The Concept of Paternalism

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)

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

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.

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)

This paper aims to answer the following question: what is the normative connection between paternalism and the paternalist’s belief about the recipient’s agency? I consider the following two views. _The Robust View_ says that paternalism is _pro tanto_ wrong insofar as the paternalist’s belief about the recipient’s agency is always disrespectful. _The Less Robust View_ says that whenever the paternalist’s belief about the recipient’s agency is disrespectful, paternalism is _pro tanto_ wrong. I interpret the major motive-based theories of paternalism as (...) endorsing the Robust view. While this view is susceptible to a devastating criticism, I argue that the Less Robust view is true. To make my case, I elucidate three ways in which the paternalist may come to hold a disrespectful belief about the recipient’s agency. I then argue that any paternalistic action which is predicated on or motivated by a disrespectful belief about the recipient’s agency is _pro tanto_ wrong. Consequently, I suggest that motive-based theorists endorse the Less Robust view instead. (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)

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)

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)

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, for science communication, and for research in science, technology, and society. Some of the contributors (...) argue that unconsenting interference with people’s ability of inquire is consistent with, and others that it is inconsistent with, efforts to democratize knowledge and decision-making. -/- These differences invite theoretical reflection regarding which goods are fundamental, whether there is a clear or only a moving boundary between informing and instructing, and whether manipulation of people’s epistemic conditions amounts to a type of intellectual injustice. The collection pays special attention to contemporary paternalistic practices in big data and scientific research, as the way in which the flow of information or knowledge might be curtailed by the manipulations of a small body of experts or algorithms. (shrink)

A common assumption is that paternalism generates a special, and especially grievous, insult. Identifying this distinctive insult is then presented as the key to unlocking the concept and determining its moral significance. I submit that there is no special insult. It is, rather, a particular form that a lack of recognition respect can take. Attempting to capture the special insult has led us into confusion. In particular, it has led theorists to abandon the idea that paternalists must act for the (...) sake of the individual whose agency they supplant, and even the notion that paternalistic action requires a distinctive motivation at all. I argue that paternalistic actions must come from a place of care and concern for the paternalised agent and show that this explains the moral significance of paternalism since it tempers the general insult that such actions deliver and provides a partial defence when paternalism is misguided. (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)

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

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

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

Are there any deep or systematic connections between paternalism and people's rights? Perhaps the connection is definitional: part of what makes an action or policy paternalistic is that it violates a right. Or perhaps the connection is normative: paternalism is (always? often? only sometimes?) morally problematic because it violates people's rights (even if we don't define "paternalism" in terms of a rights violation). My main goal in this paper is to argue for the normative connection. Part of the task will (...) be to explain exactly what the normative connection is. That will involve answering the questions embedded in the claim as well as offering an account of the right(s) that is (are) connected to paternalism's normative status. (shrink)

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

In this paper, I argue that a definition of paternalism must meet certain methodological constraints. Given the failings of descriptivist and normatively charged definitions of paternalism, I argue that we have good reason to pursue a normatively neutral definition. Archard's 1990 definition is one such account. It is for this reason that I return to Archard's account with a critical eye. I argue that Archard's account is extensionally inadequate, failing to capture some cases which are clear instances of paternalism. I (...) refine each of his three conditions, ultimately providing an improved definition of paternalistic interference. This revised definition meets specific methodological constraints, offering a definition that is both neutral between anti- and pro-paternalistic intuitions, but that also explains why paternalism is normatively significant. Specifically, this definition captures the conflict between interfering with an individual's choices and treating the individual benevolently, without making paternalism permissible or impermissible by definition. (shrink)

I first distinguish four types of objection to paternalism and argue that only one – the principled objection – amounts to a substantive and distinct normative doctrine. I then argue that this doctrine should be understood as preventing certain facts from playing the role of reasons they would otherwise play. I explain how this filter approach makes antipaternalism independent of several philosophical controversies: On the role reasons play, on what reasons there are, and on how reasons are related to values. (...) I go on to contrast the filter approach with the competing and dominant action-focused approach, which understands objections to paternalism in terms of paternalistic action, behavior, law, policy and the like. Seana Shiffrin and Peter de Marneffe are singled out as prominent recent proponents of this approach. By engaging with their definitions of paternalism, I explain how the action-focused approach makes antipaternalism dependent on the sorting of actions into paternalistic and nonpaternalistic according to what reasons support them. Because one and the same action can be supported by many different reasons, and by different sorts of reasons, such sorting is very difficult. The upshot is that antipaternalism on the action-focused account fails to provide the precise normative implications of the filter approach that I favor. (shrink)

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

People in our liberal pluralistic society have conflicting intuitions about the legitimacy of coercive hard paternalism, though respect for agency provides a common source of objection to it. The hard paternalist must give adequate reasons for her coercion which are acceptable to a free and equal agent. Coercion that fails to meet with an agent’s reasonable evaluative commitments is at least problematic and risks being authoritarian. Even if the coercer claims no normative authority over the coercee, the former still uses (...) coercion to replace the latter’s reasons or will with his own reasons or will. But does every hard paternalistic view have to invite such objection? Throughout I will assume that defenders of what I will call “Neutral Paternalism” (NP) and “Commonsense Paternalism” (CP) aim to offer reasons for coercion all can reasonably endorse despite evaluative diversity, in opposition to more objectionable forms of coercive paternalism, such as those which defend it on religious or perfectionist grounds. I will argue, nonetheless, that Gerald Dworkin’s defense of NP and Danny Scoccia’s defense of CP succumb to the same problems of objectionable imposition that saddle other forms of coercive paternalism. The shortcomings in their views suggest that even modest hard paternalism is nonetheless problematic for liberals. (shrink)

This chapter concerns the normativity of the concepts of paternalism and libertarian paternalism. The first concept is central in evaluating public health policy, but its meaning is controversial. The second concept is equally controversial and has received much attention recently. It may or may not shape the future evaluation of public health policy. In order to facilitate honest and fruitful debate, I consider three approaches to these concepts, in terms of their normativity. Concepts, I claim, may be considered nonnormative, normatively (...) charged, or normative in that they involve more complex relationships between values or duties. While the last approach is often best, other approaches may be appropriate depending on the context and purpose of discussion. The chapter’s conceptual investigation is illustrated by application to two public health policies: a tax on the consumption of fat and the encouragement of health-promoting food displays in restaurants and supermarkets. (shrink)

In this paper, first we attempt to explain the concept of paternalism from the standpoint of political philosophy. Then, restricting debate to epistemology, we will show that paternalism is based on an epistemic claim. Also, we will distinguish certain kind of paternalism as epistemic paternalism, and then will study the manners of actualization and justification of this kind of paternalism. Finally, the view is defend that the epistemic paternalism because of its valuable epistemic consequences will be legitimate if it construct (...) on some certain criterions without postulating epistemic superiority of some people, and if it is accomplished by experts. In this paper, first we attempt to explain the concept of paternalism from the standpoint of political philosophy. Then, restricting debate to epistemology, we will show that paternalism is based on an epistemic claim. Also, we will distinguish certain kind of paternalism as epistemic paternalism, and then will study the manners of actualization and justification of this kind of paternalism. Finally, the view is defend that the epistemic paternalism because of its valuable epistemic consequences will be legitimate if it construct on some certain criterions without postulating epistemic superiority of some people, and if it is accomplished by experts. In this paper, first we attempt to explain the concept of paternalism from the standpoint of political philosophy. Then, restricting debate to epistemology, we will show that paternalism is based on an epistemic claim. Also, we will distinguish certain kind of paternalism as epistemic paternalism, and then will study the manners of actualization and justification of this kind of paternalism. Finally, the view is defend that the epistemic paternalism because of its valuable epistemic consequences will be legitimate if it construct on some certain criterions without postulating epistemic superiority of some people, and if it is accomplished by experts. (shrink)

I first provide an analysis of Joel Feinberg’s anti-paternalism in terms of invalidation of reasons. Invalidation is the blocking of reasons from influencing the moral status of actions, in this case the blocking of personal good reasons from supporting liberty-limiting actions. Invalidation is shown to be distinct from moral side constraints and lexical ordering of values and reasons. I then go on to argue that anti-paternalism as invalidation is morally unreasonable on at least four grounds, none of which presuppose that (...) people can be mistaken about their own good: First, the doctrine entails that we should sometimes allow people to unintentionally severely harm or kill themselves though we could easily stop them. Second, it entails that we should sometimes allow perfectly informed and rational people to risk the lives of themselves and others, though they are in perfect agreement with us on what reasons we have to stop them for their own good. Third, the doctrine leaves unexplained why we may benevolently coerce less competent but substantially autonomous people, such as young teens, but not adults. Last, it entails that there are peculiar jumps in justifiability between very similar actions. I conclude that as liberals we should reject anti-paternalism and focus our efforts on explicating important liberal values, thereby showing why liberty reasons sometimes override strong personal good reasons, though never by making them invalid. (shrink)

This thesis is an attempt to constructively interpret and critically evaluate the liberal doctrine that we may not limit a person’s liberty for her own good, and to discuss its implications and alternatives in some concrete areas of public health policy. The thesis starts theoretical and goes ever more practical. The first paper is devoted to positive interpretation of anti-paternalism with special focus on the reason component – personal good. A novel generic definition of paternalism is proposed, intended to capture, (...) in a generous fashion, the object of traditional liberal resistance to paternalism – the invocation of personal good reasons for limiting of or interfering with a person’s liberty. In the second paper, the normative aspect of this resistance is given a somewhat technical interpretation in terms of invalidation of reasons – the blocking of reasons from influencing the moral status of actions according to their strength. It is then argued that normative anti-paternalism so understood is unreasonable, on three grounds: 1) Since the doctrine only applies to sufficiently voluntary action, voluntariness determines validity of reasons, which is unwarranted and leads to wrong answers to moral questions. 2) Since voluntariness comes in degrees, a threshold must be set where personal good reasons are invalidated, leading to peculiar jumps in the justifiability of actions. 3) Anti-paternalism imposes an untenable and unhelpful distinction between the value of respecting choices that are sufficiently voluntary and choices that are not. The third paper adds to this critique the fourth argument that none of the action types typically proposed to specify the action component of paternalism is such that performing an action of that type out of benevolence is essentially morally problematic. The fourth paper ignores the critique in the second and third papers and proposes, in an anti-paternalistic spirit, a series of rules for the justification of option-restricting policies aimed at groups where some members consent to the policy and some do not. Such policies present the liberal with a dilemma where the value of not restricting people’s options without their consent conflicts with the value of allowing people to shape their lives according to their own wishes. The fifth paper applies the understanding of anti-paternalism developed in the earlier papers to product safety regulation, as an example of a public health policy area. The sixth paper explores in more detail a specific public health policy, namely that of mandatory alcohol interlocks in all cars, proposed by the former Swedish government and supported by the Swedish National Road Administration. The policy is evaluated for cost-effectiveness, for possible diffusion of individual responsibility, and for paternalistic treatment of drivers. The seventh paper argues for a liberal policy in the area of dissemination of information about uncertain threats to public health. The argument against paternalism is based on common sense consequentialist considerations, avoiding any appeal to the normative anti-paternalism rejected earlier in the thesis. (shrink)

This article first describes a dilemma for liberalism: On the one hand restricting their own options is an important means for groups of people to shape their lives. On the other hand, group members are typically divided over whether or not to accept option-restricting solutions or policies. Should we restrict the options of all members of a group even though some consent and some do not? This dilemma is particularly relevant to public health policy, which typically target groups of people (...) with no possibility for individuals to opt out. The article then goes on to propose and discuss a series of aggregation rules for individual into group consent. Consideration of a number of scenarios shows that such rules cannot be formulated only in terms of fractions of consenters and non-consenters, but must incorporate their motives and how much they stand to win or lose. This raises further questions, including what is the appropriate impact of altruistic consenters and non-consenters, what should be the impact of costs and benefits and whether these should be understood as gross or net. All these issues are dealt with in a liberal, anti-paternalistic spirit, in order to explore whether group consent can contribute to the justification of option-restricting public health policy. (shrink)

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

This is a thesis about anti-paternalism – the liberal doctrine that we may not interfere with a person’s liberty for her own good. Empirical circumstances and moral values may certainly give us reason to avoid benevolent interference. Anti-paternalism as a normative doctrine should, however, be rejected. Essay I concerns the definitions of paternalism and anti-paternalism. It is argued that only a definition of paternalism in terms of compound reason-actions can accommodate its special moral properties. Definitions in terms of actions, common (...) in the literature, cannot. It is argued, furthermore, that in specifying the reason-actions in further detail, the notion of what is self-regarding, as opposed to other-regarding, is irrelevant, contrary to received opinion. Essay II starts out with the definition of paternalism defended in essay I and claims that however this very general definition is specified, anti-paternalism is unreasonable and should be rejected. Anti-paternalism is the position that certain reasons – referring one way or the other to the good of a person, give no valid normative support to certain actions – some kind of interferences with the same person. Since the reasons in question are normally quite legitimate and important reasons for action, a convincing argument for anti-paternalism must explain why they are invalid in cases of interference. A closer look at the reasons and actions in question provides no basis for such an explanation. Essay III considers a concrete case of benevolent interference – the withholding of information concerning uncertain threats to public health in the public’s best interest. Such a policy has been suggested in relation to the European Commission’s proposed new system for the Registration, Evaluation, and Authorisation of Chemicals. Information about uncertain threats to health from chemicals would allegedly spread anxiety and depression and thus do more harm than good. The avoidance of negative health effects is accepted as a legitimate and good reason for withholding of information, thus respecting the conclusion of essay II, that anti-paternalism should be rejected. Other reasons, however, tip the balance in favour of making the information available. These reasons include the net effects on knowledge, psychological effects, effects on private decisions and effects on political decisions. (shrink)

In this dissertation, I define and defend the moral justifiability of hard paternalism. Over the past thirty years, disagreements about the appropriate definition of paternalism have often masked further disputes in law, bioethics, and political theory over what sorts of self-regarding liberty limitation are morally permissible. I first address the conceptual problems by rigorously defending a definition of hard paternalism containing logically individually necessary and jointly sufficient conditions. Then, after a comprehensive and thorough review of virtually all the literature on (...) the subject, I outline the conditions under which hard paternalistic reasons for liberty restriction are valid. ;In Chapter One, I describe the dominant liberal landscape in the United States. Within this landscape, hard paternalism is typically viewed as an illegitimate liberty limiting principle. It is viewed as a reason for interference that cannot overcome the presumptive case for individual liberty. In Chapter Two, I identify and defend the logically necessary and sufficient conditions that define hard paternalism. In Chapter Three, I defend my definition against the preeminent writer on hard paternalism, Joel Feinberg. I argue that Feinberg has stretched the definition of soft paternalism to justify liberty limitation properly described as hard paternalism. I redraw the conceptual boundary between hard paternalism and soft paternalism. In Chapter Four, I address and then dismiss the widely-discussed consent-based or deontological arguments for the justifiability of hard paternalism. In Chapter Five , I provide my own beneficence-based or consequentialist normative defense of hard paternalism. Specifically, I contend that there are seven necessary and jointly sufficient conditions under which hard paternalism is justified. (shrink)

The unconscionability doctrine in contract law enables a court to decline to enforce a contract whose terms are seriously one-sided, exploitative, or otherwise manifestly unfair. It is often criticized for being paternalist. The essay argues that the characterization of unconscionability doctrine as paternalist reflects common but misleading thought about paternalism and obscures more important issues about autonomy and social connection. The defense responds to another criticism: that unconscionability doctrine is an inappropriate, because economically inefficient, egalitarian tool. The final part discusses (...) more interesting but neglected questions about the scope of accommodation necessary to support fully meaningful autonomous activity. (shrink)

Paternalism involves a situation in which A interferes with B primarily to protect B from the harmful consequences of his own actions. To determine if such intervention can be justified a detailed analysis of paternalism is necessary. This is provided in the first chapter. ;In the second chapter possible strategies of justification are examined. Employing Mill's essay On Liberty as a source from which a principle of justification takes shape, I maintain that he advocates paternalism where it furthers individuality, as (...) opposed to mere freedom; and I try to show how such acts are consistent with, even if not derived solely from, utilitarianism. ;The meaning and value of individuality are considered in chapter three. Individuality is understood in terms of one's having a value ordering and the capacity to choose and act accordingly. Personal value orderings, in turn, provide a sense of identity and esteem so far as they issue from a process that invokes personal traits. I then apply these findings to various forms of strong paternalism. ;Weak paternalism is discussed in chapter four. Here I explain how proponents employ the relationship between consent, voluntary agency, and self-determination in attempting to justify certain interventions and to proscribe others, some of which are sanctioned by strong paternalism. ;My next task is to elaborate on the significance of consent. After reviewing various consent modes appealed to at the level of justification--prior, subsequent, and hypothetical--I conclude that only prior consent functions in this way, and even then only in a small minority of cases in which intervention seems plausible. The implications for competing versions of paternalism are then considered. ;The final chapter consists in adjudicating the strong/weak paternalist polemic. In effecting a compromise I argue that weak paternalists fix too narrowly the moral limits of self-determination while strong paternalists fix them too widely. A concluding summation follows. (shrink)

This dissertation examines three concepts in the context of the medical setting: paternalism, autonomy and personal responsibility. Paternalism is addressed solely as a characteristic mode of medical thought and activity structuring the relationships of physicians and patients. The moral appropriateness of paternalism as a privately negotiated, individually accomplished behavior is not directly analyzed. Critical discussion of a number of prominent definitions of paternalism is provided. Analysis of these definitions supplies the materials for the welding of a comprehensive definition. The history (...) of paternalism in medicine is detailed. It is argued that paternalism historically has not been reserved as a tool for use in special or rare instances, but represents a persistently employed templet for the general organization of medical practitioners' dealings with patients. The influence of structural aspects of the organization of medicine, the nature of illness and patient-physician use of language on the expression of paternalism is explained. Clinical illustrations of institutional paternalism are provided. The moral status of this practice is considered. A principle is constructed detailing the compass of morally justified paternalism. Paternalism as an organizational institution is shown to be beyond the pale of justified intervention. It is demonstrated that the reality of institutional paternalism is inconsistent with the goals paternalism professes, the production of patient benefit. ;Three major categories of definitions of autonomy are analyzed: autonomy as free and individually chosen action; as free and rational action, and as authenticity. The components of these characterizations are analyzed, the adequacy of each definition is assessed. An eclectic definition of autonomy is introduced and defended. ;The notion of personal responsibility is considered in light of the problem of high-risk health behaviors. The issue of the requirements of personal responsibility in this context is viewed as a nexus of confrontation of three different socio-moral principles, paternalism, social utility and autonomy. Three major categories of high-risk behaviors are detailed. Consideration is given to factors which might underlie high-risk behaviors and various techniques proposed for dealing with such activity. (shrink)

An analysis of the contemporary literature on paternalism revealed that the definitions of paternalistic actions used were too narrowly confined to cases involving the interference with the person for whom such actions were taken. Certain counterexamples demonstrated that those definitions were unsuitable. An alternative definition of paternalistic actions was proposed which clearly avoided those counterexamples. ;In light of the new definition, a sampling of contemporary theories of justified paternalistic actions was then made. It was shown that a general theory of (...) justified actions would be required to provide the correct necessary conditions for justified paternalistic actions. A revision of just one of those theories was made to explore the possibility of whether or not such theories might instead provide the necessary conditions for paternalistic actions which are prima facie wrong to perform. The revision failed to reveal suitable necessary conditions. ;A theory providing the necessary and sufficient conditions for paternalistic actions which are prima facie wrong to perform in virtue of their paternalistic nature was then developed. The initial strategy for this theory was to capitalize on the fact that the definition of a paternalistic action depicted the recipient as vulnerable to being disregarded as a person in a morally wrong sense. The necessary and sufficient conditions for that theory were then tested against the counterexamples used in the previous analysis of justified paternalistic actions and the one revision explored. The proposed theory was found to successfully circumvent those counterexamples and was understood as acceptable on that basis. A sense of justified paternalistic actions was then seen to obtain when the necessary and sufficient conditions of this theory failed to be satisfied. (shrink)

This dissertation is composed of four chapters. In the first I discuss the concept of paternalism. I state and analyze a definition of 'paternalism' which provides a coherent and illuminating scheme of classification for discussing the moral problems normally associated with acts of paternalism. I then compare this definition with alternative definitions and argue that it is superior. ;In the second chapter I show why paternalism is morally objectionable. My position is that paternalism limits autonomy and that we must understand (...) why autonomy is valuable in order to understand why paternalism is morally objectionable. I argue that autonomy is valuable partly because it is a constituent of individual and social welfare. But I also argue that autonomy has moral worth which is independent of its contingent relation to welfare. The bulk of the chapter is devoted to explaining why autonomy has moral worth. ;The third chapter is a discussion of the concept of individual welfare. I discuss four conceptions of welfare: a "material" conception which maintains that there are things which are intrinsically good or intrinsically bad for persons; several versions of a happiness theory; a rational desire theory; and perfectionism. I argue that the rational desire theory is the best of these. ;In the fourth chapter I discuss the problem of justifying paternalism. I argue that it can be justified in particular cases, and I discuss two conflicting principles which could be the principles which justify paternalism. They are a utilitarian principle and what I call a "libertarian" principle. I argue that each principle justifies paternalism in only a narrow range of cases and that they may be extensionally equivalent. However, they appear to justify paternalism for different reasons. I argue that the libertarian principle appears to justify paternalism for the rights reasons but that more work is needed to confirm this. (shrink)