saying

It is not saying that the informed subject should replace the clinician. Where a clinician exists who will order the right tests, read them against thresholds of function rather than population, and support the intervention, the subject is better served in that relationship than outside it. The right to self-medicate is not an argument against clinical medicine. It is an argument for the subject’s standing within a system that has, historically, treated them as a passive object of intervention.

It is not saying that the market of supplements is exonerated. The critique in The Store That Sells the Right stands. The right to self-medicate does not extend to the right to be sold branded novelty at a mark-up of ten. It extends to the right to obtain the substrate at cost, which the current market provides only in the form of the plainest generic formulations.

It is not saying that self-medication is a solution to the absence of the physiological-rights framework. It is a stopgap. The framework this resource argues for would render most of the current recourse to informed self-medication unnecessary, because the tests would be ordered, the thresholds would be honest, and the substrate provision would be delivered as of right. Self-medication is what the exercise of the right looks like when the framework is absent. That absence is what this resource is written to correct.

Why the framework requires this foundation

A physiological right, in the sense this resource defends, is the right of a person to have their essential physiological parameters maintained, tested, and, where deficient, restored. That right presupposes, as its subject, a person entitled to act on their own body. If the subject were not so entitled, the right could be discharged only by the medical system, and its violation could be alleged only when the system had refused. But the right, in this resource’s argument, is not an entitlement against an obliging medical apparatus alone. It is an entitlement against the wider architecture that includes law, food policy, testing regulation, reimbursement, and the constituencies that shape all of them. It is a right the subject can invoke, and it can be invoked in the first instance by the subject’s own action.

The doctrine of self-care, in the Alma-Ata sense and in the WHO Guideline sense, is the doctrine that makes such a right legally coherent. It grounds the subject as an actor, not merely as a patient. Without it, the physiological-rights argument would be an argument for a better medical system on behalf of a passive population. With it, the argument is what it means to be: an argument for a right that the subject can already begin to exercise, imperfectly, in the room that has no visible door.

The door is there. It has been in the international instruments for half a century. This resource is written to help the reader see it, and to protect them from mistaking, for the door, the shelf of adjacent branded compounds that occupies the same wall.