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The concept of freedom has been considered by almost all existing philosophical and psychological theories, as well as in many other fields of human knowledge. Such considerable attention proves its importance for each human being, in particular, and the society, in general. The issue of freedom is so crucial that it has always caused serious confrontations among peoples and revolutions for freedom and human rights. Nowadays, this concept is vital as never before; it is embodied in the form of various freedoms of citizens, which are described in state constitutions in most societies in the modern world. This paper analyzes the concept of freedom in various uses and interpretations from a perspective of different disciplines, as well as exemplifies its application in the healthcare domain.
Since the times of Immanuel Kant, the concept of freedom or liberty (the two terms are mostly used interchangeably in the research) has been constantly encountered in two main uses of negative and positive liberty. Negative liberty implies the absence of obstacles, barriers, or restrictions, which are external to an individual. However, in this case, one appears to be free only superficially. In contrast, positive liberty enables a personality to take control of one’s life and realize one’s fundamental aim. In other words, positive freedom implies the presence of control on the part of the agent who is self-determined and capable of controlling own destiny, interests, feelings, or passions. It is interesting to observe the parallels between negative and positive liberty concepts and the ideas of a humanistic psychoanalyst Erich Fromm, who emphasized the difference between the concepts of freedom from and freedom for. While the first one implies a mere absence of restrictions, the second one stands for the genuine freedom to express personal feelings and act according to own intentions. Moreover, the chosen actions must be congruent with one’s personality and values.
Furthermore, numerous discussions concerning positive and negative freedom also interrelate with the concepts of free will and autonomy. Freedom is one of the most important issues in terms of human nature. Psychological personality theories consider freedom in regard to the question of to what degree individuals are free to control their thoughts and behaviors. Psychologists, as well as philosophers, strive to determine whether human free will and conscious choice are able to surpass the influence of an enormous number of factors. These factors can be external (social demands, interactions, education, upbringing, socialization, and others) or internal (subconscious impulses, drives, or instincts). The 20th century was rich in theorists who made a significant blow to the human freedom and spirituality. Some of them developed theories explaining human behavior in terms of the stimulus-reaction relationships. In particular, such psychologists as Edward L. Thorndike and Burrhus F. Skinner have founded behaviorism – a theoretical model, which denies human freedom in favor of determinism whereas its principal claim is that a person’s behavior is nothing but a sum of predicted reactions to outside stimuli. Another theory that denied freedom of the human nature is psychoanalysis, which was first introduced by Sigmund Freud, and then developed by his numerous followers, for instance, Alfred Adler, Carl G. Jung, Anna Freud, and others. Psychodynamic personality theories interpreted a human being as an arena for the fight of subconscious impulses and instincts, which ultimately deprived a person of its freedom. However, humanistic psychologists managed to develop consistent theories presenting reasonable arguments for the human capacity to make a conscious and free choice of own actions and attitudes. Such theorists as Abraham Maslow, Carl Rogers, and Erich Fromm put forward the ideas of a personality being able to transcend the lower needs and desires and rise to spirituality. Spirituality is a genuinely human sphere, in which a person discovers most humanlike and creative traits, as well as demonstrates freedom.
Humanistic and phenomenological ideas of self-realization and self-actualization come close to the philosophical concept of self-transcendence. In philosophy, self-transcendence implies the ability of a human being to transcend its lower nature, get freedom from its influences, and acquire an opportunity to discover own divine nature, which is interpreted in religion as the Kingdom of God. This desired kingdom is nothing but the freedom of a human being to determine one’s life and its quality. Geisler and Turek emphasize that the choice of destiny is in one’s hands. It depends on the free will what set of beliefs to possess and whether to follow the absolute truth, eternal moral foundations, and human values or to become a victim of aggressive impulses. Additionally, the authors assure that people’s lives have meaning, are in their hands, and depend on their free choice to believe in a loving God or to accept the Nazi or terroristic doctrine. On a related note, a popular existentialist philosopher, psychologist, and psychiatrist of the 20th century, Viktor E. Frankl influenced the views of millions of American and European citizens by his concept of human’s search for the life meaning. He introduced the concept of spiritual freedom and discussed it in relation to the potential human capacity to rise beyond conditions and make a willful and conscious choice concerning own attitude to any external conditions, either inhuman treatment in a concentration camp or severe terminal disease. Therefore, a person always has a choice and free will to decide whether to be determined by psychological, biological, or sociological conditions. By his theory and autobiographical examples from the Nazi concentration camp, Frankl proved that a human being has a freedom to choose own destiny and the capacity to preserve human essence under any circumstances. Thus, it is also possible to interpret the concept of freedom in the context of an individual’s behavior in disease. Everyone can choose how to accept it: either to give up or rediscover oneself and become morally stronger. The disruption of health caused by a severe disease results in the submission of some people, but forces others to reflect on their deep inner being, values, and life philosophy.
Every philosophical theory suggests its ethical system. The concept of freedom originated in the Western culture and was frequently associated with justice. Sandel presents the arguments of political philosophers beginning from the times of ancient Greece and incorporates them into the discussion of today’s morality, justice, and freedom. It is not disputable that an individual has a right to see justice from one’s point of view. However, the problem arises because the morality of people’s behavior, feelings, and life in the society is not interpreted unanimously by everyone. Consequently, there appears a need to decide on a common interpretation of morality and justice, as well as freedom, from the societal perspective. The analysis of the philosophical systems of the past can be of use in the decision-making and problem-solving not only in healthcare but also in other societal domains. For instance, the utilitarian theory is frequently applied in ethical decision making in the healthcare context. It suggests that a caregiver chooses the course of action that would bring happiness to a greater number of individuals involved (including family members).
A model case that illustrates the application of the concept of freedom in the healthcare setting can occur, for example, in the clinical surgical settings when a patient makes a free choice to refuse blood transfusions on the basis of religious belief in spite of a health professional’s directions. The healthcare in the US, Australia, Canada, as well as many other countries of the world, is regulated, among others, by the ethical principle of patients’ autonomy. It implies that an individual who is adult and sound in mind has a right to an autonomous decision concerning which treatment to refuse or consent to. Therefore, if a certain course of actions chosen by the caregivers contradicts person’s values, beliefs, or duties, he or she has a freedom to reject it even if the consequences might harm his or her health. A similar case can happen in the gynecological clinical settings, when a woman discovers, for example, that her fetus is diagnosed to have a Down’s syndrome. According to ethical principles and foundations of the modern healthcare system, she has a freedom to request for the termination of pregnancy. The reason for it is that the focus in today’s philosophy is on the wholeness of personality, in other words, on an individual’s moral, mental, social, and psychological well-being. Hence, a woman has the right to decide on her own whether she will be able to cope with the burden of having a child with such a severe, lifelong diagnosis. Finally, her freedom and autonomy must be respected and legally protected. An illustration of an antagonistic case can occur when health care providers choose to resort to coercive or paternalistic actions in the case a patient attempts to refuse the treatment, which comes into clash with his or her values or beliefs. As an alternative, it can also be the case of a patient at the end of life with inoperable cancer, who refuses a surgical intervention or any other treatments and chooses to spend the rest of the days quietly surrounded by relatives at home. However, a health professional insists on the surgery and further procedures at the clinic. The results of such paternalistic measures can be twofold; they will cause either the improvement in a patient’s state or, on the contrary, even stronger sufferings and death.
All in all, the antecedent concept of freedom must prevail in the healthcare decision making since every individual has the right and free will to decide what to do with the own body. That is why, in the modern healthcare, the principle of autonomy surpasses in importance even the principles of beneficence and non-maleficence, which imply the duty to do good and the duty not to inflict harm or evil. In practice, it means that the consequences of not respecting patients’ freedom to decide themselves on the interventions can be grave for both patients’ moral state and health professionals’ integrity. Frequently, the cases of medical workers demonstrating disrespect for autonomy and making a treatment decision without a patient’s consent or even against it usually result in legal issues. On the whole, the court prioritizes the personal right to autonomy and finds medical workers guilty of battery or coercion even if they were driven by the motives of saving the life.
On the whole, the concept of freedom in the present-day health care research receives a great amount of attention. Empirical methods that can be used to measure the concept of freedom include qualitative methods of analyzing people’s answers to various types of questionnaires, for instance, those aimed at measuring attitudes, perceptions, and understandings of freedom among different groups of participants. Additionally, research can employ a detailed analysis of clinical scenarios and cases in various practice settings in order to observe how the concepts of freedom and autonomy are interpreted and perceived. Overall, it is hard to overstate the importance of the concept of freedom in the whole history of humankind and its development.
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