Journal of Medical Ethics 40 (5):352-353 (2014)

Gerald Dworkin
University of California, Davis
I have reviewed, and made criticisms of, Sarah Conly's book elsewhere.1 ,2 In this comment, I am a constructive critic who wants to discuss an argument against paternalism that is different from the three which Conly emphasises in her precis. It is an argument that she attacks in her book, and I want to support her objection to it.iThe argument raises a quite particular objection to paternalism, that is, that it does not treat the object of paternalistic interference with proper respect. For paternalism always rests on a premise that the agent is making a mistake in her decision making , that she is not fully capable of making a rational decision and that she is in some way impaired in her cognitive or affective dispositions. And since all paternalistic interventions assume this premise, they all are expressing a judgement about the agent that is an insult. They fail to treat the agent as a rational and capable agent.3Two things should be noted about this argument. First, it only establishes that paternalism is pro tanto wrong. There may be occasions where an insult is less important, morally speaking, than some other consideration. Second, it is interesting to note that this objection can apply to ‘nudges’ as well as coercive interventions. For all nudges involve the premise that without the nudge the agent is more likely to make a mistake in his decisions. He will eat …
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DOI 10.1136/medethics-2013-101552
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