Paternalism

Suppose that a patient is receiving treatment options from her doctor. In one case, the doctor says, “the surgery has a 90% survival rate.” Now, suppose the doctor instead said, “the procedure has a 10% mortality rate.” Predictably, the patient is more likely to consent on the first description and more likely to dissent on the second. This is an example of a framing effect. A framing effect occurs when “the description of [logically-equivalent] options in terms of gains (positive frame) (...) rather than losses (negative frame) elicits systematically different choices.” Framing effects are ubiquitous, but they are particularly troublesome in medicine. Many worry that there is tension between valuing informed consent and using framing effects in clinical settings. In this paper, I answer this question: if an individual is subject to a framing effect when she gives her consent, does this undermine the validity of her consent? I argue that framing effects do not undermine consent in general. (shrink)

Behavioral intervention techniques leveraging reactive responses have gained popularity as tools for promoting ethical behavior. Choice architects, for example, design and present default opt-out options to nudge individuals into accepting preselected choices deemed beneficial to both the decision-maker and society. Such interventions can also employ mild financial incentives or affective triggers including joy, fear, empathy, social pressure, and reputational rewards. We argue, however, that ethical competence is achieved via reflection, and that heavy reliance on reactive behavioral interventions can undermine the (...) development of ethical competence over the long term. Specifically, drawbacks may occur through motivational displacement, dependency, moral crowding out, loss of personal autonomy, and reactance. We introduce complementary cognitive boosting techniques designed to stimulate reflective cognition, as a more promising long-term strategy for instilling ethical behavior. One such approach is the Moral Self-Awareness (MSA) motivational construct, which incrementally leads agents to increasing levels of ethical reflection. We explain why ethical boosting approaches present more edifying and durable alternatives to reactive behavioral interventions and offer suggestions for social and organizational policy. (shrink)

Concerns about threats to human autonomy feature prominently in the field of AI ethics. One aspect of this concern relates to the use of AI systems for problematically manipulative influence. In response to this, the European Union’s draft AI Act (AIA) includes a prohibition on AI systems deploying subliminal techniques that alter people’s behavior in ways that are reasonably likely to cause harm (Article 5(1)(a)). Critics have argued that the term ‘subliminal techniques’ is too narrow to capture the target cases (...) of AI-based manipulation. We propose a definition of ‘subliminal techniques’ that (a) is grounded on a plausible interpretation of the legal text; (b) addresses all or most of the underlying ethical concerns motivating the prohibition; (c) is defensible from a scientific and philosophical perspective; and (d) does not over-reach in ways that impose excessive administrative and regulatory burdens. The definition is meant to provide guidance for design teams seeking to pursue responsible and ethically aligned AI innovation. (shrink)

According to the Free Will Explanation of a traditional view of hell, human freedom explains why some people are in hell. It also explains hell’s punishment and finality: persons in hell have freely developed moral vices that are their own punishment and that make repentance psychologically impossible. So, even though God continues to desire reconciliation with persons in hell, damned persons do not want reconciliation with God. But this moral vice explanation of hell’s finality is implausible. I argue that God (...) can and would make direct or indirect alterations in their character to give them new motivational reasons that re-enable their freedom to repent. Subsequently, I argue that it is probable that each damned person will be saved eventually, because there is a potential infinity of opportunities for free repentance. Thus, if the Free Will Explanation’s descriptions of hell and divine love are correct, it is highly probable that each person in hell escapes to heaven. (shrink)

Journal of Applied Philosophy, EarlyView.

Andreas Schmidt and Neil Levy have recently defended nudging against the objection that nudges fail to treat nudgees as rational agents. Schmidt rejects two theses that have been taken to support the objection: that nudges harness irrational processes in the nudgee, and that they subvert the nudgee’s rationality. Levy rejects a third thesis that may support the objection: that nudges fail to give reasons. I argue that these defences can be extrapolated from nudges to some nonconsensual neurointerventions; if Schmidt’s and (...) Levy’s defences succeed, then some nonconsensual neurointerventions neither harness irrationality, nor subvert rationality, nor fail to give reasons. This, I claim, poses a challenge both to opponents of nonconsensual neurointerventions, and to defenders of nudging. (shrink)

We argue that the ethical case for instituting vaccine benefit programs is justified by 2 widely recognized values: (1) reducing overall harm from COVID-19 and (2) protecting disadvantaged individuals. We then explain why they do not coerce, exploit, wrongfully distort decision-making, corrupt vaccination's moral significance, wrong those who have already been vaccinated, or destroy willingness to become vaccinated. However, their cost impacts and their effects on public perception of vaccines should be evaluated.

It is generally accepted that sight—the capacity to see or to have visual experiences—has the power to give us knowledge about things in the environment and some of their properties in a distinctive way. Seeing the goose on the lake puts me in a position to know that it is there and that it has certain properties. And it does this by, when all goes well, presenting us with these features of the goose. One might even think that it is (...) part of what it is to be a perceptual capacity that it has this kind of epistemological power, such that a capacity that lacked this power could not be perceptual. My focus in this essay is the sense of taste—the capacity to taste things or to have taste experiences. It has sometimes been suggested that taste lacks sight-like epistemological power. I argue that taste has epistemological power of the same kind as does sight, but that as a matter of contingent fact, that power often goes unexercised in our contemporary environment. We can know about things by tasting them in the same kind of way as we can know about things by seeing them, but we often do not. I then consider the significance of this conclusion. I suggest that in one way, it matters little, because our primary interest in taste is not epistemic but aesthetic. But, I end by suggesting, it can matter ethically. (shrink)

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

Ever-increasing numbers of human interactions with intelligent software agents, online and offline, and their increasing ability to influence humans have prompted a surge in attention toward the concept of (online) manipulation. Several scholars have argued that manipulative influence is always hidden. But manipulation is sometimes overt, and when this is acknowledged the distinction between manipulation and other forms of social influence becomes problematic. Therefore, we need a better conceptualisation of manipulation that allows it to be overt and yet clearly distinct (...) from related concepts of social influence. I argue that manipulation is careless influence, show how this account helps to alleviate the shortcomings of the hidden influence view of manipulation, and derive implications for digital ethics. (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)

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

Nudging is the idea that people’s decisions and behaviors can be influenced in predictable, non-coercive ways by making small changes to the choice architecture. In this paper, I differentiate between type-1 nudges and type-2 nudges according to the thinking processes involved in each. With this distinction in hand, I present the libertarian paternalistic criteria for the moral permissibility of intentional nudges. Having done this, I motivate an objection to type-1 nudges. According to this objection, type-1 nudges do not appear to (...) be relevantly different than standard cases of manipulation, and manipulation is morally problematic. While I show that this objection fails, I argue that its evaluation raises a different challenge for Libertarian Paternalism. The libertarian paternalistic criteria fails because it ignores the moral distinction that exists between different kinds of nudges. That is, the distinction between what I call ‘counteractive’ and ‘non-counteractive’ nudges. I end by suggesting a revision of the criteria that avoids the problem. (shrink)

The realm of non-rational influence, which includes nudging, is home to many other morally interesting phenomena. In this paper, I introduce the term bumping, to discuss the category of unintentional non-rational influence. Bumping happens constantly, wherever people make choices in environments where they are affected by other people. For instance, doctors will often bump their patients as patients make choices about what treatments to pursue. In some cases, these bumps will systematically tend to make patients’ decisions worse. Put another way: (...) doctors will sometimes harm their patients by bumping them in systematic ways. I use the case of medical overuse, the provision of medical services where the likely harm outweighs the likely benefit to the patient, as a touchstone for arguing that doctors who systematically bump their patients towards harm can be blameworthy for their unwitting influence. (shrink)

The novelty in Adam Burgess’ paper is that he assesses nudge policies in the context of the shift in the UK government’s approach to risk from the nannying policies of Labour to the nudge policies of the Conservatives. There is a wealth of ideas in this paper. I find it useful to disentangle some of these ideas focusing on the following two questions: 1. In what respects do Labour’s nannying policies and the Conservatives’ nudge policies differ? 2. What is problematic (...) about Labour’s nannying and the Conservatives’ nudge policies? Subsequently I will reflect on how a particular strand of research in the social sciences can be made relevant to designing a more responsible way of dealing with societal risk and show how this approach can evade some of Burgess’ concerns. (shrink)

Strawson argues that we should understand moral responsibility in terms of our practices of holding responsible and taking responsibility. The former covers what is commonly referred to as backward-looking responsibility , while the latter covers what is commonly referred to as forward-looking responsibility . We consider new technologies and interventions that facilitate assignment of responsibility. Assigning responsibility is best understood as the second- or third-personal analogue of taking responsibility. It establishes forward-looking responsibility. But unlike taking responsibility, it establishes forward-looking responsibility (...) in someone else. When such assignments are accepted, they function in such a way that those to whom responsibility has been assigned face the same obligations and are susceptible to the same reactive attitudes as someone who takes responsibility. One family of interventions interests us in particular: nudges. We contend that many instances of nudging tacitly assign responsibility to nudgees for actions, values, and relationships that they might not otherwise have taken responsibility for. To the extent that nudgees tacitly accept such assignments, they become responsible for upholding norms that would otherwise have fallen under the purview of other actors. While this may be empowering in some cases, it can also function in such a way that it burdens people with more responsibility that they can (reasonably be expected to) manage. (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)

To nudge is to design choice contexts in order to improve choice outcomes. Richard Thaler and Cass Sunstein emphatically endorse nudging but reject more restrictive means. In contrast, I argue that the behavioral psychology that motivates nudging also motivates what may be called jolting — i.e. the design of choice content. I defend nudging and jolting by distinguishing them from the sometimes oppressive means with which they can be implemented, by responding to some common arguments against nudging, and by showing (...) how respect for preferences over option sets and their aggregate properties may require the trimming of option sets, as well as helpful choice contexts. (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)

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)

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)

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)

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)

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 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)

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 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 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)

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)

It is common in the autonomy literature to claim that some more demanding theories of autonomy disrespect certain individuals by giving the result that those individuals lack autonomy. This claim is often made in the context of the debate between substantive and content-neutral theories of autonomy. Proponents of content-neutral theories often argue that, in deeming certain people non-autonomous—especially certain oppressed people who seem to have internalized their oppression in certain ways—the substantive theories disrespect those people. They take this as reason (...) to accept content-neutral views over substantive views. Despite its ubiquity, this concern about disrespect is hard to pin down precisely. In this paper, I articulate two questions that need to be answered before we can understand the disrespect objection. First: Who, exactly, is supposedly being disrespected by substantive views? Second: Why is it that excluding people with these features is disrespectful? I consider a number of possible answers to each of these questions, and I argue that none of them gives us a plausible explanation of why we should think substantive theories of autonomy are disrespectful to anyone. No matter how we fill in the details, I will argue, there is simply no reason to prefer content-neutral theories of autonomy over substantive ones on the grounds of respect. (shrink)

In her paper “Democracy, Public Policy, and Lay Assessments of Scientific Testimony” Elizabeth Anderson (2011) identifies a tension between the requirements of responsible public policy making and democratic legitimacy. The tension, put briefly, is that responsible public policy making should be based on the best available scientific research, but for it to be democratically legitimate there must also be broad public acceptance of whatever policies are put in place. In this chapter I discuss this tension, with a strong focus on (...) the issue of climate change. My aims are twofold. First, I argue that the tension is harder to resolve than Anderson supposes because some ways of securing acceptance for science-based policies will themselves be democratically illegitimate. Second, I take a closer look at the role intellectual autonomy plays in the tension. Many think that what I call “science marketing” methods for securing broad(er) acceptance of scientific claims are illegitimate because they infringe on our intellectual autonomy. I argue that it is less clear that this is true than many suppose. This is because, put roughly, judicious use of targeted science marketing methods need not stop us from developing the ability to think about scientific issues for ourselves. In fact, they may even aide us in developing this ability. While this doesn’t quite resolve the tension identified by Anderson, it does some of the necessary groundwork for resolving it. (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)