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 scrutinizes the tension between individuals’ rights and paternalism. I will argue that no normative account that includes rights of individuals can justify hard paternalism since the infringement of a right can only be justified with the right or interest of another person, which is never the case in hard paternalism. Justifications of hard paternalistic actions generally include a deviation from the very idea of having rights. The paper first introduces Tom Beauchamp as the most famous contemporary hard paternalist (...) by outlining his moral theory (principlism) and showing why it, as it stands, has to allow for hard paternalism. Secondly, the paper focuses on the notion of rights within principlism. I will employ traditional theories of rights to make sense of rights in principlism. Unfortunately, this attempt fails. In the third part, then, I claim that rights can only be limited with reference to the rights or interests of others. This structure is the very point of rights, it is their bite. I will argue for this claim and show its implications. The most important implication is that not only principlism, but every normative theory that includes rights of individuals, has to abolish hard paternalism. (shrink)

En este artículo sostengo que el principio del daño es un mecanismo que tiene como objetivo lograr un equilibrio entre el juicio individual y la estabilidad social. Argumentaré que no apoyo la afirmación de que el principio del daño puede interpretarse de una manera paternalista y, en cambio, sostengo que el propósito del principio de daño, según lo previsto por John Stuart Mill, es engendrar progreso social. Es por eso que el énfasis de Mill, a menudo, cambia de la libertad (...) individual al control social. Al contrario de lo que afirman algunos estudiosos, esto no es el resultado de una inconsistencia en su pensamiento, sino que se deriva de su enfoque sobre el progreso social. (shrink)

If D commits a wrong against V, D typically incurs a corrective duty to V. But how should we respond if V has false beliefs about whether she is harmed by D’s wrong? There are two types of cases we must consider: those in which V is not harmed but she mistakenly believes that she is those in which V is harmed but she mistakenly believes that she is not. I canvass three views: The Objective View, The Subjective View and (...) The Mixed View. The Objective View holds that V’s claim depends on the correct account of harm, rather than her false beliefs, and so D has a duty to offer damages to V in but not in in order to compensate her. The Subjective View holds that, for broadly anti-perfectionist reasons, V’s claim depends on her sincere beliefs, even if they are mistaken, and so D has a duty to compensate V in but not in. The Mixed View holds that we should defer to her beliefs in but not in, so D has a duty to compensate her in both cases. In this article, I argue that we should accept The Mixed View. (shrink)

This article discusses John Stuart Mill's voluntary slavery argument in On Liberty. The author shows that standard interpretations of the argument rely on the assumption that part of Mill's objection to voluntary slavery is the permanent nature of the decision. However, in correspondence, Mill also objects to voluntary ‘coolie’ labour contracts, which he regards as a form of slavery. This produces difficulties for standard interpretations of the voluntary slavery argument. Finally, the author provides a revised interpretation of Mill's argument to (...) solve this problem. (shrink)

Freedom is one of the central values in political and moral philosophy. A number of theorists hold that freedom should either be the only or at least one of the central distribuenda in our theories of distributive justice. Moreover, many follow Mill and hold that a concern for personal freedom should guide, and limit, how paternalist public policy can be. For the most part, theorists have focussed on a person’s freedom at one specific point in time but have failed to (...) give proper attention to freedom across time. Given that we care about personal freedom now, we have reason to care about future freedom too. But what kind of distribution of freedom across a person’s lifetime should we promote as a matter of legislation and public policy? I argue that none of the candidate principles for the distribution of freedom across time is plausible. Neither a starting gate view, nor a maximisation nor a sufficientarian view is satisfactory, because none adequately reflects our various reasons to value freedom. I show that this result presents a tough challenge for theories of distributive justice and paternalism that set great store by personal freedom. (shrink)

Mill’s harm principle is commonly supposed to rest on a distinction between self-regarding conduct, which is not liable to interference, and other-regarding conduct, which is. As critics have noted, this distinction is difficult to draw. Furthermore, some of Mill’s own applications of the principle, such as his forbidding of slavery contracts, do not appear to fit with it. This article proposes that the self-regarding/other-regarding distinction is not in fact fundamental to Mill’s harm principle. The sphere of protected liberty includes not (...) only self-regarding conduct, but also actions that affect only consenting others. On the other hand, the occasional permissibility of interfering with self-regarding conduct can plausibly be explained by reference to the agent’s consent. Thus, the more important distinction appears to be that between consensual and non-consensual harm, rather than that between the self-regarding and non-self-regarding action. That is, interference can be justified in order to prevent non-consensual harms, but not to prevent consensual harms. It is argued that the harm principle, thus reformulated, both captures Mill’s intentions and is a substantively plausible position. (shrink)

I argue that libertarian paternalism is in fact paternalism, or hard paternalism, rather than a form of soft paternalism. I do so on the basis of an analysis of the paternalist act according to which the paternalist act needn’t violate the will of the agent who is the target of that act and the paternalist actor need only suspect that her action may improve the welfare of that target. The paper considers and rejects interpretations of libertarian paternalism as soft paternalism. (...) I then provide an outline as to how libertarian paternalism may be reformed in light of the finding that current libertarian paternalism is hard paternalism. The proposal is to require that the enactment of libertarian paternalist policies be conditional on opinion polling indicating support for those policies from the agents they target. (shrink)

Critical analyses of the audit profession have become more common in recent years. Many of these analyses focus on the entire audit profession in developing their criticisms and concerns. In this paper, the scope of analysis is narrowed to examine in depth the auditing profession's use of the concepts of reasonable assurance and materiality in audit performance and audit communications. Reasonable assurance and materiality are the terms that auditors use to describe the scope of their responsibility to the public. Similarly, (...) reasonable assurance and materiality are the key determinants of audit effort. An overview of official guidance, practitioner reports, and academic research reveals that these two key concepts are not well specified nor are they consistently applied in audit practice. These findings are evaluated from two competing perspectives on professions – the traditional, functionalist perspective and the critical theorists' perspective. Evaluation from the latter perspective leads to a conclusion that the profession's use of these key terms to guide practice and communication leaves the profession open to charges of mystification and unjustified paternalism. (shrink)

The notion of a non-renounceable right is an integral part of recent liberal reconciliatory attempts to justify apparently paternalistic policies, such as compulsory insurance or providing people with certain goods irrespective of their subjective preferences, non-paternalistically. However, non-renounceable rights cannot be justified non-paternalistically. A critical scrutiny of the liberal reconciliatory arguments in question reveals this and points towards a plausible paternalist justification of the policies in question.

One of the overriding interests of the literature on health care economics is to discover where personal choice in market economies end and corrective government intervention should begin. Our study addresses this question in the context of John Stuart Mill’s utilitarian principle of harm. Our primary objective is to determine whether public policy interventions concerning more than 35,000 online pharmacies worldwide are necessary and efficient compared to traditional market-oriented approaches. Secondly, we seek to determine whether government interference could enhance personal (...) utility maximization, despite its direct and indirect costs on medical e-commerce. This study finds that containing the negative externalities of medical e-commerce provides the most compelling raison d’etre of government interference. It asserts that autonomy and paternalism need not be mutually exclusive, despite their direct and indirect consequences on individual choice and decision-making processes. Valuable insights derived from Mill’s principle should enrich theory-building in health care economics and policy. (shrink)

Rawls’ The Law of Peoples does not offer a clear principled account of the way in which liberal and decent peoples should deal with benevolent absolutisms. Within the Rawlsian framework, benevolent absolutisms are a type of society that respects basic human rights and is not externally aggressive. Rawls rules out the use of coercion to engage with benevolent absolutisms but does not provide an alternative strategy. The article develops one, namely, it argues that liberal and decent peoples should use positive (...) incentives to induce benevolent absolutisms to make their transition to the status of well-ordered peoples. In so doing, it offers a principled way to expand Rawls’ international nonideal theory and, in the process, provides a more nuanced approach to the promotion of political participation in international society. The article draws on the literature on economic statecraft and political theory and constructs an incentive model with seven distinct parameters attached to its definition of incentives. Finally, the article provides a real-world example, of how to concretely implement the incentive mechanism. (shrink)

Formal views of autonomy rule out substantive rational capacities (reasons-responsiveness) as a condition of autonomous agency. I argue that such views face a number of underappreciated problems: they have trouble making sense of how autonomous agents could be robustly responsible for their choices, face the burden of explaining why there should be a stark distinction between the importance of factual and evaluative information within autonomous agency, and leave it mysterious why autonomy is the sort of thing that has value and (...) ought to be promoted. Moreover, I argue that the alternative view that includes substantive rational capacities need not have the unacceptable political implications it is sometimes thought to have. (shrink)

Paternalism is the restriction of a person's autonomy for the good of that person. It embodies a familiar conflict of intuitions: while we cherish individual freedom, we also want to protect/promote what we know to be good. So, every paternalist must meet two challenges: paternalism must be justifiable as a restriction of autonomy as well as effective in terms of well-being. In this essay, I argue that the ‘autonomy’ restricted by paternalism is a Razian brand of free self-authorship and that (...) the ‘good’ protected is captured by Martha Nussbaum's account of personal well-being. I then defend a mild welfare paternalism based on a dichotomy implicit in any defensible description of well-being. I argue that some aspects of the good life do not require endorsement and, therefore, can be justifiably and effectively promoted by autonomy-restricting means. Finally, I discuss why paternalism need not be hostile to ethical independence. (shrink)

Most anti-paternalists claim that informed and competent self-regarding choices are protected by autonomy, while ill-informed or impaired self-regarding choices are not. Joel Feinberg, among many others, argues that we can in this way distinguish impermissible “hard” paternalism from permissible “soft” paternalism. I argue that this view confronts two related problems in its treatment of ill-informed decision-makers. First, it faces a dilemma when applied to decision-makers who are responsible for their ignorance: it either permits too much, or else too little, intervention (...) to satisfy its proponents. Second, the most promising rationales in favor of the view ignore the distinction between an agent’s voluntarily bringing about some state of affairs, on the one hand, and an agent’s voluntarily assuming a risk, on the other. I conclude that a decision-maker’s ignorance is irrelevant to the permissibility of intervention on her behalf. If it is permissible to intervene in a given ill-informed choice, it would be permissible to intervene in an otherwise similar but informed choice, at least provided that intervention would produce similar benefits in both cases. This shows that we should sometimes accept straightforwardly paternalistic rationales. (shrink)

In general, we think that when it comes to the good of another, we respect that person’s will by acting in accordance with what he wills because he wills it. I argue that this is not necessarily true. When it comes to the good of another person, it is possible to disrespect that person’s will while acting in accordance with what he wills because he wills it. Seeing how this is so, I argue, enables us to clarify the distinct roles (...) that the wills of competent and incompetent people should play in third-party deliberations about their welfare. (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)

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)

John Stuart Mill didn’t take his life; but he could have done it. Had he done it when he was twenty, we would have never known what he thought about it. But he didn’t. And many years later he wrote about nature, God, religion and autonomy. My aim in this article is to show how his thoughts about nature and theism affect in fact his stance about autonomy to commit suicide.

This article proposes a theoretical re-conceptualization of power dynamics and their legitimation in contemporary business–society relations using the prism and metaphor of parentalism. The paper develops a typology of forms of parentalism along two structuring dimensions: care and control. Specifically, four ideal-types of parentalism are introduced with their associated practices and power-legitimation mechanisms. As we consider current private governance and authority through this analytical framework, we are able to provide a new perspective on the nature of the moral legitimation of (...) power dynamics in contemporary business–society relations. And we weave the threads between this conceptual frame and historical antecedents, suggesting that business ethicists need to revive old debates on paternalism in light of the current pervasive trend of modernized and subtler forms of parentalism. Implications for business ethics and political CSR are discussed. (shrink)

In this paper I look at various ways that interpersonal and social relations can be seen as required for autonomy. I then consider cases where those dynamics might play out or not in potentially paternalistic situations. In particular, I consider cases of especially vulnerable persons who are attempting to reconstruct a sense of practical identity required for their autonomy and need the potential paternalist’s aid in doing so. I then draw out the implications for standard liberal principles of paternalism, specifically (...) in clinical or therapeutic situations. The picture of potential paternalism that emerges here is much more of a dynamic, interpersonal scenario rather than a case of two separate individuals making decisions independent of each other. (shrink)

The use of tanning beds has been identified as being among the most significant causes of melanoma and non-melanoma skin cancer. Accordingly, the activity is properly seen as one that involves profound harm to self. The article examines paternalistic reasons for restricting sunbed usage. We argue that both so-called soft and hard paternalistic arguments support prohibiting the use of sunbeds. We make the following three arguments: an argument from oppressive patterns of socialization suggesting that the autonomous nature of the conduct (...) in question is questionable; an argument from so-called evaluative delusions in which individuals attach incorrect weights to some of their values; a strictly hard paternalistic argument appealing to the harm in itself pertaining to the use of sunbeds. (shrink)

The purpose of this article is to set out an Aristotelian account of individual autonomy. Individual autonomy is the capacity of the individual to make and act upon judgments for which he is held morally accountable. This sense of autonomy may be contrasted to a number of other senses. Of these, the most important are political or legal autonomy and Kantian principled autonomy. Political or legal autonomy concerns the environment in which an individual operates. It exists where individuals are able (...) to operate reasonably freely.1 For the most part we will not consider this sense except insofar as it is necessary to explain the importance placed on respecting individual autonomy. Kantian principled autonomy has been described recently by Onora O‟Neill in a series of writings.2 On this account, autonomy is seen as a characteristic of the principle behind action rather than of action per se and is not a characteristic of agents at all. (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)

Cass Sunstein and Richard Thaler contend that the government is justified in shaping certain choices of individuals to advance their well-being. In this paper, I argue that those who are committed to a robust notion of autonomy, which I call autonomy as authority, have good reason to reject the Sunstein-Thaler argument for libertarian paternalism. I draw from Joseph Raz’s idea of exclusionary reasons and Daniel Groll’s conception of autonomy to argue that the S/T argument for libertarian paternalism fails to respect (...) autonomy. I consider if soft paternalism could be called upon as a foundation for libertarian paternalism, but argue against this possibility. I conclude that an adequate defense of libertarian paternalism would need to directly attack the notion of autonomy as authority, but such an attack has yet to be mounted by the defenders of libertarian paternalism. (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)

This thesis focuses on the issue of whether or not the government is ever justified in prohibiting the actions of an individual who is harming herself but not others. I first analyze some of the key historical figures in the paternalism debate and argue that these accounts fail to adequately meet the needs of a modern, pluralistic society. Then, I analyze and critique the nuanced, soft-paternalist strategy put forth by Joel Feinberg. Finally, I defend a version of hard paternalism, arguing (...) that a balancing strategy that examines each action on a case-by-case basis shows all citizens equal, and adequate concern and respect. (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)

Ordinary Language Philosophy has largely fallen out of favour, and with it the belief in the primary importance of analyses of ordinary language for philosophical purposes. Still, in their various endeavours, philosophers not only from analytic but also from other backgrounds refer to the use and meaning of terms of interest in ordinary parlance. In doing so, they most commonly appeal to their own linguistic intuitions. Often, the appeal to individual intuitions is supplemented by reference to dictionaries. In recent times, (...) Internet search engine queries for expressions of interest have become quite popular. Apparently, philosophers attempt to surpass the limits of their own linguistic intuitions by appealing to experts or to factual uses of language. I argue that this attempt is commendable but that its execution is wanting. Instead of appealing to dictionaries or Internet queries, philosophers should employ computer-based linguistic corpora in order to confirm or falsify hypotheses about the factual use of language. This approach also has some advantages over methods employed by experimental philosophers. If the importance of ordinary language is stressed, the use of linguistic corpora is hardly avoidable. (shrink)

Distributive egalitarians believe that distributive justice is to be explained by the idea of distributive equality (DE) and that DE is of intrinsic value. The socio-relational critique argues that distributive egalitarianism does not account for the “true” value of equality, which rather lies in the idea of “equality as a substantive social value” (ESV). This paper examines the socio-relational critique and argues that it fails because – contrary to what the critique presupposes –, first, ESV is not conceptually distinct from (...) DE, and second, the idea of ESV cannot serve as a “foundation” or “root” of distributive egalitarianism. (shrink)

This thesis concerns the measurement of freedom, and its value. Specifically, I am concerned with three overarching questions. First, can we measure the extent of an individual’s freedom? It had better be that we can, otherwise much ordinary and intuitive talk that we would like to vindicate – say, about free persons being freer than slaves – will turn out to be false or meaningless. Second, in what ways is freedom valuable, and how is this value measured? It matters, for (...) example, whether freedom is valuable only insofar as it enables us to pursue specific ends we happen to value for independent reasons, or whether it is also valuable in itself. In the latter case, but not the former, more freedom will always be better. Likewise, it’s important to get clarity on what ends, exactly, freedom is especially instrumentally valuable in promoting, since this goes to how much we should care about it. And finally, the liberal political tradition asserts that there is a special sphere of personal choices within which individuals should be free to do as they please, for reasons over and above the value of freedom itself. Now, can we measure the extent to which states and individuals respect individual liberties, and can we weigh the importance of respecting liberty against competing values like social welfare? To answer these questions, I follow the axiomatic tradition of social choice theory, and I develop several novel measures of freedom – including the first measure of freedom ever proposed that is sensitive to how modally robustly our options are available – a novel approach to measuring the diversity of an opportunity set, and I develop an account of the value of freedom according to which an important part of why freedom matters is that it enables us to improve our preferences through learning, and I construct ways of measuring the value of freedom along this dimension of value. Finally, in later chapters, I provide a representation result for a measure of illiberalism, i.e. of the degree to which states fail to respect the rights of their citizens, and I extend this result to provide a characterization of moral theories that express concern for respecting the rights of others. The final chapter closes by discussing how this concern may be weighed against concerns for social welfare. (shrink)

According to the doctrine of informed consent medical procedures are morally permissible when a patient has consented to the treatment. Problematically it is possible for a patient to consent to or refuse treatment which consequently leads to a decline in her best interests. Standardly, such conflicts are resolved by prioritising the doctrine of informed consent above the requirement that the medical practitioner acts in accordance with the duty of care. This means that patient free choice is respected regardless as to (...) whether her choice leads to a decline in her best interests, since to disrespect patient choice would be an instance of ‘unwarranted’ paternalism. This thesis defends the claim that in cases where patient consent comes into conflict with her best interests, paternalistic interference is in fact justified. The ambition of the thesis is thus twofold: in the first place I argue that the doctrine of informed consent cannot be used as an ethical guarantor for medical decision making. Secondly I will conclude that hard paternalism is justified in medical practice, thereby calling for a reversal of the prioritisation of informed consent procedures over the medical practitioner’s duty of care. (shrink)

In liberal moral theory, interfering with someone’s deliberate engagement in a self-harming practice in order to promote their own good is often considered wrongfully paternalistic. But what if self-harming decisions are the product of an oppressive social context that imposes harmful norms on certain individuals, such as, arguably, in the case of cosmetic breast surgery? Clare Chambers suggests that such scenarios can mandate state interference in the form of prohibition. I argue that, unlike conventional measures, Chambers’ proposal recognises that harmful, (...) discriminatory norms entail a twofold collective moral obligation: to eliminate the harmful norm in the long run, but also to address unjust harm that is inflicted in the meantime. I show that these two obligations tend to pull in opposite directions, thus generating a serious tension in Chambers’ proposal which eventually leads to an undue compromising of the second obligation in favour of the first. Based on this discussion, I develop an alternative proposal which, instead of prohibiting breast implant surgery, offers compensation for the disadvantages suffered by individuals who decide not to have surgery. (shrink)

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