Most books on ethics are boring. Against Autonomy 1 is fun to read because its helpful and profound points are made without a fuss. Author Sarah Conly is right that “when individuals engage in behavior that undercuts their own chances of happiness, state interference may be justified”.In what follows I argue that Conly misinterprets that thesis in three ways. First, she says that her paternalism seeks to “help people get where they want to go... live the lives they truly (...) want to live”. That's a different idea from the one I quoted earlier. Why? Because people do not always want to live in the way that would give them the highest chance of happiness. Conly is surely right that when we “habitually choose the large fries”, that's not always because large fries is what we want truly. Such choice can also reflect ignorance and miscalculation on our parts—when we simply “choose ineffective means to our ends”. But Conly fails to recognise another potential source. Sometimes self-harming choice reflects what we truly want at the time. Many young people do not care much about health problems in their older years. They habitually choose large fries not because they …. (shrink)

The article aims to demonstrate that the nudge theory suffers from three main weaknesses stemming from its theoretical dependence on behavioural economics. The first two weaknesses endanger the paternalistic goal, whereas the third does not justify the libertarian attribute. The first weakness lies in the incomplete realistic characterisation of behavioural economics theory that is the central theoretical pillar of Nudge theory. The second weakness is even more relevant. The normative model of behavioural economics is neoclassical rationality. It can be applied (...) to choices in conditions of risk, when it is possible to forecast the probability of the outcomes of one’s choices. On the contrary the real life problems are inside a complex and uncertain environment. In an uncertain environment the neoclassical algorithms are no longer valid, in that they postulate the knowledge of the probability of the outputs. Thus errors and bias, as observed in behavioural economics, are not such in many instances, but they are instead adaptive and therefore rational responses to the context of decision-making. Therefore nudge theory that pursues the normative paternalistic objective of neutralising the bias and judgement errors discovered by behavioural economics and putting paternalistically the citizen on the right track, is in fact proceeding in the wrong direction. The last weakness concerns an assumption of Nudge theory about the duality of mind. System 1 represents the intuitive mind, while System 2 corresponds to the analytical one. System 1 tends to make decisions quickly and unconsciously, while System 2 follows a slow and conscious process. Biases and judgement errors are mainly generated by System 1. However, System 2 may later intervene to correct them. From this premise, the Nudge theory affirms its libertarian character. In this paper I will argue that the dualism of the mind would not entail the reversibility of some nudges, particularly of default states. In this way the fundamental pillar is weakened to justify the libertarian character of the nudge theory. (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)

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)

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)

While this paper does not explicitly define the concept of autonomy, the way Ubel et al describe clinicians’ failures to enhance their patients’ autonomy reflects a broader understanding of autonomy than the default account as free and informed choice. In this OPC I would demonstrate that the communication strategies the authors recommend reflects a more sophisticated conception of autonomy than the understanding that typically prevails in bioethics. I will also distinguish between weak and strong forms of paternalism, and (...) argue that a weak paternalistic approach is not only defensible but also aligns with the strategies the authors propose. Thus, by clarifying the concept of autonomy we can show how it can be enhanced in practice. (shrink)

: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)

I introduce a new distinction between two types of paternalism, which I call ‘internal’ and ‘external’ paternalism. The distinction pertains to the question of whether the paternalized subject’s current evaluative judgments are mistaken relative to a standard of correctness that is internal to her evaluative point of view—which includes her ‘true’ or ‘ideal’ self—as opposed to one that is wholly external. I argue that this distinction has important implications for (a) the distinction between weak and strong (...) class='Hi'>paternalism; (b) the distinction between soft and hard paternalism; and (c) medical practice, where internal paternalism can, and probably often does, occur. (shrink)

Paternalism has generally been thought of as forcible or coercive interference with a person's liberty of action which is justified because it will prevent harm to that person's welfare interests or the like. Opposition to paternalistic interference with adults, whether it involves the intervention of the state or another adult individual, has usually been based on a concern to preserve human autonomy or self-determination. More strictly it is opposition to so-called ‘strong’ paternalism - interventions to protect or benefit (...) a person despite the person's informed voluntary consent to the contrary- which has been grounded on such a commitment to self-determination. ‘Weak’ paternalism involves interference where there is a defect in the decision-making capacities of the person interfered with. It is claimed to be justifiable insofar asconsentto the interference would be forthcoming were these capacities restored. (shrink)

Paternalism has generally been thought of as forcible or coercive interference with a person's liberty of action which is justified because it will prevent harm to that person's welfare interests or the like. Opposition to paternalistic interference with adults, whether it involves the intervention of the state or another adult individual, has usually been based on a concern to preserve human autonomy or self-determination. More strictly it is opposition to so-called ‘strong’ paternalism - interventions to protect or benefit (...) a person despite the person's informed voluntary consent to the contrary- which has been grounded on such a commitment to self-determination. ‘Weak’ paternalism involves interference where there is a defect in the decision-making capacities of the person interfered with. It is claimed to be justifiable insofar asconsentto the interference would be forthcoming were these capacities restored. (shrink)

Can epistemic paternalistic practices make us better epistemic agents? While a satisfying answer to this question will ultimately rest at least partly on empirical findings, considering the epistemological discussion on evidence, knowledge, and epistemic virtues can be insightful. In this paper, Giada Fratantonio argues that we have theoretical reasons to believe that strong epistemic paternalistic practices may be effective at mitigating some evidential mistakes, in fostering true belief, and even for allowing the subject of the intervention to gain knowledge. However, (...) we have reasons to expect that these practices will not be able to make the subject of the intervention an overall better epistemic agent at the dispositional level. She then considers weak epistemic paternalistic practices, e.g., epistemic nudging, and provides some reasons for optimism. Finally, Fratantonio considers the implications that these theoretical considerations have for education. (shrink)

Legal restrictions of the right to self-determination increasingly pretend to be compatible with the liberal concept of autonomy: they act upon a ‘soft’ or autonomy-orientated paternalistic rationale. Conventional liberal critique of paternalism turns out to be insensitive to the intricate normative problems following from ‘soft’ or ‘libertarian’ paternalism. In fact, these autonomy-oriented forms of paternalism could actually be even more problematic and may infringe liberty rights even more intensely than hard paternalistic regulation. This paper contributes to the (...) systematic differentiation of soft and hard paternalism by discussing the (legal) concept of autonomy and elaborates the moral and legal limits of autonomy-orientated paternalism. (shrink)

Libertarian paternalism is a weak form of paternalism that recommends nudges rather than bans, restrictions, or other strong interventions. Nudges influence people’s choice by modifying contextual factors (the “choice architecture”). This paper explores the possibility of an epistemic analogue of libertarian paternalism. What I call “epistemic libertarian paternalism” is a weak form of epistemic paternalism that recommends “epistemic nudges” rather than stronger paternalistic interventions. Epistemic nudges influence people’s beliefs and judgments by modifying contextual factors (...) (the “epistemic choice architecture”). The main aim of this paper is to defend epistemic libertarian paternalism from the “irrationality problem”, which I take to be the most urgent problem for epistemic libertarian paternalism; given how epistemic nudges work (i.e. they typically co-opt psychological biases), nudged beliefs are irrational. In response to the irrationality problem, I admit that nudged beliefs are often (not always, though) irrational, but insist that there are conditions in which epistemic nudging can be justifiable nonetheless. I will propose two conditions that are jointly sufficient for justifiable epistemic nudging: “Veridicality Condition” (which says that nudged beliefs are more likely to be true than non-nudged beliefs) and “Not-More-Irrationality Condition” (which says that nudged beliefs are not more likely to be irrational than non-nudged beliefs). (shrink)

In the grand debate between the paternalist and the libertarian, VanDeVeer sides decidedly with the libertarian. Paternalistic intervention he regards as presumptively wrong, and so the question becomes whether there are countervailing, morally relevant considerations by which paternalistic intervention can be justified. In shifting the burden of justification to the paternalist, VanDeVeer is not being innovative. H. L. A. Hart broke that ground in his Law, Liberty, and Morality in 1963, and Ronald Dworkin used the technique effectively in his 1966 (...) Yale Law Journal essay "Lord Devlin and the Enforcement of Morals." VanDeVeer's contribution, however, is in the explanation he gives for laying the burden of justification on those who would defend paternalistic intervention. Whereas Hart's explanation spoke at the societal or governmental level, VanDeVeer's speaks at the level of the individual person. He rests his argument on the essence of the libertarian position: a principle of overarching individual human autonomy. Consistent with his individualistic focus, he avoids restricting his definitions of paternalistic intervention to activities at the societal or governmental level. VanDeVeer insists that there are moral bounds to paternalistic intervention on the part of private individuals, and it is, perhaps, both the strength and the weakness of the book that he by and large joins conceptually paternalistic intervention by the government and paternalistic intervention by private individuals. (shrink)

The aim of this article is to defend the morality of the Golden Rule from the objection that it will lead to intolerable paternalism. Once religious paternalism is allowed, Inquisitors come forward to care for the weak-willed and obtuse masses. Eventually, the Inquisitors lose their faith, and focus their concern upon harmony, health, and happiness in this life. The outcome is either a constrained distopia that is abhorrent (Huxley), or a cruel distopia which is the antithesis of (...) what the Golden Rule is supposed to prescribe (Orwell), Paternalism presupposes knowledge that an agent is acting against his own best interests. Such epistemic justification is not available in matters of ethics or faith. (shrink)

Both for reasons of their own and because of congressionally mandated changes in the Family Education Rights and Privacy Act, many colleges and universities have changed the way they deal with alcohol abuse by their students. One of these changes has been to adopt a policy of “Parental Notification” according to which parents of an underaged student found guilty of consuming alcohol are notified after a first offense. I argue that this is a paternalistic policy in need of justification, and (...) that justifying it is made the more difficult because of barriers to its being successfully pursued. Nonetheless, I suggest that such a policy, if a weak paternalistic one, can be morally justified. (shrink)

Paternalist policies in public health often aim to improve people’s well-being by reducing their options, regulating smoking offering a prime example. The well-being challenge is to show that people really are better off for having their options reduced. The distribution challenge is to show how the policies are justified since they produce losers as well as winners. If we start from these challenges, we can understand the importance of the empirical evidence that a very high proportion of smokers regret smoking. (...) In short, it is important that they regret it and important that the proportion is so high. This paper explains how, philosophically, regret can relate to well-being and it considers some of the strengths and weakness in the empirical research that the explanation brings out. The regret case for regulating smoking is indeed strong, although not as strong as the empirical researchers think. It is much weaker for paternalistic intervention in other public health problems, such as obesity and binge drinking. (shrink)

The consequentialist project for human rights -- Exceptions to libertarian natural rights -- The main principle -- What is well-being? What is equity? -- The two deepest mysteries in moral philosophy -- Security rights -- Epistemological foundations for the priority of autonomy rights -- The millian epistemological argument for autonomy rights -- Property rights, contract rights, and other economic rights -- Democratic rights -- Equity rights -- The most reliable judgment standard for weak paternalism -- Liberty rights and (...) privacy rights -- Clarifications and responses to objections -- Conclusion. (shrink)

: Ulysses contracts have faced paternalism objections since they first were proposed. Since the contracts are designed to override a present request from a legally competent patient in favor of a past request made by that patient, enforcement of these contracts was argued to be unjustifiable strong paternalism. Recent legal developments and new theories of practical reasoning suggest that the discussion of Ulysses contracts should be revived. This paper argues that with a proper understanding of the future-directed planning (...) embodied in Ulysses contracts, the charge of strong paternalism can be answered, and the enforcement of some Ulysses contracts may be justified under the rubric of weak paternalism. (shrink)

The 2015 UK Supreme Court judgment in Montgomery v Lanarkshire reinforces the importance of informed consent to medical treatment. This paper suggests that Montgomery recognises the challenge faced by vulnerable individuals in choosing between treatment options and making decisions with appreciation of information about material risks. The judgment endorses a form of weak paternalism to safeguard such persons, which is not disrespectful of the aggregate principles of the Mental Capacity Act 2005. But ethical practice requires professionals to tread (...) carefully between weak and hard paternalism in the context of therapeutic interactions with vulnerable patients, while ensuring their awareness of material risks. (shrink)

Livestock production has been confronted with several epidemics over the last decades. The morality of common animal disease strategies—stamping out and vaccination—is being debated and provokes controversies among farmers, authorities and the broader public. Given the complexity and controversy of choosing an appropriate control strategy, this article explores the potential of nano-enabled diagnostics in future livestock production. At first glance, these applications offer promising opportunities for better animal disease surveillance. By significantly shortening the reaction time from diagnosis to appropriate control, (...) they could complement the current disease management strategies. Although nano-enabled diagnostics will not make livestock disease eradication strategies redundant or completely free of the culling of infected animals, these diagnostics could significantly reduce the number of culled animals and animal suffering. This article aims to demonstrate that the ethical assessment of advanced diagnostics can build on the experiences with decision making in biomedical ethics where nonmaleficence, beneficence, autonomy and justice serve as important benchmarks. Nano-enabled diagnostics may be an ethically sound solution if it can resolve the dilemma between stamping out and vaccination in favor of the latter and if it can balance the autonomy–paternalism dilemma between farmers and authorities. The technology should allow to be switched on and off by farmers, whilst simultaneously allowing for a weak paternalism on behalf of authorities in order to benefit the farmer and broader society and to protect them from harm. (shrink)

Libertarian paternalism's notion of “nudging” refers to steering individual decision making so as to make choosers better off without breaching their free choice. If successful, this may offer an ideal synthesis between the duty to respect patient autonomy and that of beneficence, which at times favors paternalistic influence. A growing body of literature attempts to assess the merits of nudging in health care. However, this literature deals almost exclusively with health policy, while the question of the potential benefit of (...) nudging for the practice of informed consent has escaped systematic analysis. This article focuses on this question. While it concedes that nudging could amount to improper exploitation of cognitive weaknesses, it defends the practice of nudging in a wide range of other conditions. The conclusion is that, when ethically legitimate, nudging offers an important new paradigm for informed consent, with a special potential to overcome the classical dilemma between paternalistic beneficence and respect for autonomy. (shrink)

In recent decades, behavioral sciences have introduced into economic theories of choice the image of weak willed individuals with limited rationality, whose decisions are affected by systematic errors. From here, theorists of libertarian paternalism originate the thesis of the possibility of State interventions that promote citizens’ welfare by conditioning their choices while, at the same time, safeguarding their freedom. The Author asserts that such a public promotion of individual welfare is equivalent to the transformation of the welfare State (...) into a paternalistic State and that its theorists aim to avoid the debate about the conflict between exercising liberty and containing the public expenditure which is necessary to protect social rights. (shrink)

Libertarian paternalism describes the idea of nudging—that is, steering individual decision-making while preserving freedom of choice. In medicine, libertarian paternalism has gained widespread attention, specifically with respect to interventions designed to promote healthy behaviours. Some scholars argue that nudges appropriately balance autonomy and paternalistic beneficence, while others argue that nudges inherently exploit cognitive weaknesses. This paper further explores the ethics of libertarian paternalism in public health. The use of nudges may infringe on an individual’s voluntary choice, autonomy (...) and informed consent, but they are ethically justified when there is a clear public health benefit to the manipulation of choice. (shrink)

The books’ goal is to answer the question: Do the weaknesses of value-free economics imply the need for a paradigm shift? The author synthesizes criticisms from different perspectives (descriptive and methodological). Special attention is paid to choices over time, because in this area value-free economics has the most problems. In that context, the enriched concept of multiple self is proposed and investigated. However, it is not enough to present the criticisms towards value-free economics. For scientists, a bad paradigm is better (...) than no paradigm. Therefore, the author considers whether value-based economics with normative approaches such as economics of happiness, capability approach, libertarian paternalism, and the concept of multiple self can be the alternative paradigm for value-free economics. This book is essential reading to everyone interested in the current state of economics as a discipline. (shrink)

Many public health dilemmas involve a tension between the promotion of health and the rights of individuals. This article suggests that we should resolve the tension using our familiar liberal principles of government. The article considers the common objections that liberalism is incompatible with standard public health interventions such as anti-smoking measures or intervention in food markets; there are special reasons for hard paternalism in public health; and liberalism is incompatible with proper protection of the community good. The article (...) argues that we should examine these critiques in a larger methodological framework by first acknowledging that the right theory of public health ethics is the one we arrive at in reflective equilibrium. Once we examine the arguments for and against liberalism in that light, we can see the weaknesses in the objections and the strength of the case for liberalism in public health. (shrink)

In recent decades, behavioral sciences have introduced into economic theories of choice the image of weak willed individuals with limited rationality, whose decisions are affected by systematic errors. From here, theorists of libertarian paternalism originate the thesis of the possibility of State interventions that promote citizens’ welfare by conditioning their choices while, at the same time, safeguarding their freedom. The Author asserts that such a public promotion of individual welfare is equivalent to the transformation of the welfare State (...) into a paternalistic State and that its theorists aim to avoid the debate about the conflict between exercising liberty and containing the public expenditure which is necessary to protect social rights. (shrink)

Background Best interests is a ubiquitous principle in medical policy and practice, informing the treatment of both children and adults. Yet theory underlying the concept of best interests is unclear and rarely articulated. This paper examines bioethical literature for theoretical accounts of best interests to gain a better sense of the meanings and underlying philosophy that structure understandings. Methods A scoping review of was undertaken. Following a literature search, 57 sources were selected and analysed using the thematic method. Results Three (...) themes emerged. The first placed best interests within the structure of wider theory, noting relationships with consequentialism, deontology, prudential value theory, rights and political philosophy. The second mapped a typology of processes of decision-making, among which best interests was ambiguously positioned. It further indicated factors that informed best interests decision-making, primarily preferences, dignity and quality of life. The final theme considered best interests from a relational perspective. Conclusions Characterisation of best interests as strictly paternalist and consequentialist is questionable: while accounts often suggested a consequentialist basis for best interests, arguments appeared philosophically weak. Deontological accounts, found in law and Kantianism, and theories of political liberalism influenced accounts of best interests, with accounts often associating best interests with negative patient preferences (i.e. individual refusals). There was much more emphasis on negative interests than positive interests. Besides preference, factors like dignity and quality of life were held to inform best interests decisions, but generally were weakly defined. To the extent that preferences were unable to inform decision making, decisions were either made by proxy authority or by an intersubjective process of diffuse authority. Differing approaches reflect bifurcations in liberal philosophy between new liberalism and neo-liberalism. Although neither account of authority appears dominant, bias to negative interests suggests that bioethical debate tends to reflect the widespread ascendancy of neo-liberalism. This attitude was underscored by the way relational accounts converged on private familial authority. The visible connections to theory suggest that best interests is underpinned by socio-political trends that may set up frictions with practice. How practice negotiates these frictions remains a key question. (shrink)

Critics argue that adaptive preference theorists misrepresent oppressed people's reasons for perpetuating their oppression. According to critics, AP theorists assume that people who adapt their preferences to unjust conditions lack the psychic capacities that would allow them to develop their own normative perspectives and/or form appropriate values. The misrepresentation is morally problematic, because it promotes unjustified paternalism and perpetuates colonial stereotypes of third‐world women. I argue that we can imagine a conception of AP that is consistent with acknowledging agency (...) in people who perpetuate their oppression. I offer a weak perfectionist conception of AP that is consistent with recognising agentic capacities in the oppressed. On my conception, APs are preferences incompatible with an agent's basic wellbeing that formed under unjust conditions — and that an agent would reverse upon exposure to better conditions. My conception encourages respectful treatment of the oppressed without requiring us to abandon the feminist political goals the notion of AP is meant to serve. It helps us identify real‐world preferences that are problematically adapted to oppressive conditions and offers an account of why they seem not to be women's ‘true preferences’. (shrink)

In this paper it is argued that physicians’ restrictive attitudes in offering abortions during 1946–1965 in Sweden were due to their private values. The values, however, were rarely presented openly. Instead physicians’ values influenced their assessment of the facts presented—that is, the women's’ trustworthiness. In this manner the physicians were able to conceal their private values and impede the women from getting what they wanted and needed. The practice was concealed from both patients and physicians and never publicly discussed. It (...) is also argued that a similar tacit practice could currently be applied by palliative care physicians. Such practice might allow palliative care physicians to be restrictive when offering sedation therapy without appearing paternalistic or declaring conscientious objections. However, the practice runs counter to patients’ right to participate in making decisions. The women seeking abortion began to oppose the situation and eventually a new abortion law was introduced 1975. Patients at the end of life will never be able to protest against palliative care physicians’ restrictive attitudes. This is a vulnerable and weak group, unable to lodge complaints after the treatment. In order to respect patients’ autonomy, even suffering patients at the end of their lives, it is suggested that physicians should openly declare their values when it comes to providing treatments that might shorten life. Such transparency might facilitate more genuine shared decision-making and accordingly less suboptimal end-of-life care. (shrink)

Doctors routinely refuse donation offers from prospective living kidney donors with certain comorbidities such as diabetes or obesity out of concern for donor wellbeing. This refusal occurs despite the ongoing shortage of kidney transplants and the superior performance of living donor kidney transplants compared to those from deceased donors. In this paper, we argue that this paternalistic refusal by doctors is unjustified and that, within limits, there should be greater acceptance of such donations. We begin by describing possible weak (...) and strong paternalistic justifications of current conservative donor acceptance guidelines and practices. We then justify our position by outlining the frequently under-recognised benefits and the routinely overestimated harms of such donation, before discussing the need to respect the autonomy of willing donors with certain comorbidities. Finally, we respond to a number of possible objections to our proposal for more liberal kidney donor acceptance criteria. We use the situation in Australia as our case study, but our argument is applicable to comparable situations around the world. (shrink)

The basic relationship between people should be care, and the caring life is the highest which humans can live. Unfortunately, care that is not thoughtful slides into illegitimate intrusion on autonomy. Autonomy is a basic good, and we should not abridge it without good reason. On the other hand, it is not the only good. We must sometimes intervene in the lives of others to protect them from grave harms or provide them with important benefits. The reflective person, therefore, needs (...) guidelines for caring. Some contemporary moralists condemn paternalism categorically. This work examines weaknesses in their arguments and proposes new guidelines for paternalism, which it calls "parentalism" to avoid the patriarchal connotations of the old term. Its antiparentalism is more moderate than standard antipaternalism based on an exaggerated respect for autonomy. The work explores implications for both the personal sphere of interactions between individuals, such as friends and family members, and the public sphere of institutions, legislation, and the professional practices. (shrink)

Because of the importance of Confucian doctrines in shaping ethical business practices under Chinese leadership, revealing the roles of other Chinese ethical doctrines in modern Chinese leadership is informative. A thorough understanding of the ethical foundations of Chinese leadership is necessary for fruitful interaction with Chinese leaders, according to cultural fit theory. The present study illustrates the philosophical foundations of business management, based on dialogues with five eminent corporate executive officers (CEOs). It reveals that the CEOs practice a style of (...) Chinese leadership synthesizing Confucian, Daoist, Mohist, and Legalist doctrines. The Confucian doctrines advocate benevolence, harmony, learning, loyalty, righteousness, and humility. They are the most prevalent tenets that support paternalism and collectivism. The Daoist doctrines emphasize flexibility and reversion (e.g., the principle that the weak can defeat the strong). They bolster the leader’s forbearance. The Mohist doctrines underpin thrift and working with the masses whereas the Legalist doctrines inculcate self-control and innovativeness. Hence, contemporary Chinese leadership does not rely exclusively on Confucian ethics and this reflects evolution over 1000s of years. (shrink)

One important ethical issue for health promotion and public health work is to determine what the goals for these practices should be. This paper will try to clarify what some of these goals are thought to be, and what they ought to be. It will specifically discuss two different approaches to health promotion, such as, behavior change and empowerment. The general aim of this paper is, thus, to compare the behavior-change approach and the empowerment approach, concerning their immediate goals or (...) aims, and to morally evaluate the strengths and weaknesses of these two goal models, in relation to the ultimate goal of health promotion. The investigation shows that the behavior-change approach has several moral problems. First of all, it is overly paternalistic and often disregards the individual’s or group’s own perception of what is important—something that also increases the risk of failed interventions. Furthermore, it risks leading to ‘victim blaming’ and stigmatization, and to increased inequalities in health, and it puts focus on the ‘wrong’ problems, i.e., behavior instead of the ‘causes of the causes’. It is thereafter shown that the empowerment approach does not have any of these problems. Finally, some specific problems for the empowerment approach are discussed and resolved, such as, the idea that empowering some groups might lead to power over others, the objection that the focus is not primarily on health, and the fact that empowered people might choose to live lives that risk reducing their health. (shrink)

Anita Silvers (1998) has criticized those who argue that members of marginalized groups are vulnerable to a special threat posed by physician-assisted suicide (PAS) and voluntary active euthanasia (VAE). She argues that paternalistic measures prohibiting PAS/VAE in order to protect these groups only serve to marginalize them further by characterizing them as belonging to a definitively weak class. I offer a new conception of vulnerability, one that demonstrates how rich, educated, white males, who are typically regarded as having their (...) autonomy enhanced by their social status, are just as, if not more, vulnerable to threats posed by PAS/VAE as a result of the harmful social messages at work just below the surface of contemporary Western culture. I use this new conception of vulnerability to reinforce arguments for continued statutory prohibitions on PAS/VAE. (shrink)

In the search for a globally binding ethical minimal consensus in dealing with research on human beings the awareness of the cultural specificity of such questions will be of central importance. France provides a good example of such cultural specificities. Three basic structures of French discussion on research ethics can be enumerated: first the particular weight placed on therapeutic benefit, second a particular accentuation on freedom and voluntarism, and third its lesser attention to the aspect of ability to give consent. (...) The weak emphasis on the ability to give consent is rooted as much in the traditionally paternalistically imbued physician-patient relationship as in the French legal system, in which the doctrine of consent is not given the fundamental position of importance found in the Anglo-Saxon countries. As an important Roman country, a different accentuation in the ethical discussion on research on humans can be recognised, a discussion in which for a long time the right of self determination was less of a criterion for decision than the teleology of medical action. It is precisely this aspect of latent cultural influence in ethical convictions which is of decisive importance for future discussion on research on humans. (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)

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)

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)

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)

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)

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)

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)

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)

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)