The paradox of promoting choice in a collectivist system

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Abstract
In both the policy1 and academic2 literatures, the issue of extending patient choice in the UK National Health Service (NHS) is currently a much discussed issue. From December 2005—for example, general practitioners (GPs) will be required to offer patients needing elective surgery the choice of five providers at the point of referral.1 Choice is often thought of as an intrinsically good thing; that is, that people value choice in and of itself.3 A probable underlying reason for this belief is that choice is tied in with the notion of individual autonomy, or freedom, a concept that looms large in ethical theories of the good. Beauchamp and Childress—for example, classified respect for autonomy—along with beneficence, non-maleficence and justice—as one of the four prima facie moral principles that most serious moral thinkers can agree upon, regardless of moral, religious, philosophical, cultural, and social background.4

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