Paternalism in Applied Ethics

Nudging is the idea that people’s decisions and behaviors can be influenced in predictable, non-coercive ways by making small changes to the choice architecture. In this paper, I differentiate between type-1 nudges and type-2 nudges according to the thinking processes involved in each. With this distinction in hand, I present the libertarian paternalistic criteria for the moral permissibility of intentional nudges. Having done this, I motivate an objection to type-1 nudges. According to this objection, type-1 nudges do not appear to (...) be relevantly different than standard cases of manipulation, and manipulation is morally problematic. While I show that this objection fails, I argue that its evaluation raises a different challenge for Libertarian Paternalism. The libertarian paternalistic criteria fails because it ignores the moral distinction that exists between different kinds of nudges. That is, the distinction between what I call ‘counteractive’ and ‘non-counteractive’ nudges. I end by suggesting a revision of the criteria that avoids the problem. -/- . (shrink)

Many philosophers distinguish between "hard" paternalism, which supposedly violates autonomy, and "soft" paternalism, which does not. This chapter begins by critically assessing Joel Feinberg's account of the distinction, according to which hard paternalism interferes with voluntary self-regarding choices while soft paternalism interferes with substantially nonvoluntary self-regarding choices. It then considers several other ways to draw the hard/soft distinction. Ultimately, the chapter concludes that although the hard/soft distinction is a crucially important component of most antipaternalist views, it is surprisingly difficult to (...) draw in a satisfying way. (shrink)

In Our Best Interest argues that it is permissible to intervene in a person's affairs whenever doing so serves her best interest without wronging others. Jason Hanna makes the case for paternalism, responding to common objections that paternalism is disrespectful or that it violates rights, and arguing that popular anti-paternalist views confront serious problems.

“Libertarian paternalism” aims to harness cognitive biases in order to improve prudential decision-making. Some critics have objected that libertarian paternalism is wrongly manipulative. I argue that this objection is mostly unsuccessful. First, I point out that some strategies endorsed by libertarian paternalists can help people to better appreciate reasons. Second, I develop an account of manipulation according to which an agent manipulates her target by worsening the target’s deliberative position. The means of influence defended by libertarian paternalists—for instance, the judicious (...) use of default rules—are not manipulative in this way. (shrink)

Most anti-paternalists claim that informed and competent self-regarding choices are protected by autonomy, while ill-informed or impaired self-regarding choices are not. Joel Feinberg, among many others, argues that we can in this way distinguish impermissible “hard” paternalism from permissible “soft” paternalism. I argue that this view confronts two related problems in its treatment of ill-informed decision-makers. First, it faces a dilemma when applied to decision-makers who are responsible for their ignorance: it either permits too much, or else too little, intervention (...) to satisfy its proponents. Second, the most promising rationales in favor of the view ignore the distinction between an agent’s voluntarily bringing about some state of affairs, on the one hand, and an agent’s voluntarily assuming a risk, on the other. I conclude that a decision-maker’s ignorance is irrelevant to the permissibility of intervention on her behalf. If it is permissible to intervene in a given ill-informed choice, it would be permissible to intervene in an otherwise similar but informed choice, at least provided that intervention would produce similar benefits in both cases. This shows that we should sometimes accept straightforwardly paternalistic rationales. (shrink)

Most opponents of paternalism agree that autonomy does not protect substantially impaired choices. Yet this common anti-paternalist view faces serious problems. First, I argue that it threatens to justify nearly all beneficial intervention, since all imprudent choices are impaired. Attempts to avoid this problem yield other implications that anti-paternalists would reject. Second, I argue that anti-paternalists have no convincing way of showing that impaired choices, such as those produced by emotional distress, are not protected by autonomy. In light of these (...) problems, we should likely accept a hard paternalist view--one that permits intervention simply in virtue of the consequences. (shrink)

The fear of the largely unknown consequences of being exposed to coronavirus should have brought a more dynamic interplay of beliefs and opinions for those who in the footsteps of J.S. Mill believe that the limits of power, which can be legitimately exercised by society over the individual, is to prevent harm to others (Mill, 1859, Introduction). To be kept in a room is an invitation to think or do things with a higher degree of intelligence, empathy and tact. Our (...) surprise is that not much debate or critical interaction has taken place on the choice of locking down the majority of the populations of over 185 countries, after the outbreak of the newest Coronavirus (COVID-19). Instead of testing and isolating those who are sick, general lockdown occurred which could be seen as “a gross usurpation upon the liberty of private life” in the absence of a clear demonstration that lockdown is preventing some harm. The anthropologist Jean-Dominique Michel has recently unfold in a diachronic process the lockdown process (Michel, 2020), through his daily reporting, pointing out some the potentially harmful consequences of this choice. He has critically analysed the idea of an allegedly constructive and positive “social distancing”, which will have deep educational, economic, health consequences, without clearly having a grip on the overall pandemic, which rolls out without possible control. Le deep axiological and ethical question for philosophers is what type and degree of authority is needed during this period. Is it as Stoic philosophers many have thought self-discipline which is needed, as precondition “to follow the path of duty and virtue”? To resolve the struggle between liberty and authority would not yet mean rushing into blind and passive submission to drastic and non-useful constraints. In an authority based understanding severity means working harder, to do what is needed in order to “never permit [our] soul to be caught by […] pain” (Seneca, Clem., Nussbaum, 1994:426). Consequently, we should not accept to suspend critical thinking in order to remain loyal to any authority, which doesn’t mean not respecting public health policy measures. It means instead have the courage to affirm our resistance toward misconceptions, in particular if they are likely to have harmful consequences. Our article will review some of these problematic situations highlighting that no society is free or can achieve the objective of a fairly pluralistic set of values (including freedom of access to education, of a good health protection for all, or of having independent media and a credible press), without a given social practice of these values. No general basic liberties can be respected on the whole, as Mill claims, without some previous and gradual evolution can happen, namely before other more specific liberties have met sustainable social practice. Let’s show how this logic of spreading of values unfolds in the context of the Coronavirus crisis and the omnipresent focus on some physical spread of the disease, as it is always the case in infectious disease epidemics. (shrink)

Personal autonomy is often lauded as a key value in contemporary Western bioethics. Though the claim that there is an important relationship between autonomy and rationality is often treated as uncontroversial in this sphere, there is also considerable disagreement about how we should cash out the relationship. In particular, it is unclear whether a rationalist view of autonomy can be compatible with legal judgments that enshrine a patient's right to refuse medical treatment, regardless of whether the reasons underpinning the choice (...) are known and rational, or indeed whether they even exist. Jonathan Pugh brings recent philosophical work on the nature of rationality to bear on the question of how we should understand personal autonomy in contemporary bioethics. In doing so, he develops a new framework for thinking about the concept of autonomy, one that is grounded in an understanding of the different roles that rational beliefs and rational desires have to play in it. Pugh's account allows for a deeper understanding of d the relationship between our freedom to act and our capacity to decide autonomously. His rationalist perspective is contrasted with other prominent accounts of autonomy in bioethics, and the revisionary implications it has for practical questions in biomedicine are also outlined. (shrink)

Jeffrey Brown, Greg Hoskins and Elizabeth Sperry pose questions about three different policy questions that are discussed in From Field to Fork: Food Ethics for Everyone: policy interventions to address obesity, welfare guidelines for egg production, and the safety of genetically engineered foods. However all three critiques turn on the question of what we can expect a non-specialist to know, and how much information they can be expected to process in making an ethical decision about what to eat. My response (...) situates each question within literature on so-called “fast” and “slow” thinking. I argue that while ethical theories appear to have supposed that people are slow thinkers who can be expected to process a great deal of complexity, food ethics must be founded on principles that respect the habitual and heuristic basis of much eating behavior. (shrink)

In this note, we would like to respond to some remarks with which Cass Sunstein has, in turn, responded to our paper 'Nudges as a Threat to Privacy' in this journal. First, we address his contention that nudges are among the less problematic government practices as regards to privacy issues. Second, as he has clarified in his response that he doesn't think an all too well-informed government would be a good idea, we point out that this leaves a gaping hole (...) in his justification of libertarian paternalism. Third, we point out a new problem with gathering information about the preferences of citizens, namely that observation tends to distort behavior and hence leads to misguided inferences about goals and ends. (shrink)

Public health policies typically assume that there are characteristics and constraints over health that an individual cannot control and that there are choices that an individual could change if he is nudged or provided with incentives. We consider that health is determined by a range of personal, social, economic and environmental factors and we discuss to what extent an individual can control these factors. In particular, we assume that the observed health status of an individual is a result of factors (...) within the individual’s control and constraints the individual faces. We suggest three different constraints: budget, time and psychological constraints and position various determinants of health according to increasing levels of constraint and increasing degrees of individual control. We finally discuss public health policies such as nudging, intervening and rewarding within this new framework and show that the level of constraints and the degree of individual control on health status are essential dimensions to consider when designing and implementing public health policies. (shrink)

European Journal of Political Theory, Ahead of Print.

This chapter examines what role new behaviour-modification policies – commonly known as “nudges” – might play in cultivating virtues. At first sight, they would appear to be ruled out as a candidate means; but, by offering a more nuanced analysis, the chapter argues that some nudges have virtue-cultivating properties. It distinguishes between two kinds of nudges – 'automatic-behavioural' and 'discernment-developing' – and shows that what divides them is the ability of the latter, which the former lacks, to play an ecological-educative (...) role in developing the virtue of practical reason, which is required for the other virtues too. It thus provides an answer to the question of whether virtue-cultivating nudges are possible, while remaining neutral on whether virtue cultivation is, or under what conditions it could be, a legitimate aim of liberal-democratic states. (shrink)

Here I pursue two main aims: (1) to articulate and defend a Kantian conception of duties to self, and (2) to explore the ramifications of such duties for the moral justification of paternalism. I conclude that there is a distinctive reason to resent paternalistic intercessions aimed at assisting others in fulfilling their duties to self (or the self-regarding virtues necessary thereunto), based on the fact that the goods realized via their fulfillment are historical, i.e., their value depends on an individual's (...) casual contribution to their fulfillment. (shrink)

The aim of this paper is to (i) examine the concept of epistemic paternalism and (ii) explore the consequences of normative questions one might ask about it. I begin by critically examining several definitions of epistemic paternalism that have been proposed, and suggesting ways they might be improved. I then contrast epistemic and general paternalism and argue that it’s difficult to see what makes epistemic paternalism an epistemic phenomenon at all. Next, I turn to the various normative questions one might (...) ask about epistemic paternalism and discuss the literature’s assumptions of epistemic consequentialism and veritism. I close by comparing and contrasting epistemic paternalism with other phenomena in social epistemology, such as disagreement or testimony. (shrink)

A recent paper by Bullock (2018) raises a dilemma for proponents of epistemic paternalism. If epistemic paternalists contend that epistemic improvements contribute to one’s wellbeing, then their view conflates with general paternalism. Instead, if they appeal to the notion of a distinctive epistemic value, their view is unjustified, in that concerns about epistemic value fail to outweigh concerns about personal sovereignty. In this chapter, I address Bullock’s challenge in a way that safeguards the legitimacy of epistemic paternalism, albeit restricting its (...) scope to a limited range of cognitive projects. After shedding light on a problem with how Bullock singles out cases to which the dilemma applies, I argue that there is at least one reasonable way of interpreting the notion of ‘personal autonomy’ which legitimates and justifies undertaking epistemically paternalistic interferences for one’s epistemic good. (shrink)

Epistemic paternalism is the thesis that in some circumstances we are justified in interfering with the inquiry of another for their own epistemic good without consulting them on the issue. In this paper, I address the issue of who is rationally entitled to undertake paternalistic interferences, and in virtue of which features one has this entitlement. First, I undermine the view according to which experts are the most apt people to act as paternalist interferers. Then, I argue that epistemic authorities (...) are in a better position to satisfy the requirements of justified epistemic paternalism, when conceived according to the service model of epistemic authority. Finally, I offer a virtue-based account of paternalist interferers and show how it can apply to cases in which the interferer is a group or an institution. (shrink)

While paternalism has been a long-standing philosophical issue, it has recently received renewed attention among scholars and the general public. Comprising twenty-seven chapters by a team of international contributors, this handbook is divided into five parts: (i) What is Paternalism; (ii) Paternalism and Ethical Theory; (iii) Paternalism and Political Philosophy; (iv) Paternalism without Coercion; (v) Paternalism in Practice. Within these sections central debates, issues, and questions are examined, including: how should paternalism be defined or characterized? How is paternalism related to (...) such moral notions as rights, well-being, and autonomy? When is paternalism morally objectionable? What are the legitimate limits of government benevolence? To what extent should medical practice be paternalistic? (shrink)

Paternalism means, roughly, benevolent interference: benevolent because it aims at promoting or protecting a person’s good; interference because it restricts his liberty without his consent. The paternalist believes herself superior in that she can secure some benefit for the person that he himself will not secure. Paternalism is opposed by the liberal tradition, at least when it targets sufficiently voluntary behavior. In legal contexts, policies may be paternalistic for some and not for others, forcing trade-offs. In medical contexts, paternalism can (...) be an open or hidden aspect of the relationship between caregiver and patient. (shrink)

The philosophical debate on paternalism is conducted as if the property of being paternalistic should be attributed to actions. Actions are typically deemed to be paternalistic if they amount to some kind of interference with a person and if the rationale for the action is the good of the person interfered with. This focus on actions obscures the normative issues involved. In particular, it makes it hard to provide an analysis of the traditional liberal resistance to paternalism. Given the fact (...) that actions most often have mixed rationales, it is not clear how we should categorize and evaluate interfering actions for which only part of the rationale is the good of the person. The preferable solution is to attribute the property of being paternalistic not to actions, but to compounds of reasons and actions. The framework of action–reasons provides the tools for distinguishing where exactly paternalism lies in the complex web of reasons and actions. (shrink)

Epistemic paternalism is the practice of interfering with someone’s inquiry, without their consent, for their own epistemic good. In this chapter, I explore the relationship between epistemic paternalism and two other epistemological theses: epistemic permissivism and standpoint epistemology. I argue that examining this relationship is fruitful because it sheds light on a series of cases in which epistemic paternalism is unjustified and brings out notable similarities between epistemic permissivism and standpoint epistemology.

Many of us hold false beliefs about matters that are relevant to public policy such as climate change and the safety of vaccines. What can be done to rectify this situation? This question can be read in two ways. According to the descriptive reading, it concerns which methods will be effective in persuading people that their beliefs are false. According to the normative reading, it concerns which methods we are permitted to use in the service of persuading people. Some effective (...) methods—a programme of brainwashing, say—would not be permissible. In this paper I compare “methods of rational persuasion” with what you might call “marketing methods” such as how one frames the problem of climate change. My aim is to show that “marketing methods” are preferable to “methods of rational persuasion”. My argument has two parts. First, I argue that the evidence suggests that “marketing methods” are more effective in persuading people to change their minds. Second, I argue that “marketing methods” are an acceptable response to the normative question. (shrink)

According to one influential view, requirements to elicit consent for medical interventions and other interactions gain their rationale from the respect we owe to each other as autonomous, or self-governing, rational agents. Yet the popular presumption that consent has a central role to play in legitimate intervention extends beyond the domain of cases where autonomous agency is present to cases where far from fully autonomous agents make choices that, as likely as not, are going to be against their own best (...) interest. The question how we should understand the rationale for eliciting consent in this range of ‘non-ideal’ cases is comparatively ill understood. In this paper, I explore the prospects of accounting for consent requirements in such ‘non-ideal’ cases by appealing to a set of agency-based interests; including an interest in playing a meaningful part in joint decisions affecting ourselves and others. (shrink)

Debates on the nature and justifiability of paternalism typically focus only on adults, sometimes presuming without argument that paternalism towards children is a non-issue or obviously justified. Debates on the moral and political status of children, in turn, rarely connect with the rich literature on paternalism. This chapter attempts to bridge this gap by exploring how issues that arise in the general debate on paternalism are relevant also for the benevolent interference with children. I survey and discuss various views and (...) argue for my own: that paternalism towards children is in most respects like paternalism towards adults and stands in the same need of justification, though such justification is more often forthcoming both because children are typically less prudent than adults and so benefit more from interference, and because, in some respects, interference is less harmful to them. (shrink)

Traditionally, medical professionals have taken a paternalistic stance towards their patients and have relied on a traditional approach to medical ethics. In recent years, in Britain, however, a new 'managerialism' has developed in the National Health Service. This stresses consumerism and greater patient choice and is changing the relationship between doctors and patients. This paper draws out the implications for patients. It describes the ethical characteristics of the two conflicting approaches and argues the need to stress again the view of (...) the patient as an individual person. (shrink)

Shared views regarding the moral respect which is owed to children in family life are used as a guide in determining the moral permissibility of nontherapeutic clinical research procedures involving children. The comparison suggests that it is not appropriate to seek assent from the preadolescent child. The analogy with interventions used in family life is similarly employed to specify the permissible limit of risk to which children may be exposed in nontherapeutic research procedures. The analysis indicates that recent writers misconceive (...) how certain moral principles, such as respect for personal autonomy, require us to act toward children. The results are also used to assess proposed federal regulations on research with children. (shrink)

When are we morally obligated as a society to help the homeless, and is coercive interference justified when help is not asked for, even refused? To answer this question, we propose a comprehensive taxonomy of different types of homelessness and argue that different levels of autonomy allow for interventions with varying degrees of pressure to accept help. There are only two categories, however, where paternalism proper is allowed, be it heavily qualified. The first case is the homeless person with severely (...) diminished autonomy as a result of mental illness, and the second case is the homeless person who runs a risk of serious and imminent harm to self. In the first case, namely, that of soft paternalism, we argue that coercive intervention in the case of a refusal to accept help should be focused on the provision of housing that meets basic needs—needs that we outline in the article. In the case of imminent and severe harm to self, the case of hard paternalism, we argue that forced intervention can only be allowed if it is temporary and local, namely focused on getting someone out of harm’s way. (shrink)

In many or most instances of paternalism, more than one person acts paternalistically, or more than one person is treated paternalistically. This chapter discusses some complications that arise in such group cases, which are largely ignored in the conceptual debate. First, a group of people who together perform an action may do so for different reasons, which makes it more challenging to determine whether the action is paternalistic. This gives us some reason not to pin the property of being paternalistic (...) on actions, since we may alternatively pin it on reasons for actions and allow that these differ between members in the group. Second, the prevention of harmful consensual interactions is sometimes paternalism towards both or all involved, but only if all benefit from interference with themselves rather than with other members in the group, or if all want the harm or risk (more or less) for its own sake. Third, interrelations between three components of paternalism - interference, benevolence and consent - gives us reason to allow that an action can be paternalistic towards some but not others of those affected. This makes it even more difficult, and less relevant, to determine whether or not actions are paternalistic. (shrink)

The novelty in Adam Burgess’ paper is that he assesses nudge policies in the context of the shift in the UK government’s approach to risk from the nannying policies of Labour to the nudge policies of the Conservatives. There is a wealth of ideas in this paper. I find it useful to disentangle some of these ideas focusing on the following two questions: 1. In what respects do Labour’s nannying policies and the Conservatives’ nudge policies differ? 2. What is problematic (...) about Labour’s nannying and the Conservatives’ nudge policies? Subsequently I will reflect on how a particular strand of research in the social sciences can be made relevant to designing a more responsible way of dealing with societal risk and show how this approach can evade some of Burgess’ concerns. (shrink)

In their recently published book Nudge (2008) Richard H. Thaler and Cass R. Sunstein (T&S) defend a position labelled as ‘libertarian paternalism’. Their thinking appeals to both the right and the left of the political spectrum, as evidenced by the bedfellows they keep on either side of the Atlantic. In the US, they have advised Barack Obama, while, in the UK, they were welcomed with open arms by the David Cameron's camp (Chakrabortty 2008). I will consider the following questions. What (...) is Nudge? How is it different from social advertisement? Does Nudge induce genuine preference change? Does Nudge build moral character? Is there a moral difference between the use of Nudge as opposed to subliminal images to reach policy objectives? And what are the moral constraints on Nudge? (shrink)

In this commentary on Yashar Saghai's article "Salvaging the Concept of Nudge" (JME 2013) I discuss his distinction between a 'prod' (which is 'substantially controlling') and a 'nudge' (which is ‘substantially non-controlling’).

Considerations of objective-value freedom and status freedom do impose constraints on policies that restrict access to cigarettes. As to the objective-value freedom, something of value is lost when anti-alcohol policies lead to pub closures interfering with valued life styles, and a similar, though weaker, argument can be made for cigarettes. As to status freedom, non-arbitrariness requires consultation with vulnerable populations to learn what might aid them with smoking cessation.

The Government uses various policy tools to reduce alcohol consumption. There are restrictions on promotions, information campaigns, and pricing policies. These policies do not stand unchallenged. Restrictions on promotions irk business, information campaigns fail to reach the less educated, and pricing policies hurt responsible but poor consumers. So what about Thaler and Sunstein’s Nudge? Nudges keep choices open but change the “choice architecture” so as to help those who would like to drink less, and they do so in ways that (...) constructively engage business. Let us focus on one choice environment here, namely beer consumption in British pubs. (shrink)

We sometimes witness events that might be dangerous (e.g. that might end in someone being abused) but that might not be. These cases involve various kinds of uncertainty. How does a morally responsible bystander respond? This essay describes and evaluates Active Bystander training programs.

This paper offers a non-paternalistic justification for prospective research review as providing a credible social assurance that the institutions of scientific advancement respect and affirm the moral equality of all community members and as creating a “market” in which stakeholders working to advance diverse ends also advance the common good.

Respect for autonomy and beneficence are frequently regarded as the two essential principles of medical ethics, and the potential for these two principles to come into conflict is often emphasised as a fundamental problem. On the one hand, we have the value of beneficence, the driving force of medicine, which demands that medical professionals act to protect or promote the wellbeing of patients or research subjects. On the other, we have a principle of respect for autonomy, which demands that we (...) respect the self-regarding decisions of individuals. As well as routinely coming into opposition with the demands of beneficence in medicine, the principle of respect for autonomy in medical ethics is often seen as providing protection against beneficial coercion (i.e. paternalism) in medicine. However, these two values are not as straightforwardly opposed as they may appear on the surface. In fact, the way that we understand autonomy can lead us to implicitly sanction a great deal of paternalistic action, or can smuggle in paternalistic elements under the guise of respect for autonomy. -/- This paper is dedicated to outlining three ways in which the principle of respect for autonomy, depending on how we understand the concept of autonomy, can sanction or smuggle in paternalistic elements. As the specific relationship between respect for autonomy and beneficence will depend on how we conceive of autonomy, I begin by outlining two dominant conceptions of autonomy, both of which have great influence in medical ethics. I then turn to the three ways in which how we understand or employ autonomy can increase or support paternalism: firstly, when we equate respect for autonomy with respect for persons; secondly, when our judgements about what qualifies as an autonomous action contain intersubjective elements; and thirdly, when we expect autonomy to play an instrumental role, that is, when we expect people, when they are acting autonomously, to act in a way that promotes or protects their own wellbeing. I then provide a proposal for how we might work to avoid this. I will suggest that it may be impossible to fully separate paternalistic elements out from judgements about autonomy. Instead, we are better off looking at why we are motivated to use judgements about autonomy as a means of restricting the actions of patients or research subjects. I will argue that this is a result of discomfort about speaking directly about our beneficent motivations in medical ethics. Perhaps we can reduce the incentive to smuggle in these beneficent motivations under the guise of autonomy by talking directly about beneficent motivations in medicine. This will also force us to recognise paternalistic motivations in medicine when they appear, and to justify paternalism where it occurs. (shrink)

Many people feel that respecting a person’s autonomy is not sufficiently important to obligate us to stay out of their affairs in all cases; but the ground for interference may often turn out to be a hunch that the agent cannot really be competent, or cannot really know what her decision implies; for if she were both of these things, surely she would not make such a foolish decision. This paper suggests a justification of paternalism that does not rely on (...) such appeals. I argue that in cases where an agent will undergo a significant alteration in their evaluative outlook – ‘evaluative shift’ – three central, persuasive objections to paternalism lose their force, and offer a prima facie case for paternalism in some of these cases. I then suggest that we can extend this argument to some cases where evaluative alteration is not predictable, but where the risk and harm are both significant. In such cases, paternalism may be justified. (shrink)

Epistemic paternalism is the thesis that a paternalistic interference with an individual's inquiry is justified when it is likely to bring about an epistemic improvement in her. In this article I claim that in order to motivate epistemic paternalism we must first account for the value of epistemic improvements. I propose that the epistemic paternalist has two options: either epistemic improvements are valuable because they contribute to wellbeing, or they are epistemically valuable. I will argue that these options constitute the (...) foundations of a dilemma: either epistemic paternalism collapses into general paternalism, or a distinctive project of justified epistemic paternalism is implausible. (shrink)