Paternalism in Applied Ethics

In ‘Treating Adolescents Differently’, Skelton, Black, and Forsberg develop their wellbeing-based justification of the asymmetrical treatment of adolescent consent and refusal in the context of health care to justify the differential and paternalistic treatment of adolescents more generally. The core of the Skelton, Black, and Forsberg’s view is a variabilist theory of what is fundamentally and non-instrumentally prudentially good for adolescents, which includes the prudential value of what they call shielding—or the value of being insulated from full responsibility for their (...) choices. This theory of wellbeing, they argue, explains why adolescents may be treated differential and paternalistically in numerous domains. It is good for them to be shielded because it allows for a variety of freedom from making certain kinds of decisions in the absence of a safety net provided by others in supportive and caring relationships. Skelton, Black, and Forsberg argue that their account of the justification of differential and paternalistic treatment of adolescents has attractive implications for a range of cases and holds up well in the face of philosophical criticism. (shrink)

I argue that the discussion around the True Preferences Knowledge Problem in behavioral welfare economics has suffered from a missing distinction between two different knowledge problems: one about welfare, and the other about public policy. Here, I separate those knowledge problems and show that, given their different success conditions, it is no surprise that we haven’t found a satisfactory answer to “the” true preferences knowledge problem. There is an embedded tendency to try to answer the policy knowledge problem by engaging (...) the welfare knowledge problem. I show that the impulse is misguided, and that we do not need to appeal to a complete theory of how preferences are related to welfare to answer questions about policy. However, this does not mean that we need to stop talking about preferences. We can make progress on the policy knowledge problem without appealing to a theory of welfare by focusing on the information that people are giving us about the mistakes they are making. I introduce repudiated preferences as a device that allows us to break out of this cycle and start to make progress in our discussions of nudging and Behavioral Intervention Policies without first solving the welfare knowledge problem. Finally, I acknowledge the challenges that still face this approach, and trace some avenues for how further work could build on these insights. (shrink)

A guest edited volume of the Journal of Applied Philosophy devoted to topics regarding the ethics of nudges, particularly those that have received little or no treatment up to now. Since the publication of Nudge in 2008, nudges have become widely used tools in policymakers' toolbox. Concurrently, ethicists have discussed which conditions, if any, ensure the fair and ethically legitimate implementation of such untraditional policy techniques. The debates have focused primarily on the alleged intrusiveness of nudges and their lack of (...) factual transparency. The special issue is intended to enrich the debate in the conviction that the clarity of the terms adopted within the debate could be improved and that some relevant ethical perspectives have been left out in assessing the morality of nudges. Specifically, the aims of this special issue are twofold, normative and conceptual. On the one side, we delve into the concepts on which the evaluation of nudging hinges, such as "preferences", "resistibility", and "libertarianism". Since the meanings assigned to such concepts drive our evaluation of nudging, their comprehension is critical. On the other side, the acceptability of nudges has been extensively assessed in the light of ethical theories developed within Western philosophy, and not with alternative but promising ethical frameworks from the Global South. Relatedly, some values implicated in nudging, such as the ethics of nudging vulnerable populations, have been overshadowed by scholars' attention to decisional autonomy. The special issue gives these themes the attention they deserve. (shrink)

Large language models now possess human-level linguistic abilities in many contexts. This raises the concern that they can be used to deceive and manipulate on unprecedented scales, for instance spreading political misinformation on social media. In future, agentic AI systems might also deceive and manipulate humans for their own purposes. In this paper, first, I argue that AI-generated content should be subject to stricter standards against deception and manipulation than we ordinarily apply to humans. Second, I offer new characterizations of (...) AI deception and manipulation meant to support such standards, according to which a statement is deceptive (resp. manipulative) if it leads human addressees away from the beliefs (resp. choices) they would endorse under “semi-ideal” conditions. Third, I propose two measures to guard against AI deception and manipulation, inspired by this characterization: “extreme transparency” requirements for AI-generated content and “defensive systems” that, among other things, annotate AI-generated statements with contextualizing information. Finally, I consider to what extent these measures can protect against deceptive behavior in future, agentic AI systems. (shrink)

Some policies are paternalistic and discriminatory at the same time (e.g., certain benevolent sexist policies). Such policies constitute an interesting, yet somewhat overlooked, category. We scrutinize what paternalistic discrimination is and account for its wrongness. First, we argue that paternalistic discrimination is pro tanto wrong because it is disrespectful. The disrespect consists in the selective negligence or denial of some people’s moral power over their own good. This applies even if the policies and actions in question benefit those interfered with. (...) Second, we show that paternalistic discrimination gives rise to a dilemma in situations where different social groups face different risks. In such situations, a choice must be made between (i) protecting people equally and (ii) respecting people's moral power over their own good equally. Finally, we show that paternalistic discrimination in certain cases shows a lack of respect for the moral worth of the persons who are not the target of the policies. (shrink)

This paper is an investigation into the conditions under which anti-love biomedical intervention is justified. Our central claim is that anti-love biomedical intervention can be justified without the “simultaneous consent” of recipients (where the simultaneous consent of a person S is understood as S’s consent at time t to an intervention at t) when it contributes to increased autonomy. We begin with an overview of earlier discussions of the ethics of anti-love biomedical intervention, focusing on the pioneering work of Earp (...) and colleagues. We then present some cases in which paternalistic intervention may be effective. We will then present an argument for the idea of anti-love biomedical intervention without simultaneous consent, based on an analogy between (biomedical intervention in) addiction and (biomedical intervention in) love. One premise of this argument is that love and addiction are importantly similar in that they can compromise the autonomous capacity for self-governing. The other premise of this argument is that biomedical intervention in addiction without simultaneous consent can be justified if the intervention is expected to restore the compromised capacity for self-governing. We will propose the “Ulysses contract”, a contract to enforce anti-love biomedical intervention when the recipient refuses it, as a possible measure of such paternalistic intervention and discuss its possible risks. (shrink)

Dominic Wilkinson’s defence of identity-relative paternalism raises many important issues that are well worth considering. In this short paper, I will argue that there could be two important differences between the first-party and third-party cases that Wilkinson discusses, namely, a difference in associative duties and how the decision relates to the decision maker’s own autonomous life. This could mean that identity-relative paternalism is impermissible in a greater number of cases than he suggests.

Liberalism and paternalism are often seen as incompatible on the grounds that liberalism recognizes autonomy as the highest value, while paternalism limits autonomy for the sake of more valuable goods such as health and safety. This article offers an argument for the compatibility of liberalism and paternalism. At the heart of the argument is the philosophical distinction between having autonomy and exercising autonomy. The second way of defending autonomy is indeed incompatible with paternalism, but the first justifies paternalism when its (...) purpose is to limit choices that reduce one’s autonomy. A modified version of John Rawls’s veil of ignorance is presented to justify the preference for having autonomy over exercising autonomy. The practical consequences of this form of liberal paternalism are then examined and analyzed using three examples: voluntary sale of oneself into slavery, addiction to opioid drugs, and compliance with road safety measures (seat belt, motorcycle helmet). The argument presented provides a justification for liberal paternalism that does not rely on any controversial or perfectionist conception of the good, and is therefore compatible with the classical interpretation of liberal neutrality. It concludes by considering the compatibility of the proposed argument with other versions of liberal paternalism, including perfectionist, respectful, Kantian, libertarian, and left-libertarian paternalism. The conclusion is that all versions except the left-libertarian one is compatible with the justification described, while Peter Vallentyne’s left-libertarian paternalism suffers from internal inconsistency. (shrink)

This chapter examines age discrimination from the perspective of age-differentiated paternalism. Many people share the intuition that paternalism is less problematic when applied to children than to the elderly. The chapter examines this intuition by considering not only the dimensions of competence and voluntariness but also the magnitude of the good promoted by paternalistic interventions. While this dual account does not generally challenge common-sense intuitions about paternalism, it introduces additional complexity when evaluating paternalistic interventions in a wide range of cases (...) where age plays a part. The chapter considers many examples, from age-differentiated rules for access to sterilization, through age-differentiated fines for not using a helmet, to age-differentiated prices for cigarettes. (shrink)

Identity-Relative Paternalism, as defended by Wilkinson, holds that paternalistic intervention is justified to prevent an individual from doing to their future selves (where there are weakened prudential unity relations between the current and future self) what it would be justified to prevent them from doing to others.1 Wilkinson, drawing on the work of Parfit and others, defends the notion of Identity-Relative Paternalism from a series of objections. I argue here, however, that Wilkinson overlooks a significant problem for Identity-Relative Paternalism—namely, that (...) it yields unactionable and self-contradictory results when applied to choices where both options present potential harms to future selves. (shrink)

A growing number of decision theorists have, in recent years, defended the view that rationality is permissive under risk: Different rational agents may be more or less risk-averse or risk-inclined. This can result in them making different choices under risk even if they value outcomes in exactly the same way. One pressing question that arises once we grant such permissiveness is what attitude to risk we should implement when choosing on behalf of other people. Are we permitted to implement any (...) of the rationally permissible risk attitudes, is there some specific risk attitude that is required when choosing for others, or are we required to defer to the risk attitudes of the people on whose behalf we are choosing? This article elaborates on this question, explains its wider practical and theoretical significance, provides an overview of existing answers, and explores how to go about providing a more systematic account of how to choose on behalf of others in risky contexts. (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 paternalism; (b) the distinction (...) between soft and hard paternalism; and (c) medical practice, where internal paternalism can, and probably often does, occur. (shrink)

Pickering, Newton-Howes, and Young argue for externalism about competence—the view that “welfare judgments are part of judgments about competence” and posit an “explanatory connection” betwe...

According to some philosophers, if moral agency is understood in behaviourist terms, robots could become moral agents that are as good as or even better than humans. Given the behaviourist conception, it is natural to think that there is no interesting moral difference between robots and humans in terms of moral agency (call it the _equivalence thesis_). However, such moral differences exist: based on Strawson’s account of participant reactive attitude and Scanlon’s relational account of blame, I argue that a distinct (...) kind of reason available to humans—call it _human-relative reason_—is not available to robots. The difference in moral reason entails that sometimes an action is morally permissible for humans, but not for robots. Therefore, when developing moral robots, we cannot consider only what humans can or cannot do. I use examples of paternalism to illustrate my argument. (shrink)

In defense of nudging policies, proponents have pointed out that choice architecture is inevitable. However, critics have objected that shaping people’s choices in an intentional way is not inevitable and involves an objectionable substitution of judgment, with the choice architect imposing his will on others. Accordingly, the inevitability of choice architecture in general does not provide reason to accept intentional nudges. In contrast to this view, the paper argues that precisely because the choice architects will unavoidably contribute to people’s choices, (...) it is permissible for them to consider the content of the choices that their choice architecture promotes. Specifically, I argue that it is often within choice architects’, including states’, own legitimate sphere of control whether they want to contribute to other people’s behaviors through their organization of the choice architecture. It is argued that such intentional choice architecture does not involve objectionable substitution of judgment. (shrink)

In response to the Covid-19 pandemic, many states in the United States issued stay-at-home orders that prohibited people from leaving their homes except to access essential services. Upon reopening, a number of those states passed mask mandates requiring people to wear face coverings while in public, but as I write this, in October of 2020, there remain a substantial number of states that have not outlawed what I'll call ‘mask-less shopping’. This is a mistake. After describing the standard, public health (...) argument for outlawing mask-less shopping and explaining why it fails, I give a better argument for outlawing mask-less shopping that depends on the claim that mask-less shopping is analogous to drunk driving. It follows that every state should outlaw it. (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)

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)

The COVID-19 pandemic has brought significant challenges to healthcare systems worldwide, and in Africa, given the lack of resources, they are likely to be even more acute. The usefulness of Traditional African Healers in helping to mitigate the effects of pandemic has been neglected. We argue from an ethical perspective that these healers can and should have an important role in informing and guiding local communities in Africa on how to prevent the spread of COVID-19. Particularly, we argue not only (...) that much of the philosophy underlying Traditional African Medicine is adequate and compatible with preventive measures for COVID-19, but also that Traditional African Healers have some unique cultural capital for influencing and enforcing such preventive measures. The paper therefore suggests that not only given the cultural context of Africa where Traditional African Healers have a special role, but also because of the normative strength of the Afro-communitarian philosophy that informs it, there are good ethical reasons to endorse policies that involve Traditional Healers in the fight against COVID-19. We also maintain that concerns about Traditional African Healers objectionably violating patient confidentiality or being paternalistic are much weaker in the face of COVID-19. (shrink)

Most adult persons with anorexia satisfy the existing criteria widely used to assess decision-making capacity, meaning that incapacity typically cannot be used to justify coercive intervention. After rejecting two other approaches to justification, Professor Radden concludes that it is most likely not possible to justify coercive medical intervention for persons with anorexia in liberal terms, though she leaves it open whether some other framework might succeed. I shall assume here that the standard approach to assessing decisionmaking capacity is adequate.1 The (...) question then is whether we can justify—within a liberal framework—coercive intervention with the decision of a competent... (shrink)

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

Bioethics, Volume 36, Issue 2, Page 194-200, February 2022.

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)

Adolescents are routinely treated differently to adults, even when they possess similar capacities. In this article, we explore the justification for one case of differential treatment of adolescents. We attempt to make philosophical sense of the concurrent consents doctrine in law: adolescents found to have decision-making capacity have the power to consent to—and thereby, all else being equal, permit—their own medical treatment, but they lack the power always to refuse treatment and so render it impermissible. Other parties, that is, individuals (...) who exercise parental responsibility or a court, retain the authority to consent on an adolescent’s behalf. We explore four defences of the doctrine. We reject two attempts to defend the asymmetry in the power to consent to and refuse medical treatment by reference to transitional paternalism. We then consider and reject a stage of life justification. Finally, we articulate a justification based on the distinctiveness of adolescent well-being. (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)

Our aim in this brief essay is not to defend a particular policy or attitude toward lockdown measures in the United States or elsewhere, but to consider the scope and limits of different types of arguments that can be offered for them. Understanding the complexity of these issues will, we hope, go some way to helping us understand each other and our attitudes toward state responses to the pandemic.

Nudging is the idea that people’s decisions should be influenced in predictable, non-coercive ways by making changes to the way that options are presented to them. Central to the debate about nudging is the question of whether it is morally permissible to intentionally nudge others. Libertarian paternalists maintain that this can be the case. In this paper, I present the libertarian paternalistic criteria for the moral permissibility of intentional nudges. Having done this, I motivate two objections. The first one targets (...) the moral permissibility of nudging in general. The second one targets the moral permissibility of only a subset of nudges. After evaluating both of these objections, I conclude that although they are unsuccessful, the evaluation of The Manipulation Objection shows that the libertarian paternalistic criteria for the moral permissibility of intentional nudges fails. I end by suggesting a possible revision to the criteria that avoids the problem, considering its limitations, and providing examples of its applications. (shrink)

Thaler and Sunstein advocate 'libertarian paternalism'. A libertarian paternalist changes the conditions under which people act so that their cognitive biases lead them to choose what is best for themselves. Although libertarian paternalism manipulates people, Thaler and Sunstein say that it respects their autonomy by preserving the possibility of choice. Conly argues that libertarian paternalism does not go far enough, since there is no compelling reason why we should allow people the opportunity to choose to bring disaster upon themselves if (...) sometimes they will make the wrong decision. She defends 'coercive paternalism'. The present paper argues that errors in reasoning are not due only to cognitive biases. People also make errors because they have an insufficient level of general intelligence. Intelligence is distributed on a continuum. Those who fall on higher levels of the continuum have greater abilities, in certain contexts, to reason about both their own and others' interests. Coercive paternalism may sometimes be appropriate to prevent less intelligent people from engaging in self-destructive behavior due to errors of reasoning. (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)

Response to commentaries on 'The right not to know and the obligation to know'.

There is significant controversy over whether patients have a ‘right not to know’ information relevant to their health. Some arguments for limiting such a right appeal to potential burdens on others that a patient’s avoidable ignorance might generate. This paper develops this argument by extending it to cases where refusal of relevant information may generate greater demands on a publicly funded healthcare system. In such cases, patients may have an ‘obligation to know’. However, we cannot infer from the fact that (...) a patient has an obligation to know that she does not also have a right not to know. The right not to know is held against medical professionals at a formal institutional level. We have reason to protect patients’ control over the information that they receive, even if in individual instances patients exercise this control in ways that violate obligations. (shrink)

The traditional liberal view on conflicts between care for wellbeing and respect for choice and desire is that we should look to degrees of competence and voluntariness to determine which moral imperative should take priority. This view has likely influenced the common view that children’s choices should be considered only to the extent that this promotes their future autonomy and helps us determine their best interests. I reject both the general traditional liberal view and its application to children. Competence and (...) voluntariness, as well as maturity, are at best proxies for what really matters, which is wellbeing, choice and desire. We typically have reason to respect children’s choices, irrespective of any further positive consequences. If we should more often make children do what they do not want to do, this is mainly because, though we should care about respecting their choices, we should care even more about their wellbeing and future autonomy. (shrink)

In this comment on Kenneth Iserson’s article, ”Do You Believe in Magic? Shove, Don’t Nudge: Advising Patients at the Bedside,” I discuss the definition of and the moral evaluation of nudging. I propose that using persuasive descriptions and intentionally building trust in patients by one’s demeanor is a form of nudging. I argue that nudging is not necessarily morally problematic, but that it can be controlling and can limit liberty, despite proponents’ claims to the contrary. I agree with Iserson that (...) clinicians should give their patients explicit advice, but add that they should ideally also be aware of the more subtle psychological effects of advice giving. (shrink)

The fear of the largely unknown consequences of being exposed to coronavirus should have brought a more dynamic interplay of beliefs and opinions for those who in the footsteps of J.S. Mill believe that the limits of power, which can be legitimately exercised by society over the individual, is to prevent harm to others. It is surprising that not much debate or critical interaction has taken place on the choice of locking down most of the populace in 185 countries after (...) the outbreak of COVID-19. The general lockdown, instead of testing and isolating the sick, can be seen as ‘a gross usurpation upon the liberty of private life.’ The axiological and ethical question confronting philosophers relates to the type and degree of authority needed during this period. As Mill claims, no general basic liberties can be respected overall without some previous and gradual evolution, that is, before other more specific liberties have met sustainable social practice. This essay reviews some of the problematic situations highlighting that no society is free or can achieve the objective of a fairly pluralistic set of values without a given social practice of these values, and shows how this logic of spreading of values unfolds in the context of the Coronavirus crisis. (shrink)

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

The late Robert Veatch, one of the United States’ founders of bioethics, never tired of reminding us that the paradigm-shifting contribution that bioethics made to patient care was to liberate patients out of the hands of doctors, who were traditionally seen to know best, even when they decidedly did not know best. It seems to us that with the advent of COVID-19, health policy has come full-circle on this. COVID-19 gave rise to a large number of purportedly “ethical” guidance documents (...) aiming to assist health care providers and practitioners with responding to the ethical challenges that might arise in their response to the pandemic. Ethics has two primary functions: provide clear action guidance, and provide clear action justification. The documents in question arguably reflect the ultimate policy triumph of bioethical “principlism”, and, perhaps surprisingly, as a corollary, the ultimate triumph of “doctor-knows-best”. (shrink)

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

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

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

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)

Political communities across the world have recently sought to tackle rising rates of vaccine hesitancy and refusal, by implementing coercive immunization programs, or by making existing immunization programs more coercive. Many academics and advocates of public health have applauded these policy developments, and they have invoked ethical reasons for implementing or strengthening vaccine mandates. Others have criticized these policies on ethical grounds, for undermining liberty, and as symptoms of broader government overreach. But such arguments often obscure or abstract away from (...) the diverse values that are relevant to the ethical justifications of particular political communities’ vaccine‐mandate policies. We argue for an expansive conception of the normative issues relevant to deciding whether and how to establish or reform vaccine mandates, and we propose a schema by which to organize our thoughts about the ways in which different kinds of vaccine‐mandate policies implicate various values. (shrink)

This dissertation examines how we should respond to situations in which a person acts profoundly imprudently. We can, e.g., imagine the motorcyclist who prefers to drive without insurance and without a helmet. How should we, or the policy-makers, counter such imprudent activities performed by others? One option is that we do nothing, meaning that we do not interfere with other people’s imprudent behaviour, at the same time refraining from providing assistance in cases where the risk of the activities materialises. A (...) second option is to provide unconditional assistance to the person in need by taxing everyone. A third option is that we regulate the risky activity prior to the accident (e.g. by forcing the person to take out insurance, imposing security measures, or perhaps banning the activity in question). No matter what we choose, our choice seems to compromise at least one of the following moral considerations: i) satisfying sufficiency, ii) avoiding paternalism, or iii) internalising the costs associated with the risky activities (so that the persons performing the activities carry the relevant costs). For the same reason, it has been pointed out that together the three considerations constitute a trilemma, the so-called ‘imprudence trilemma.’ The dissertation argues that we should accept paternalism when people act so imprudently that they risk suffering serious, absolute deprivation as a result (i.e. in cases of relevance to the trilemma). That is not to say that we should always interfere when a person acts profoundly imprudently. The paternalistic view defended is that it is a good and relevant (but not necessarily decisive) reason in favour of interfering with a person’s voluntary choices that such interference will promote the person’s interests or well-being. Pace the anti-paternalistic view, I argue that such reasons should be included in the assessment of policies and actions that interfere with people’ liberty or autonomy. (shrink)

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

It is increasingly clear that children's excessive consumption of products high in added sugar causes obesity and obesity-related health problems like type 2 diabetes, cardiovascular disease, and metabolic syndrome. Less clear is how best to address this problem through public health policy. In contrast to policies that might conflict with adult's right to self-determination — for example sugar taxes and soda bans — this article proposes that children's access to products high in added sugars should be restricted in the same (...) way that children's access to tobacco products is restricted. The article first considers how the recommended policy will protect a child's right to an open future while not violating parental rights. The article then explores how the implementation of the recommended policy can help transform the social meaning of sugar and thereby curb the parental supply of added sugar to children — a central cause of obesity. The article also addresses several potential objections. (shrink)

In this paper, I argue against the commonly held view that paternalism is all things considered wrong when it interferes with a person’s autonomy. I begin by noting that the plausibility of this view rests on the assumption that there is a morally relevant difference in the normative reasons concerning an intervention in a person’s self-regarding actions and an intervention in his other-regarding actions. I demonstrate that this assumption cannot be grounded by wellbeing reasons, and that autonomy-based reasons of non-interference (...) also cannot adequately explain the difference. Following this, I propose that the difference in the reasons related to an intervention in a person’s self-regarding actions and an intervention in his other-regarding actions can be explained by the value of holding a person responsible for his choices. Nonetheless, this does not result in paternalistic behavior that interferes with autonomy being all things considered wrong. Instead, I show that the reason to hold a person responsible for a diminution of his wellbeing does not necessarily defeat the wellbeing reasons that count in favor of paternalistic behavior. (shrink)