# Out-paternalizing the government (getting oxygen for my baby)

*This post does not contain medical advice that most people should attempt to emulate. Considering this home treatment specifically made sense for us. **My spouse has a four-year nursing degree and several years of experience working in Intensive Care Units.** I've spent a non-trivial amount of time researching medical stuff.*

*Note the risks of DIY oxygen in this footnote*[^m9btnebtcy]

Preamble
--------

It rankles somewhat that medications require prescriptions. Like any good libertarian[^vynncr69wz], I feel that regardless of what they do to me, my right to substances only ends only when [it causes me to punch your nose](https://www.goodreads.com/quotes/10318150-the-right-to-swing-my-fist-ends-where-the-other). And even then, I think the criminalization should be of nose-punching.

Granted, without restrictions, many people would make worse decisions about what to do with their brains and bodies than (historically) what government bodies would have decided for them. Notwithstanding, it's *their* bodies and brains: they should be theirs to do with as they wish so long as they're not hurting anyone else[^di9rz0jj4zc]. Who is the government to make decisions for them (and me)? "For our own good"?! Fucking paternalism.

As if they actually know better. (For what it's worth, I'm the kind of guy to advise my spouse [to cut off her leg](https://docs.google.com/presentation/d/1VF_sh1aqByPfvQT0KkflHqxPsygplJFo15YceRei0KI/edit?usp=sharing), contrary to the advice of doctors.)

You know who should get to do paternalism? Me. I'm a father. My 19-month-old child may or may not be advanced for her age, but I think it's legit for her mother and me to make some choices for her, counter to her own desires, such as puffs of her asthma inhaler, even though she resists.

![](https://39669.cdn.cke-cs.com/rQvD3VnunXZu34m86e5f/images/21ef3081cea2df5bd9c42340e5f051e42896a31889981c79.png)

Oxygen Quest
------------

My child has reactive airways that get closed up when she gets a cold[^1c3fq1h3bush]. We took her to the hospital at 11-months and 17-months due to cold-induced labored breathing. That first visit was very upsetting to the little baby. I'd never seen her scream and cry like that. Just extreme distress. 

On her first trip, she didn't yet know the word "no". On the second trip, her plaintive cries of "no no no no no" when a face mask was held on her face were heartbreaking. There's an emotional impact from violating such a clear, verbally asserted protest from your child. 

Following the first trip to the ED (emergency department), we acquired an oxygen saturation measurement device (not regulated!), and its reading reassured my spouse on one occasion between the first and second visits that an ED visit wasn't yet warranted on that occasion[^88oc2e44cg]. Still, the time would come for a second visit.

On September 8, my daughter had another cold that had been going on for a few days (day care, am I right?). It had started to get bad several days in. At **11:52 AM**, my spouse messaged:

![](https://39669.cdn.cke-cs.com/rQvD3VnunXZu34m86e5f/images/7d4e18597943cc6b464597f4f4ce99895bdb265f6afafe0c.png)

and twenty minutes later:

![](https://39669.cdn.cke-cs.com/rQvD3VnunXZu34m86e5f/images/b3c415cd739051aab0007baa432fb48f1dd90415c67c3787.png)

![](https://39669.cdn.cke-cs.com/rQvD3VnunXZu34m86e5f/images/81f7c6ebc8ba5e5e1d9d626f0c0b6b03db80df4584c7038e.png)

![](https://39669.cdn.cke-cs.com/rQvD3VnunXZu34m86e5f/images/ab6ffb85c4fb581bcda48ee888078ca42d38a4f5293b9199.png)

![](https://39669.cdn.cke-cs.com/rQvD3VnunXZu34m86e5f/images/556b82df680a14eb54223dcebcb6a519768dbc8781208772.png)

![](https://39669.cdn.cke-cs.com/rQvD3VnunXZu34m86e5f/images/2efeb0192cc580ad09ed3ecd8c4aeed1d5994fa9dfce252d.png)

*this was actually false – they could do more*

Just oxygen? Surely we can get oxygen at home. It's just *oxygen*.  The thing we're already breathing a lot of already. At the same time as my spouse was monitoring and attempting to make a decision about going in, I began Oxygen Quest.

By **12:30 PM,** I started by looking at Facebook Marketplace and Craigslist. Indeed, people sell oxygen canisters for a few hundred dollars. Promising, though tricky to get one fast. As is the case in many domains, it's 10x harder to get something tomorrow than in a week, and another 10x harder to get it in a few hours than tomorrow.

![](https://39669.cdn.cke-cs.com/rQvD3VnunXZu34m86e5f/images/e10d397782c19c57635835bc79a2d40ab37e0c4f306208dc.webp)

With ChatGPT's help, I also able to figure out all the parts of the system needed: flow regulator, tubing, cannuals/masks, and whether a given canister would have a standardly compatible connector vs needing an adaptor of some kind.

But by **1:00 PM**, the situation was not good. 

![](https://39669.cdn.cke-cs.com/rQvD3VnunXZu34m86e5f/images/1d3c830a32611db0e0bcf8186eb4fc2066f192295cdd6484.jpg)

92-94 is borderline, < 92 is seek care

I was not going to be able to procure oxygen that fast, and we decided to head into the emergency department.

* * *

**It's important for this piece that my spouse was wrong that the only thing hospital could/would do that we couldn't was provide supplemental oxygen.** It's possible that if we'd had oxygen at home, that would have been sufficient to turn things around. It's also possible that it wouldn't have. I then expect my spouse would have noticed via her monitoring, and we'd have ended up in the hospital anyway but a few hours later.

While I'm not completely sure, I think it is unlikely that attempting home supplemental oxygen would have resulted in masking some worse underlying thing, in our child's specific case, and thereby making things much worse. Other cases could be in different.

Matter of thefact, the hospital was able to do more than just oxygen. First, don't underestimate the diagnostic ability of pediatric doctors who do this every day, even if you have some medical training. Second, the treatment they provided and which worked wonders was to administer a steroid (plus albuterol,  a bronchodilator we did have) via a nebulizer, a device more effective at delivering the drug deep into the lungs compared to a typical inhaler. It really turned things right around, and the hospital didn't even do oxygen on this occasion.

* * *

Even once we'd decided to make the hospital trip, it would still be useful to have oxygen at home. Having home oxygen might be the difference between a costly and unpleasant overnight trip, vs going home sooner and being okay. And though I said the steroid worked wonders, it wasn't instant.

Sitting in the hospital with a tired child watching Bluey on a small screen attached to an impressively solid yet movable arm, I opened my laptop and continued Oxygen Quest. One challenge is that even if you have a canister, oxygen is a regulated medical substance. Of course. They can't just give it to you; you need a prescription. And like, it is something you can hurt yourself with. If you're being paternalistic, it's not crazy to be paternalistic about it. But my spouse is a trained ICU nurse and is competent to administer oxygen and monitor its effects.

Turns out that oxygen isn't just part of human respiration. It's used in many things, notably welding. But no dice. I didn't test this one by calling around myself, but forums of people hunting around for medical oxygen said that no welding place would risk filling your medical tank with welding-grade oxygen for $5 or $20. The risk of getting in major major trouble is not worth it. Even if they'd been willing, I buy that medical oxygen has much greater purity, and I didn't want to risk giving my child oxygen to breathe that might contain hydrocarbons, particulates, or other contaminants that mere welding oxygen can contain.

What do? I tried consulting Claude (maybe ChatGPT too) and was told it was not possible. Gotta get a prescription!  Yet, I  don't trust LLMs when they say there isn't a way. I persisted.

I found a forum where they said,  *you know else uses oxygen beyond sick people and welders? Divers and pilots!* Makes sense. What's more, they use oxygen rated for human consumption! I was amused and pleased.

A little more research and I then knew that medical oxygen is commonly called *USP* (US Pharmacopeia) oxygen  and it falls under FDA regulations. Divers and pilots use *ABO* (aviation breathing oxygen), regulated by the FAA. Their purity is much the same, though ABO permits lower moisture content (risk of freezing at high altitudes?). ABO is fine for medical use.

More importantly, it seems at least some dive shops will just fill up your medical oxygen canister (or even clean and certify it), no prescription required.  Deep Ocean Explore in Oakland replied to my Yelp message, affirming they do air, nitrox, and pure oxygen fills.

Gathering necessary pieces, I ordered an excessive amount of tubing and pediatric nasal cannulas from Amazon. No prescription required, but they only sell packs of 50, and I wanted to have a few sizes/styles just in case.

* * *

Thankfully, by approx **4:20 PM**, following a treatment she hated receiving and I hated watching (and assisting with me), things had really turned around, and we went home. Rapidly, our child had gone from completely lethargic to playing in the backyard. Crisis averted. By spouse remarked that her expectations might have been anchored too much on the elderly patients from the ICU, and healthy children actually bounce back fast.

![](https://39669.cdn.cke-cs.com/rQvD3VnunXZu34m86e5f/images/e93e342fde3ebf79837d1576fb4c6191bf86a6df305cffb5.jpg)

24mins from ED to BY

Even though we'd made it through this time, it still seemed worth being prepared, and I put some more effort into sourcing home oxygen.

I'd focused on canisters; I'm not sure why I focused on them, but I'd also given thought and some searches to oxygen concentrator devices. People are selling these second-hand on Facebook Marketplace. And also the companies directly sell them too, no prescription required? Regulation is not consistent. I nearly bought one refurbished for $400.

Perhaps a failure of rationality, I didn't actually click buy once the emergency had passed. We've been proactive about giving the inhaler when our daughter gets sick, which seems to have helped. This last weekend just got a bit bad.

But a friend was in the house! Just so happens this friend had an oxygen concentrator in storage. He'd acquired it during Covid back when they feared hospitals might be overloaded or highly risky. I offered to buy it, and now we have one. I hope we never need to use it.

* * *

It's common wisdom to not get between a mother bear and her cubs. You can find many other videos of animals being protective of their offspring. The idea that parents are protective isn't new to me. It's interesting to feel it from the inside. I can *feel* how much I would do for my daughter[^gp0j3ao0pyk]. Getting her some oxygen is the least.

So, dear government, I'm not sure if you looking after me unasked for, or subject to corrupt regulatory capture, but I want you to know your paternalism is no match for mine. And you better watch for when my kid gets big enough to take care of herself.

Reflections on Regulation
=========================

Interestingly, my feelings regarding regulation have shifted from the start of writing this post until this point. It seems there a lot of ways to hurt yourself with oxygen. Even with my spouse and I on the extreme right tail of medical competency, judgment about optimal treatment was plausibly off.

Now, my indignant opening paragraph said it wasn't about whether or not people would make bad decisions, it's that it was their decision to make and taking that away is bad. Funny though, when I think about it in practice being overwhelmingly bad to give people access to medical oxygen, that I then I want to seek justification for this under some libertarian model. I think it can be done, as per my footnote regarding some kind of contractualism-type thing.

I don't like that anyone is prohibited from engaging in transactions they want, but also wouldn't like if anyone was forced into transactions they didn't want to. So let's suppose:

*   There is some big medical conglomerate entity consisting of various providers such as doctors, hospitals, drug-makers, etc.
*   This entity has a rule that membership means not selling people things that might hurt them. Any provider who chooses to join, has accepted this deal for the benefits provided, e.g., doctors refer you to this pharmacy.
*   If so, I think it's fine that some provider refuses to sell you something, and even that it listens to some central body that's deciding what is okay to sell and under what conditions.

The problem with our current system is that it outlaws anyone existing outside of the medical conglomerate. That's not cool. Perhaps if I were to run a government, I'd aim to set up a highly medical conglomerate that's just really good, such that people would prefer to use it. But you're allowed to compete with it and people are allowed to buy non-conglomerate services and products, at your own risk.

I feel less mad right now that medical oxygen isn't just something you can buy from standard medical supplies stores. And in fact you can get it elsewhere, they're not regulating it that hard. So eh, maybe kind reasonable. There's more to reason through here, maybe for another post.

[^m9btnebtcy]: Risks of DIY Oxygen administration:Fire/explosion: Oxygen-enriched rooms and fabrics ignite very easily; smoking, candles, stoves, or sparks can cause severe fires. Cylinders are high-pressure and dangerous if mishandled.Masking serious illness & delaying care: Oxygen can improve the number (SpO₂) or how someone feels while a serious underlying problem (heart attack, PE, pneumonia, sepsis, etc.) worsens in the background.Wrong dosing (too much / too little / unnecessary):Too little or weak setup → false sense of security when they actually need hospital-level support.Too much, especially in COPD/CO₂ retainers → rising CO₂, confusion, drowsiness, potentially coma.Using oxygen when SpO₂ is actually fine → treats nothing, distracts from the real issue.Equipment hazards: Incorrect regulators/tubing, or leaks; possible contamination or infection from dirty cannulas or non-sterile humidifier water. 

[^vynncr69wz]: Noticing that so many around me think the same, I feel grateful for my epistemic luck. 

[^di9rz0jj4zc]: I think this "hurting anyone else" piece is where most of the discussion is to be had, plus some question of contractualism and there being some rights that one pro-socially gives up as being part of society. Maybe that should include freedoms that you might use to hurt yourself, but... 

[^1c3fq1h3bush]: I received some impression this is fortunately something she will grow out of. 

[^88oc2e44cg]: Oxygen saturation measurement is also part of safely administering oxygen supplementation. 

[^gp0j3ao0pyk]: The scrupulosity in me insists I disclose that the cost of hospital visits (even with insurance) also provided motivation to avoid hospital visits. That said, money not spent on the hospital is available to spend on my daughter in other ways.