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However, when the “others” are those with whom the rider is in a primary relationship, it may be more compelling to consider an “ethics of care framework,” in which motorcycle riders would have a duty to consider how their behaviors affect their loved ones and may even require riders to suppress their own desires in order to reduce harm to others, especially dependents, such as children and elderly parents.Many proponents of mandatory motorcycle helmet laws claim that the devastating injuries helmetless riders often sustain place undue burdens on others in the form of increased insurance premiums, avoidable drains on the health care system, and the potential costs of long-term care that may entail state-supported health care services.In West Virginia, a predictable annual tradition occurs as the legislature wraps up its session: the state trauma providers receive an e-mail from the their state representatives and senators asking that we weigh in on whether to continue or repeal the state’s mandatory helmet law.As medical professionals, surgeons need to play a role in public policy decisions that relate to health care, including the debate over helmet laws.And, although the number of organs recovered from motor vehicle accidents each year is fairly small and would increase nationwide organ donation numbers by less than 1 percent, opponents of mandatory helmet laws could claim that the autonomous decision to ride without a helmet may provide a societal benefit that offsets the associated societal burdens.However, such an argument would do little to justify the imposition of unnecessary burdens on the cyclist’s loved ones.For example, commenting on the mandatory helmet law debate, A Brotherhood Against Totalitarian Enactments (ABATE) has said it does not “advocate that you ride without a helmet when the law is repealed, only that you have the right to decide.” Of course, these autonomous decision-making rights are not absolute, and may be limited when the choice of an individual unfairly burdens others or puts them at significant risk.The Institute of Medicine defines public health as “what we, as a society, do collectively to assure the conditions in which people live can be healthy.” In making claims such as “my body, my choice,” helmet law opponents imply that their actions affect no one else.

For example, the helmet use compliance rate in Arkansas was 97 percent under the state’s universal helmet law; it dropped to 52 percent when the universal law was repealed and replaced with a partial law.Similarly, when universal laws were repealed in favor of partial laws, Florida saw its compliance drop from 99 percent to 53 percent, and in Louisiana compliance went from 100 percent down to 52 percent.Furthermore, the NHTSA found that in states with laws requiring only minors to wear helmets, less than 40 percent of underage riders who were fatally injured wore a helmet, indicating that despite a law requiring helmet use it is difficult to determine whether a rider is underage, thereby hampering enforcement.This section looks at the ethical and philosophical rationales that both sides in the helmet debate offer to support their positions.Autonomy is generally understood to mean the freedom and ability to be self-governing or to make personal decisions without undue influence or interference from others.

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