Epistemic paternalism is the thesis that in some circumstances we are justified in interfering with the inquiry of others for their own epistemic good without consulting them on the issue. This paper addresses the issue of who is rationally entitled to undertake paternalistic interferences, and in virtue of which features one has this entitlement. First, it undermines the view according to which experts are the most apt people to act as paternalist interferers. Then it argues 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, it offers a virtue‐based account of paternalist interferers and shows how it can apply to cases in which the interferer is a group or an institution. (shrink)

Rashad Rehman, Nipa Chauhan and Rebecca Greenberg argue that beneficent paternalism should be integrated into shared decision-making in the NICU to maximize the patient’s best interests.

This essay focuses on conceptual engineers who aim to improve other people's patterns of inference and attention by shaping their concepts. Such conceptual engineers sometimes engage in a form of epistemic paternalism that I call paternalistic cognitive engineering: instead of explicitly persuading, informing and educating others, the engineers non-consultatively rely on assumptions about the target agents’ cognitive systems to improve their belief forming. The target agents could reasonably regard such benevolent exercises of control as violating their sovereignty over their (...) own belief formation. This is a pro tanto reason against such engineering. In addition to the relevant projects of conceptual engineering, paternalistic cognitive engineering plausibly includes certain kinds of nudging and evidence suppression. I distinguish the sovereignty-based concern from other ethical worries about conceptual engineering and discuss how one might justify the relevant conceptual engineering projects despite the sovereignty-based reason against them. (shrink)

A powerful critique of nudge theory and the paternalist policies of behavioral economics, and an argument for a more inclusive form of rationality.

What makes paternalism wrong? I give an indirect answer to that question by challenging a recent trend in the literature that I call the exclusionary strategy. The exclusionary strategy aims to show how some feature of the paternalizee’s normative situation morally excludes acting for the paternalizee’s well-being. This moral exclusion consists either in ruling out the reasons for which a paternalizer may act or in changes to the right-making status of the reasons that (would) justify paternalistic intervention. I argue (...) that both versions of the exclusionary strategy fail to explain the wrongness of paternalism and that they struggle to accommodate the mainstream view that paternalism is only pro tanto wrong. Their failure consists either in being implausibly strong expressions of antipaternalism or in struggling to spell out the scope of exclusion in an uncomplicated way. After discouraging this exclusionary strategy, I suggest we can capture what is appealing about it—as well as avoiding its pitfalls—by sketching a philosophical model in which we compare the weights of reasons for and against paternalistically interfering. To precisify this sketch, I introduce some conceptual tools from the literature on practical reasoning—in particular, the concept of modifiers—and suggest that these tools offer a better starting point for figuring out what makes paternalism (pro tanto) wrong. (shrink)

This volume considers forms of information manipulation and restriction in contemporary society. It explores whether and when manipulation of the conditions of inquiry without the consent of those manipulated is morally or epistemically justified. The contributors provide a wealth of examples of manipulation, and debate whether epistemic paternalism is distinct from other forms of paternalism debated in political theory. Special attention is given to medical practice, science communication, and research in science, technology, and society. Some of the contributors (...) argue that unconsenting interference with or "conceptual engineering" of people’s beliefs and ability of inquire is consistent with, and others that it is inconsistent with, efforts to democratize knowledge and decision-making. (shrink)

When paternalism is deemed morally justified, weak paternalism—which restricts itself to assisting the target of paternalism realize his own preferences—is the preferred (less problematic) alternative. In determining the appropriateness of weak paternalism, the level of certitude of the paternalist regarding the correctness of her assessment of the true preferences of the one‐paternalized is obviously a crucial factor. Yet in the ethics of paternalism this parameter has escaped systematic treatment. This paper aims to initiate discussion on (...) this indispensable consideration for weak paternalism. Analysing a real‐life dilemma of paternalism in healthcare, the paper focuses on the theoretical question of how the paternalist can optimize her certitude by combining personal knowledge of the individual patient with population data on treatment refusal/consent of patients facing similar decisions. The paper presents an outline of a decision‐making scheme that can be valuable in medical ethics and beyond. (shrink)

This paper explores the possibility that some cases of criminal paternalism might include among their justifying reasons an appeal to human dignity.

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.

:Contemporary global governance is organized around an odd pairing: care and control. On the one hand, much of global governance is designed to reduce human suffering and improve human flourishing, with the important caveat that individuals should be allowed to decide for themselves how they want to live their lives. On the other hand, these global practices of care are also entangled with acts of control. Peacebuilding, public health, emergency aid, human rights, and development are expressions of this tension between (...) care and control. There is a concept that captures this tension: paternalism. Drawing on our moral intuitions, I argue that paternalism is the attempt by one actor to substitute his judgment for another actor's on the grounds that such an imposition will improve the welfare of the target actor. After discussing and defending this definition, I note how our unease with paternalism seems to grow as we scale up from the interpersonal to the international, which I argue owes to the evaporation of community and equality. After exploring the implications of this definition and distinguishing it from other forms of intervention, I consider how different elements of paternalism combine to generate different configurations. Specifically, I point to five dimensions that are most relevant for examining the paternalism found in contemporary global and humanitarian governance: the tools used to restrict another actor’s liberty ; the scope of the interference ; the purpose of the intervention ; the source of the paternalizer’s confidence ; and the mechanisms of accountability. These different elements often correlate historically, suggestive of two ideal types of global paternalism: strong and weak. Contemporary global and humanitarian governance is largely the weak variety: force is severely proscribed, interference is relatively restricted, the paternalizer’s confidence has epistemic roots, and accountability to local populations remains a noble but rarely practiced goal. I further speculate that a major reason for this difference is the effects of liberalism and rationalization. I use this taxonomy to suggest how two different global efforts to improve the lives of those peoples living in what were perceived to be unstable and illiberal territories — the civilizing missions of the nineteenth century and the peacebuilding operations of the post-Cold War period — exhibited different kinds of paternalism. I conclude by reflecting on the ethics of international paternalism. (shrink)

Erik Malmqvist defends the prohibition on kidney sales as a justifiable measure to protect individuals from harms they have not autonomously chosen. This appeal to ‘group soft paternalism’ requires that three conditions be met. It must be shown that some vendors will be harmed, that some will be subject to undue pressure to vend, and that we cannot feasibly distinguish between the autonomous and the non-autonomous. I argue that Malmqvist fails to demonstrate that any of these conditions are likely (...) to obtain. His argument involves two common errors. First, he, like many, proceeds on a mistaken understanding of how to assess harm. What matters is not the balance of costs and benefits of vending, but a comparison of potential vendors’ welfare across two possible courses of action. Second, Malmqvist's concerns about third-party pressure are predicated on an empirically unrealistic understanding of the operation of a regulated market. A widely underappreciated fact is that kidney sales will be relatively rare, and most who try to vend will be unable to. Because pressure on another to vend will not result in the desired outcome, few will exert it. (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)

In a number of recent publications, Cass Sunstein and Richard Thaler have argued for a novel approach to the design of public policy. Their proposal has received a great deal of attention, both within academic circles and the public at large. Drawing upon evidence from behavioral economics and empirical psychology, the authors attempt to demonstrate that the conventional antagonism between libertarians and paternalists within political theory dissolves in conditions that obtain widely in public decision-making. Where free choice and the promotion (...) of individual welfare can coexist, the authors believe that designers of public policy ought to be libertarian paternalists. In this paper I criticize their proposal on grounds that the authors are unable to sufficiently motivate the paternalistic element of their approach. I argue that the empirical evidence cited by the authors is capable of supporting a number of competing approaches, including what I call libertarian utilitarianism and libertarian justice. Since the evidence that the authors draw upon does not provide us any grounds for selecting between these rival approaches, I conclude that Sunstein and Thaler are unable to provide us with a convincing guide for the design of public policy. In order to show that this is the case, I consider three arguments in favor of libertarian paternalism, and find each lacking. I end with some comments about what we can properly conclude on the basis of Sunstein and Thaler’s arguments. (shrink)

Concerns over medical paternalism are especially salient when there exists a conflict of values between patient and clinician. This is particularly relevant for psychiatry, the field of medicine for which the phenomenon of conflicting values is most present and for which the specter of medical paternalism looms large. Few cases are as glaring as that of anorexia nervosa (AN), a disorder that is considered to be egosyntonic (meaning its symptoms are reflectively endorsed by the patient) and maintained by (...) the presence of pathological values. One might think, given this, that an approach to medicine that foregrounds the role of values in clinical encounters would be particularly well suited to address the problem of medical paternalism in treating AN. As it happens, this is precisely the goal of values-based medicine, an approach to medicine that prioritizes the integration of patients’ unique values into the aims of treatment and that has been touted as being particularly applicable to psychiatric conditions such as AN. Although this strategy may initially appear promising, in this paper I will argue that the directive to incorporate patient values (as dictated by values-based medicine) cannot do the work of mitigating medical paternalism in the treatment of egosyntonic disorders such as AN. Rather than chalking this up as a failure due to AN being a particularly challenging case, I will instead conclude that the failure of values-based medicine in this context cuts to the heart of the limitations of rectifying medical paternalism within psychiatry as it currently exists. (shrink)

"Paternalism" comes from the Latin pater, meaning to act like a father, or to treat another person like a child. In modern philosophy and jurisprudence, it is to act for the good of another person without that person's consent, as parents do for children. It is controversial because its end is benevolent, and its means coercive. Paternalists advance people's interests at the expense of their liberty. In this, paternalists suppose that they can make wiser decisions than the people for (...) whom they act. Sometimes this is based on presumptions about their own wisdom or the foolishness of other people, and can be dismissed as presumptuous. But sometimes it is not. It can be based on relatively good knowledge, as in the case of paternalism over young children or incompetent adults. Sometimes the role of paternalist is thrust upon the unwilling, as when we find ourselves the custodian and proxy for an unconscious or severely retarded relative. Paternalism is a temptation in every arena of life where people hold power over others: in childrearing, education, therapy, and medicine. But it is perhaps nowhere as divisive as in criminal law. Whenever the state acts to protect people from themselves, it seeks their good; but by doing so through criminal law, it does so coercively, often against their will. (shrink)

I take as my starting point the “one very simple principle” proclaimed by Mill in On Liberty … “That principle is, that the sole end for which mankind are warranted, individually or collectively, in interfering with the liberty of action of any of their number, is self-protection. That the only purpose for which power can be rightfully exercised over any member of a civilized community, against his will, is to prevent harm to others. He cannot rightfully be compelled to do (...) or forbear because it will be better for him to do so, because it will make him happier, because, in the opinion of others, to do so would be wise, or even right.”. (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)

Libertarian paternalism is often considered as an oxymoron that uses the means of libertarianism to meet the ends of paternalism. It is considered as paternalistic as it covertly transforms into a paternalistic apparatus through the endorsement of the choices the State/authority wants people to make. It is argued that since libertarian paternalism invokes incentives which works differently than coercion, this paper and various other scholars reiterate and respond by arguing that the mere replacement of coercion with incentives (...) does not make libertarian paternalism less paternalistic. A libertarian paternal State exploits the malleability of men to mould their behaviour according to the propositions of the ruling class which the rulers often assert to be in the best interests of the masses. In this article, Orwell‟s Animal Farm, would be used as an analogy to unpack and conceptually analyse the ethical implications of libertarian paternalism. (shrink)

According to rational will views of paternalism, the wrongmaking feature of paternalism is that paternalists disregard or fail to respect the rational will of the paternalized, in effect substituting their own presumably superior judgments about what ends the paternalized ought to pursue or how they ought to pursue them. Here I defend a version of the rational will view appealing to three rational powers that constitute rational agency, which I call recognition, discrimination, and satisfaction. By appealing to these (...) powers, my version of the rational will view can rank the wrongfulness of paternalistic acts in terms of the extent to which such acts (a) amount to supplanting the paternalized individual’s identity as a rational agent with that of the paternalist, and (b) the degree of mistrust the paternalistic act shows in the paternalized individual’s rational agency. My rational powers account thus provides a more complete account of why paternalism is a powerful, but not decisive or absolute, objection to an act or policy. My rational powers account also provides powerful explanations of why rational suasion deflects charges of paternalism; why consenting to intercessions in one’s rational agency negates paternalism; why we ordinarily believe that strong paternalism is more objectionable than weak paternalism; and why we ordinarily believe that hard paternalism is more objectionable than soft paternalism. (shrink)

Cases of paternalism usually involve disagreement between the paternalist and the paternalized subject. But not all the disagreements that give rise to paternalism are of the same kind and, as a result, not all instances of paternalism are morally on a par. There is, in other words, a moral difference between different kinds of paternalism, which can be explained in terms of the nature of the disagreements that give rise to the paternalism in the first (...) place. This paper offers a novel account of how to characterize the nature of these disagreements such that we can explain this moral difference. (shrink)

Many believe that paternalism is less wrong in intimate relationships. In this paper, we argue that this view cannot be justified by appeal to (i) beneficence, (ii) shared projects, (iii) vulnerability, (iv) epistemic access, (v) expressivism, or (vi) autonomy as nonalienation. We finally provide an error theory for why many may have believed that paternalism is less wrong in intimate relations.

1. It is commonly held that paternalism (invariably) involves ‘an assumption of superiority’, wherein the paternalizing agent assumes that – on top of any advan.

In this article we examine Classical Confucian political thinking through the lens of paternalism. We situate Confucianism amid contemporary models of paternalism to show that Confucianism can be understood as a soft form of paternalism regarding its method. Confucianism stresses cultivation of the people by moral exemplars to guide the people to act in ways that are in their own best interests. This is in contrast to use of law and punishment as a deterrent of unwanted behaviours (...) of the people. We demonstrate that Confucian paternalism does not advocate for a static top-down structure of governance that is incapable of reform, underscoring its non-authoritarian ideal. We do this by stressing the vital upward momentum constituted in general cultivation of the wider population utilizing li. The picture that emerges from an examination of Confucian political thought through the lens of paternalism is what we name “exemplary paternalism.”. (shrink)

Paternalistic behaviour directed towards a person’s informed and competent decisions is often thought to be morally impermissible. This view is supported by what we can call the Anti-Paternalism Principle. While APP might seem plausible when employed to show the wrongness of paternalism by the state, there are some cases of paternalistic behaviour between private, informed, and competent individuals where APP seems mistaken. This raises a difficulty for supporters of APP. Either they need to reject APP to accommodate our (...) intuitions in these cases, or provide grounds for thinking that paternalistic behaviour between certain private individuals is different in a morally relevant sense. In this paper, I explore several possible morally relevant differences, and find all of them unsatisfactory as grounds for maintaining the plausibility of APP. (shrink)

Defends Kantian paternalism: Interference with an individual’s liberty for her own sake is justified absent her actual consent only to the extent that such interference stands a reasonable chance of preventing her from exercising her liberty irrationally in light of the rationally chosen ends that constitute her conception of the good. More specifically, interference with an individual’s liberty is permissible only if, by interfering, we stand a reasonable chance of preventing that agent from performing actions she chose due to (...) distorted reasoning and which would result in that agent’s rationally chosen ends not being as fully realized as they would have been had she so acted. -/- Applied to suicide intervention Kantian paternalism implies that such intervention is justified to the extent that it prevents a person from ending her life when, due to distorted reasoning, she engages in suicidal behavior that is at odds with her rationally chosen ends. (shrink)

Toleration is one of the fundamental principles that inform the design of a democratic and liberal society. Unfortunately, its adoption seems inconsistent with the adoption of paternalistically benevolent policies, which represent a valuable mechanism to improve individuals’ well-being. In this paper, I refer to this tension as the dilemma of toleration. The dilemma is not new. It arises when an agent A would like to be tolerant and respectful towards another agent B’s choices but, at the same time, A is (...) altruistically concerned that a particular course of action would harm, or at least not improve, B’s well-being, so A would also like to be helpful and seeks to ensure that B does not pursue such course of action, for B’s sake and even against B’s consent. In the article, I clarify the specific nature of the dilemma and show that several forms of paternalism, including those based on ethics by design and structural nudging, may not be suitable to resolve it. I then argue that one form of paternalism, based on pro-ethical design, can be compatible with toleration and hence with the respect for B’s choices, by operating only at the informational and not at the structural level of a choice architecture. This provides a successful resolution of the dilemma, showing that tolerant paternalism is not an oxymoron but a viable approach to the design of a democratic and liberal society. (shrink)

Recent findings from psychology and behavioral economics suggest that we are “predictably irrational” in the pursuit of our interests. Paternalists from both the social sciences and philosophy use these findings to defend interfering with people's consumption choices for their own good. We should tax soda, ban cigarettes, and mandate retirement savings to make people healthier and wealthier than they’d be on their own. Our thesis is that the standard arguments offered in support of restricting people’s consumption choices for their own (...) good also imply support for “epistocratic” restrictions on people’s voting choices for their own good. Indeed, the philosophical case for paternalistic restrictions on voting choices may be stronger than the case for restricting personal consumption choices. So, paternalists face a dilemma: either endorse less interference with consumption choices or more interference with voting choices. (shrink)

As the use of nudges by governmental agencies becomes more common, the need for normative guidelines regarding the processes by which decisions about the implementation of specific nudges are taken becomes more acute. In order to find a justified set of such guidelines one must meet several theoretical challenges to Libertarian Paternalism that arise at the foundational level. In this paper, I identify three central challenges to Libertarian Paternalism, and suggest that Susan Hurley's political philosophy as presented in (...) her Natural Reasons (1989) can be viewed as offering powerful responses to them. (shrink)

Modern military organizations are paternalistic organizations. They typically recognize a duty of care toward military personnel and are willing to ignore or violate the consent of military personnel in order to uphold that duty of care. In this paper, we consider the case for paternalism in the military and distinguish it from the case for paternalism in medicine. We argue that one can consistently reject paternalism in medicine but uphold paternalism in the military. We consider two (...) well-known arguments for the conclusion that military organizations should not be entitled to use experimental drugs on troops without first obtaining the informed consent of those troops. We argue that both of these are unsuccessful, in the absence of an argument for the rejection of paternalism in the military altogether. The case for military paternalism is widely accepted. However, we consider three ways in which it could be challenged. (shrink)

This paper compares the capability approach (CA) and libertarian paternalism (LP) to see whether they are compatible. The comparison focuses on rationality, wellbeing, and freedom. The main theoretical framework is Sen’s ‘reason to value’ (RtV). The relevance of this to CA, and LP is analysed, and whether the primacy that CA and LP both accord to reason leads to paternalism is examined. Although the principal focus is on Sen’s, Sunstein’s and Thaler’s original ideas, their key concepts are analysed (...) in the context of the contemporary critical literature on the topic. This critical analysis not only makes it possible to assess whether CA and LP are compatible, but also to see how they perceive rationality, wellbeing, and freedom. The critical analysis further differentiates the various interpretations of RtV in the literature and explains how CA and LP function. (shrink)

Pharmaceutical paternalism is the normative stance upheld by pharmaceutical regulatory agencies like the US Food and Drug Administration. These agencies prevent patients from accessing treatments declared safe and ineffective for the patient’s good without their consent. Libertarian critics of the FDA have shown a number of significant flaws in regulatory paternalism. Against these objections, I will argue that, in order to make an informed decision about treatments, a libertarian patient should request full disclosure of the uncertainty about an (...) experimental treatment. But pharmaceutical markets, on their own, are not a reliable source of information about such uncertainty. And companies have the power to capture any independent expert who may assess it. Therefore, the libertarian is better off deferring on an independent regulatory body the assessment of the pharmaceutical risks, constraining access to treatments until tested. (shrink)

In this article, I argue that even if we hold that at least some paternalistic behaviour is impermissible when directed towards innocent persons, in certain cases, the same behaviour is permissible when directed towards criminal offenders. I also defend the claim that in some cases it is morally preferable to behave paternalistically towards offenders as an alternative to traditional methods of punishment. I propose that the reason paternalistic behaviour is sometimes permissible towards an offender is the same reason that inflicting (...) intentional harm on an offender is permissible – namely, that it is sometimes a morally justified method of punishing an offender for his wrongdoing. (shrink)

In this article I argue for a particular analysis of paternalism. I start by examining Dworkin's conditions for the paternalist act and make a case for alternative conditions. I argue that the paternalist actor acts irrespective of what she believes the wishes of the target of her action are and the paternalist actor acts because she has a positive epistemic standing that the act may or will improve the welfare of the target of her action. I also argue that (...) it is consistent with my analysis that there are paternalist acts that don't interfere with the autonomy of the object of the paternalist act. I describe some such acts and make the case that such acts, when they are paternalist acts, may be morally permissible and outline the factors that bear on their permissibility. Finally I locate my analysis in the literature by comparing it to a number of other accounts. (shrink)

A common objection to paternalism concerns its expressive content. Many reject paternalistic policies and actions on the ground that they arguably involve insulting expressions of disrespect toward those subjected to them. The paper challenges this view. It argues that refraining from acting paternalistically can be disrespectful. Specifically, the paper argues that there is a relevant way in which A disregards the moral worth of B if A stands idly by when B is about to act very imprudently. If true, (...) treating others with equal respect and concern, as relational egalitarians and others rightly ask us to do, will somewhat surprisingly sometimes involve treating them paternalistically. (shrink)

This paper argues that participation in an intimate relationship can generate additional or stronger reasons for one to act paternalistically toward the intimate. Moreover, participation in such a relationship can also weaken or cancel some of the presumptive reasons of respect one would otherwise have not to interfere. The paper also reflects, more generally, on the nature of intimate relationships, the normative significance of paternalism, and the normative differences between paternalism in larger-scale institutional contexts and paternalism in (...) closer, interpersonal ones. -/- . (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)

Paternalistic interventions restrict individuals’ liberty or autonomy so as to guide their decisions towards options that are more beneficial for them than the ones they would choose in the absence of such interventions. Although some philosophers have emphasised that there is a case for justifiable paternalism in certain circumstances, much of contemporary moral and political philosophy works from a strong presumption against paternalistic interventions. However, Richard Arneson has argued that there are egalitarian reasons that support the case for (...) class='Hi'>paternalism: paternalistic interventions can protect poor decision-makers from making ‘bad’ choices, thus preventing inequalities between them and those with better decision-making skills. This paper seeks to clarify and advance our understanding of the egalitarian argument for paternalism. Arneson’s argument adds an important and often neglected dimension to the debate about paternalism but also raises a number of questions about equality, paternalism and the relationship between the two. (shrink)

Paternalism in the medical care of children is appropriate and ethically justifiable. However, dilemmatic disagreement by paternalistic agents as to which clinical choice is in the child's best interest may occur because of the underlying conflict between two rival standards for the moral value of life: longevity versus quality. Neither standard is unreasonable. Either could be the basis for choice of medical care by the parents or by the pediatrician. Having the child choose between options disputed by his parents (...) and the pediatrician is unlikely to resolve their conflict. Exercise of informed consent by the adolescent requires agreement by his parents to relinquish their paternalistic veto. The probable best-interest choice by the child when he has matured could be reasonably made from either standard. Therefore, the longevity/quality of life question ought not ordinarily to be foreclosed by paternalistic authority which opts for one standard to the exclusion of the other. Medical interventions, paternalistically determined, are justified in the face of deteriorating quality, but only as long as the interventions themselves do not cause deterioration. Application of this limitation of paternalism to the zone of agreement between the rival life standards is made to clinical case examples. Multiple extrinsic criteria may measure the quality of life. Three quality factors, sensation of pain, capacity to communicate and physical functioning are considered. The extent of the zone of agreement between the two life standards varies because quality of life is a relative good, contingent both upon which extrinsic criteria are selected to assess it and upon the priorities which are set among these criteria. (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 (the NHS). 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)

Is it allowable for your government, or anyone else, to influence or coerce you 'for your own sake'? This is a question about paternalism, or interference with a person's liberty or autonomy with the intention of promoting their good or averting harm, which has created considerable controversy at least since John Stuart Mill's On Liberty. Mill famously decried paternalism of any kind, whether carried out by private individuals or the state. In this volume of new essays, leading moral, (...) political and legal philosophers address how to define paternalism, its justification, and the implications for public policy, professional ethics and criminal law. So-called 'libertarian' or non-coercive paternalism receives considerable attention. The discussion addresses the nature of freedom and autonomy and the relation of individuals to law, policy and the state. The volume will interest a wide range of readers in political philosophy, public policy and the philosophy of law. (shrink)

In their new book Escaping Paternalism, Glen Whitman and Mario Rizzo try to persuade readers to be skeptical of behavioral paternalism. Rizzo and Whitman describe behavioral...

This article examines two currently disputed issues regarding public policy for mentally retarded people. First, questions are raised about the legal tradition of viewing mental competence as an all-or-nothing attribute. It is argued that recently developed limited competence and limited guardianship laws can provide greater freedom for retarded people without sacrificing needed protection. Second, the question of who should act paternalistically for retarded people incapable of acting for themselves is examined. Rothman's claim that special formal advocates are the best representatives (...) for retarded people is discussed and criticized. It is argued that parents, professionals and legal advocates should share decision-making authority on behalf of those who are incompetent. (shrink)

This paper addresses the issue of paternalism in child-rearing. Since the parent–child relationship seems to be the linguistic source of the concept, one may be tempted to assume that raising a child represents a particularly appropriate sphere for paternalism. The parent–child relationship is generally understood as a relationship that is supposed to promote the development and autonomy-formation of the child, so that the apparent source of the concept is a form of autonomy-oriented paternalism. Far from taking (...) class='Hi'>paternalism to be overtly unproblematic in such paradigmatic, pedagogical settings, this article analyzes how an effort should be made to understand a child’s capacities and which standards parents should be held to when deciding whether interference truly serves the child’s interests. (shrink)

In contemporary paternalism literature, persuasion is commonly not considered paternalistic. Moreover, paternalism is typically understood to be problematic either because it is seen as coercive, or because of the insult of the paternalist considering herself superior. In this paper, I argue that doctors who persuade patients act paternalistically. Specifically, I argue that trying to persuade a patient (here understood as aiming for the patient to consent to a certain treatment, although he prefers not to) should be differentiated from (...) trying to convince him (here understood as aiming for the patient to want the treatment) and recommending (the doctor merely providing her professional opinion). These three forms of influence are illustrated by summaries of video-recorded hospital encounters. While convincing and recommending are generally not paternalistic, I argue that persuasion is what I call communicative paternalism and that it is problematic for two reasons. First, the patient’s preferences are dismissed as unimportant. Second, the patient might wind up undergoing treatment against his preferences. This does not mean that persuasion always should be avoided, but it should not be undertaken lightly, and doctors should be aware of the fine line between non-paternalism and paternalism. The fact that my analysis of paternalism differs from traditional accounts does not imply that I deem these to be wrong, but rather that paternalism should be considered as a more multi-faceted concept than previous accounts allow for. (shrink)

Over the last ten years or so, John Stuart Mill’s position on paternalism has been thoroughly re-examined by philosophers. The majority view now seems to be that it is unreasonable to rule out paternalism altogether. The argument is often couched in vaguely utilitarian terms: the benefit of a particular paternalistic measure may so clearly outweigh the disadvantage, if there is any, that it is utterly unreasonable to object to it. For instance, it is unreasonable to object to a (...) law enforcing the wearing of seat belts when driving, given the enormous benefits and the minor irritation of having to conform. (shrink)

Donald VanDeVeer probes the moral complexities of the question: under what conditions is it permissible to intervene invasively in the lives of competent persons--for example, by deception, force, or coercive threat--for their own good? In a work with broad significance for law, public policy, professional-client relations, and private interactions, he presents a theory of an autonomy-respecting" paternalism. Originally published in 1986. The Princeton Legacy Library uses the latest print-on-demand technology to again make available previously out-of-print books from the distinguished (...) backlist of Princeton University Press. These editions preserve the original texts of these important books while presenting them in durable paperback and hardcover editions. The goal of the Princeton Legacy Library is to vastly increase access to the rich scholarly heritage found in the thousands of books published by Princeton University Press since its founding in 1905. (shrink)

Insufficient vaccination coverage is an important public health problem in many countries, since it leads to the loss of herd protection and the resurgence of previously exterminated diseases. However, policies of mandatory childhood vaccination capable of raising vaccination rates continue to be controversial. In this article I review the arguments for mandatory childhood vaccination, setting out the strongest teleological argument in favour, and then critically examining the two strongest potential objections: paternalism and the parental prerogative. I argue that the (...) challenge of paternalism fails because it confuses the identities of those subject to restricted liberty and those who autonomously dissent, and because non-vaccination imposes risks on others. I argue that the challenge of a parental prerogative fails because it cannot be intuitively or theoretically supported in a form that would make it permissible to impose risks on others. I conclude that in lieu of further and more plausible objections at least some policies of mandatory childhood vaccination are morally permissible. (shrink)

Typically, we think of republicans and liberals as being suspicious of paternalistic law. But in this paper, I argue that enactment of paternalistic law is actually demanded by republican and liberal values, and that enacting certain paternalistic laws is one way that the republican or liberal state performs its core function. As I explain it, this core function is to create and to maintain conditions of right-conditions of freedom, non-domination, justice, etc.-among persons capable of making legitimate second-personal claims on one (...) another. I argue, though, that individual persons are capable of making legitimate second-personal claims on themselves, in precisely the way that calls for state intervention. In other words, I argue that paternalistic law is demanded by considerations of right. (shrink)

Interference is paternalistic when it restricts an individual’s freedom for their own good. Anti-paternalists, such as John Stuart Mill, object to this for various reasons, including that the individual is usually a better judge of her own interests than the would-be paternalist. However, Wilkinson argues that a Parfitian reductivist approach to personal identity opens the door to what he calls ‘identity-relative paternalism’ where someone’s present action is restricted for the sake of a different future self.1 This is an interesting (...) argument, but it is not clear whether it involves permissible paternalism. At the risk of stating the obvious, permissible paternalism must be both permissible and paternalistic. Wilkinson’s identity-relative paternalism could be either, but not obviously both. If the present and future selves are different individuals, then interference is potentially permissible but no longer paternalistic. Alternatively, they are identical, in which case the interference is genuine paternalism, but cannot be justified by appeal to their distinctness. Wilkinson may escape this dilemma by invoking Parfit, who challenges the common notion that identity is all or nothing.2 According to Parfit’s revisionary view, the present and future self may share some connections but not others. However, once we have identified these similarities and differences, there is no further question whether or not they …. (shrink)