Self-Command in Practice, in Policy, and in a Theory of Rational Choice

An increasingly familiar occurrence for obstetricians is being asked by patients to withhold anesthesia during delivery. The physician often proposes that a facemask be put beside the patient who may inhale nitrous oxide as she needs it. But some determined patients ask that no such opportunity be provided: if gas is available they will use it, and they want not to be able to. The request is interesting for decision theory, and raises questions of ethics, policy, and physician responsibility, even if the woman is merely making a mistake-if she simply does not know how painful labor will be and how glad she will be, even in retrospect, if the pain is relieved. But some women who make this request have had…