The right to health care is a right to care that is not too costly to the provider, considering the benefits it conveys, and is effective in bringing about the level of health needed for a good human life, not necessarily the best health possible. These considerations suggest that, where possible, society has an obligation to provide preventive health care, which is both low cost and effective, and that health care regulations should promote citizens’ engagement in reasonable preventive health care (...) practices. (shrink)

The “disability paradox” is the idea that for those who become severely disabled, their own quality of life assessment remains at or slightly below the QoL assessments of normal controls. This is a source of skepticism regarding third-person QoL judgments of the disabled. I argue here that this skepticism applies as well to those who are in the minimally conscious state. For rather simple means of sustaining an MCS patient’s life, the cost of being wrong that the patient would not (...) want further support is high. Pair this cost with the reason to be skeptical of third-person judgments, and my argument suggests not withholding food and water from MCS patients. (shrink)

In this article we argue that a widespread adoption of nudging can alter legal and political institutions. Debates on nudges thus far have largely revolved around a set of philosophical theories that we call individualistic approaches. Our analysis concerns the ways in which adherents of nudging make use of the newest findings in the behavioral sciences for the purposes of policy-making. We emphasize the fact that most nudges proposed so far are not a part of the legal system and are (...) also non-normative. We propose two ideal types: “law-as-normative” and “law-as-instrumental”, that allow us to understand and evaluate the relation of nudges and the law. We stress the importance of law as a safeguard for the possible negative consequences of nudges and conclude with proposals that could complement nudging policies. (shrink)

Behavioral paternalism raises deep concerns that do not arise in traditional welfare economics. These concerns stem from behavioral paternalism’s acceptance of the defining axioms of neoclassical rationality for normative purposes, despite having rejected them as positive descriptions of reality. We argue that behavioral paternalists have indeed accepted neoclassical rationality axioms as a welfare standard; that economists historically adopted these axioms not for their normative plausibility, but for their usefulness in formal and theoretical modeling; that broadly rational individuals might fail to (...) satisfy the axioms for various reasons, making them unpersuasive as normative criteria; and that even if their violation did constitute irrationality, that would not justify paternalists’ choosing among inconsistent preferences to define an individual’s “true” preferences. (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)

Basing their claims on findings in the behavioral sciences that illuminate cognitive deficiencies, scholars spanning multiple disciplines argue that certain features of free market capitalist societies threaten human wellbeing, especially insofar as such societies are marked by a proliferation of consumer choices and incessant demands on decision making. This paper thus attempts three things. First, it outlines the criticisms of the expansive freedoms found in free market societies, based on those findings, in order to provide a reliable overview of the (...) shape of the critics’ concerns. Second, it surveys typical objections to these critics’ concerns, while also taking note of actual and anticipated counter-responses, in order to demonstrate why the debate about the value of those freedoms is not settled by those objections. Third, it argues that one objection remains that demands further debate and consideration before the critics’ choice restrictions should materialize. Namely, since there is solid evidence that entrepreneurship contributes to overall happy and healthy societies, and since the benefits of entrepreneurship are best realized in the types of societies marked by more expansive freedoms than the critics would countenance, the critics, who are concerned with general wellbeing, ought to consider the impact of their choice-restricting proposals on entrepreneurship. This paper does not claim that these critics offer baseless concerns about various threats to our wellbeing that arise from ample exercises of liberty, but it does argue that recognizing the role that entrepreneurship plays in fostering such wellbeing severely dampens the force of their implications for liberty. (shrink)

Obesity is often considered a public health crisis in rich countries that might be alleviated by preventive regulations such as a sugar tax or limiting the density of fast food outlets. This paper evaluates these regulations from the point of view of equity. Obesity is in many countries correlated with socioeconomic status and some believe that preventive regulations would reduce inequity. The puzzle is this: how could policies that reduce the options of the badly off be more equitable? Suppose we (...) distinguish: (1) the badly off have poor options from (2) the badly off are poor at choosing between their options (ie, have a choosing problem). If obesity is due to a poverty of options, it would be perverse to reduce them further. Some people in public health say that preventive regulations do not reduce options but, I shall argue, they are largely wrong. So the equity case for regulations depends on the worst off having a choosing problem. It also depends on their having a choosing problem that makes their choices against their interests. Perhaps they do. I ask, briefly, what the evidence has to say about whether the badly off choose against their interests. The evidence is thin but implies that introducing preventive regulations for the sake of equity would be at least premature. (shrink)

The title of the article in the initial online publication was mixed up with copy editing information. The original article has been corrected.

This is lightly edited and referenced version of a presentation given at the 20th International Philosophy of Nursing conference in Quebec on 23rd August 2016. Philosophical texts are not given the same prominence in nurse education as their more valued younger sibling, primary research evidence, but they can influence practice through guidelines, codes and espoused values. John Stuart Mill’s harm principle, found in On Liberty, is not a universal law, and only a thoroughgoing libertarian would defend it as such, though (...) it, or its remnants, can be seen can be seen in policy documents. But its influence is weakening. Smoking bans in enclosed spaces were initially justified with other‐regarding considerations, but judgements from unsuccessful legal challenges from patients in UK psychiatric hospitals rely on preventing harm to the smoker, even when smoking outside, which does not harm others. In the wake of legislation, no‐smoking policies enacted by hospitals are becoming more aggressive, banning smoking both inside and outside, and extending the use of power gained through employment to prevent nurses assisting patients enjoy a lawful habit. Mill’s dictum has been subverted, and this speaks to the fundamental purpose of nursing. Should nurses collude and willingly exert their power for their version of the good of the patient? Or should they instead reaffirm values that support and facilitate life choices made by autonomous people? The paper supports the latter option, and this has wider application for nursing which can be illuminated, if not settled, by revisiting Mill and his famous dictum. (shrink)

Despite having worked in higher education for over twenty years, I am still, first and foremost, a practicing nurse. My employer requires me to be a nurse and my regulator regards what I do as nursing. My practice is regulated by the Code and informed by nursing ethics. If I am nurse, practicing nursing, does that mean that my students are my patients? This paper considers how the relationship that I have with my students can be informed by the ethics (...) of the nurse/patient relationship. After some initial theoretical preparation concerning argument from analogy, the paper identifies some areas for comparison between the two relationships. Areas of similarity and difference identify two areas of concern: Nurse education and educators regularly engage in coercion and surveillance in an attempt to increase student success, both of which would be considered outside nursing ethics. It is concluded that these coercive practices are not conducive to an environment where character is cultivated. Despite current financial and workforce pressures, nurse lecturers and more especially their managers would do well to return to the professional ethics of nursing to question and guide their practice. (shrink)

Is it a stronger interference with people's freedom to withdraw options they currently have than to withhold similar options they do not have? Drawing on recent theorizing about sociopolitical freedom, this article identifies considerations that often make this the case for public policy. However, when applied to tobacco control, these considerations are shown to give us at best only very weak freedom-based reason to prioritize the status quo. This supports a popular argument for so-called “endgame” tobacco control measures: If we (...) believe that cigarettes would and should be withheld from entering markets in hypothetical scenarios in which they do not yet exist, then we also have reason to seek their abolition in situations, such as ours, in which cigarettes do exist—if necessary by banning their sale. The same considerations are then used to disarm objections that have recently been raised to using nudges in public policy. (shrink)

Der libertäre Paternalismus befürwortet Eingriffe in die Entscheidungsfindung von Bürgern, ohne ihnen Optionen völlig nehmen zu wollen. Vielmehr soll die Lenkung des Willens durch Schubser geschehen. Im folgenden Beitrag möchte ich zeigen, dass der libertäre Paternalismus auf tönernen Füßen steht. Ich bediene mich dabei des polemischen Bilds von Quacksalbern. Dieses Bild passt zu meinem argumentativen Vorgehen, da ich erstens zeigen will, dass der libertäre Paternalismus falsche Diagnosen über vermeintliche Krankheiten der Willensbildung stellt, und zweitens, dass er die falsche Therapie empfiehlt. (...) Im ersten Teil des Artikels kritisiere ich die Diagnose des libertären Paternalismus, wonach Menschen in ihrer Entscheidungsfindung systematisch fehlschlagen. Die Auswirkungen der zugrundeliegenden psychologischen Forschung werden missinterpretiert und damit vielen menschlichen Entscheidungen eine Art Defekt zugeschrieben. Der zweite Teil des Beitrags hinterfragt die Therapie des libertären Paternalismus. Für entsprechende Interventionen in die Wahlarchitektonik muss Wissen erlangt werden über die Richtung, in welche die Menschen jeweils geschubst werden sollten. Die hier genannte epistemische Aufgabe kann mit den theoretischen Mitteln des libertären Paternalismus nicht gelöst werden. (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)

This article explores two opposing views from Warring States China concerning the value of human natural spontaneity and large-scale government coercion. On the one hand, the Ruist philosopher Xunzi championed a comprehensive and coercive ethical, political, and social system or Way that he believed would lead to social order and moral cultivation while opposing people’s xìng. On the other hand, the authors of roughly books 8–10 of Zhuangzi, the primitivists, criticized a Way bearing a striking resemblance to Xunzi’s on the (...) grounds that it seriously harms people by opposing their xìng. I argue that the primitivists offer compelling reasons for Xunzi to modify his own Way regarding its relationship with xìng, though their own proposed alternative Way is not very attractive. I conclude with a brief discussion of one primitivist-inspired alternative view found in the Lü Shi Chun Qiu, which plausibly suggests that one way of respecting people’s xìng is by offering them opportunities to explore their natural abilities. (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)

Recent efforts by legislative officials and public health advocates to reform the US food stamp program, or Supplemental Nutrition Assistance Program, have focused on restricting the types of foods eligible for purchase with SNAP benefits, specifically sugar-sweetened beverages. We argue that it is, in principle, permissible for the US government to enact a SNAP-specific SSB ban prohibiting the purchase of SSBs with SNAP benefits. While the government has a duty to ensure that citizens meet their nutritional needs, since SSBs provide (...) negligible nutrition, it has no obligation to subsidize them. Additionally, there is good reason to think that a SNAP-specific SSB ban would enable the government to better fulfill two other duties—improving citizens’ health and providing public services like Medicaid and Medicare in a more cost-effective manner. Still, because the costs and benefits of such a ban remain uncertain, we argue that the government should conduct well-designed pilot projects to help determine the effects of an SSB ban. (shrink)

Is implementing the beneficent nudge program morally permissible in worlds like ours? I argue that there is reason for serious doubt. I acknowledge that beneficent nudging is highly various, that nudges are in some circumstances morally permissible and even called for, and that nudges may exhibit respect for genuine autonomy. Nonetheless, given the risk of epistemic injustice that nudges typically pose, neither the moral permissibility of beneficent nudging in the abstract, nor its case-by-case vindication, appears sufficient to justify implementing a (...) nudge program in worlds like ours. Drawing on Miranda Fricker’s account of epistemic injustice, I argue that the cogent defense of any nudge program, relative to worlds like ours, stands in need of serious attention to its potential for fostering or sustaining epistemic injustice. A more specific point hinges on recognizing a form of epistemic injustice not enough attended to in the literature to date, which I call reflective incapacitational injustice. This includes relative disadvantages in the attaining of the capacity to engage in critical reason, such as the capacity to go in for potentially critical reasoned deliberation and discursive exchange concerning ends. Since Cass Sunstein’s First Law of behaviorally informed regulation would be taken, in worlds like ours, to justify indeterminately many nudges leading to such epistemic injustice we have general grounds for doubting the moral permissibility of this nudge program. We should hence oppose the implementation of any such program until it is shown not to violate the demands of epistemic justice. (shrink)

Governments and policy-makers have of late displayed renewed attention to behavioural research in an attempt to achieve a range of policy goals, including health promotion. In particular, approaches which could be labelled as ‘nudges’ have gained traction with policy-makers. A range of objections to nudging have been raised in the literature. These include claims that nudges undermine autonomy and liberty, may lead to a decrease in responsibility in decision-making, lack transparency, involve deception, and involve manipulation, potentially occasioning coercion. In this (...) article I focus on claims of coercion, examining nudges within two of the main approaches to coercion—the pressure approach and the more recent enforcement approach. I argue that coercion entails an element of control over the behaviour of agents which is not plausibly displayed by the kinds of serious examples of nudges posited in the literature. (shrink)

In The Community of Advantage, Robert Sugden reconstructs and defends an account of the liberal tradition in normative economics in the light of the findings of Behavioural Economics. In...

Described as the ‘exemplary liberal’, John Stuart Mill is employed to support a dizzying array of different, even competing visions of liberalism. That he has been so widely appropriated is certainly a result of the plural perspectives and tensions embedded in Mill’s political writings. Yet, while Mill scholars have generally been attuned to these tensions, contemporary critics of liberalism have been less careful in their uses of his work. Mill is used as an archetype of liberalism, and is often depicted (...) as a less complex thinker than is justified. He is now a popular target in debates concerning the dilemmas of liberal individualism, and the inadequacies of liberal approaches to culture, harm, and to progress in the context of empire. Such studies present Mill as a thinker driven by ideological certainty, whereas he is more appropriately regarded as someone moved by political uncertainty. Drawing on his Autobiography, I recover Mill’s appreciation for the uncertainties of political thought and action to... (shrink)

Over recent years, a number of behavioural economic-informed policy frameworks have been developed, ranging from soft and hard forms of paternalism, to regulation against negative externalities, the so-called nudge, shove and budge approaches. This article considers these different frameworks as applied to some of the challenges posed by the social care needs of contemporary societies. It is argued that all of the frameworks are worthy of serious consideration in this policy domain, in that they offer food for thought on how (...) financial contributions to pay for social care might be increased, and how the quality of social care provision may be improved given available resources. (shrink)

Este trabajo interpreta el auge de los códigos éticos y de la ética profesional desde el punto de vista de su contribución a la formación de una ciudadanía democrática. Se analizan diversos aspectos de la ética profesional desde la perspectiva de una ética del agente para la que bienes, normas y virtudes resultan factores complementarios para el cultivo de la inteligencia y el juicio individual. A través de una concepción de la democracia que la vincula con los hábitos y modos (...) de vida, la ética profesional adquiere una renovada significación como elemento central para la autorrealización personal y la emancipación social. En definitiva, bajo el rótulo del profesionalismo democrático, y de la mano de la filosofía moral y política de Dewey, se muestra que la ética profesional es más que un campo de aplicación, un elemento constituyente de una ética cívica en el marco de una sociedad democrática. (shrink)

Some rights are so important for human autonomy and well-being that many scholars insist they should not be waived, traded, or abandoned. Privacy is a recent addition to this list. At the other end of the spectrum is the belief that privacy is a mere unimportant interest or preference. This paper defends a middle path between viewing privacy as an inalienable, non-waivable, non-transferrable right and the view of privacy as a mere subjective interest. First, an account of privacy is offered (...) that clarifies the concept and demonstrates how privacy is directly related to human health and well-being. Second, along with considering and rejecting several accounts for why privacy might be considered an inalienable right, an argument is offered for why it is morally permissible to waive, transfer, abandon, or alienate privacy. (shrink)

This paper defends traditional political philosophy against the challenges Gaus leverages against it in The Open Society and Its Complexities. Granting Gaus that consensus on the principles of political philosophy is not forthcoming and that complexity undermines many of our most ambitious reform efforts, the paper argues that much work remains for political philosophy as it has been practiced for centuries. This is for three reasons. First, Gaus's own defense of the open society requires resources from the very traditions that (...) he tends to dismiss. Secondly, the kinds of reform Gaus encourages us to focus on in light of complexity presuppose answers to philosophical questions, answers that philosophers have long attempted to provide. Thirdly, not all politically salient philosophical questions are aimed at action guidance. Despite the value in Gaus's analysis, I conclude that political philosophy's future will look, at least in part, like its storied past. (shrink)

Advocates of cognitive enhancement maintain that technological advances would augment autonomy indirectly by expanding the range of options available to individuals, while, in a recent article in this journal, Schaefer, Kahane, and Savulescu propose that cognitive enhancement would improve it more directly. Here, autonomy, construed in broad procedural terms, is at the fore. In contrast, when lauding the goodness of enhancement expressly, supporters’ line of argument is utilitarian, of an ideal variety. An inherent conflict results, for, within their utilitarian frame, (...) the content of rational, hence autonomous, choices is quite restricted. Further, advocates do not clearly indicate their relative emphasis between the often conflicting goals of maximizing benefit and avoiding harm. In practice, their construction of harms is highly expansive, for disabilities include any constraints that “rational” people would decline if it were technically possible to do so. For advocates, this means that where enhancement measures are available, those constraints become avoidable limitations, and not to remove them is to harm. The centrality of harm-avoidance and their ideal utilitarian frame entail sociopolitical requirements that enhancement defenders disallow when trumpeting autonomy in the vein of individual choice. Advocates have thus not done enough to support the claim that their views are wholly separate from earlier eugenics. (shrink)

Many of our daily activities are now made more convenient and efficient by virtual assistants, and the day when they can be designed to instruct us in certain skills, such as those needed to make moral judgements, is not far off. In this paper we ask to what extent it would be ethically acceptable for these so-called virtual assistants for moral enhancement to use subtle strategies, known as “nudges”, to influence our decisions. To achieve our goal, we will first characterise (...) nudges in their standard use and discuss the debate they have generated around their possible manipulative character, establishing three conditions of manipulation. Secondly, we ask whether nudges can occur in moral virtual assistants that are not manipulative. After critically analysing some proposed virtual assistants, we argue in favour of one of them, given that by pursuing an open and neutral moral enhancement, it promotes and respects the autonomy of the person as much as possible. Thirdly, we analyse how nudges could enhance the functioning of such an assistant, and evaluate them in terms of their degree of threat to the subject’s autonomy and their level of transparency. Finally, we consider the possibility of using motivational nudges, which not only help us in the formation of moral judgements but also in our moral behaviour. (shrink)

Given that many people with disabilities have been excluded from political deliberation and subjected to infantilizing and degrading treatment from others, many members of the disability rights movement are understandably critical of policies and practices that speak on behalf of people with disabilities and presume to know what is really in their best interest. Yet, this analysis argues that a general principle of anti-paternalism is not desirable for disability politics. In particular, people with cognitive disabilities are sometimes unable to make (...) important decisions by themselves, and may require assistance from family members or more cognitively able and verbally fluent citizens to make their political voices and choices heard. Drawing from John Locke and Alasdair MacIntyre, this article reconsiders the relationship between paternalism and autonomy, suggesting that autonomous decisionmaking and expression are best thought of as collaborative processes undertaken between people with a range of capacities. (shrink)

When new drugs are approved by the Food and Drug Administration, the default assumption is that they will be available by prescription only, safe for use exclusively under clinical supervision. The paternalism underlying this default must be interrogated in order to ensure appropriate respect for patient autonomy. Upon closer inspection, prescription requirements are justified when nonprescription status would risk harm to third parties and when a large segment of the population would struggle to exercise their autonomy in using a drug (...) safely and effectively on their own. Although these justifications can support prescription status for many drugs, we propose that reversing the FDA's current default to instead begin with a presumption in favor of over‐the‐counter status is the best way to avoid interference with valid claims of patient autonomy. Under this approach, a range of drug products could be considered for an OTC switch, including oral contraceptives, statins, and HIV‐prevention drugs. (shrink)

The permissibility of nudging in public policy is often assessed in terms of the conditions of transparency, rationality, and easy resistibility. This debate has produced important resources for any ethical inquiry into nudging, but it has also failed to focus sufficiently on a different yet very important question, namely: when do nudges undermine a patient’s voluntary consent to a medical procedure? In this paper, I take on this further question and, more precisely, I ask to which extent the three conditions (...) of transparency, rationality, and easy resistibility can be applied to the assessment of voluntary consent too. After presenting two examples, designed to put pressure on these three conditions, I show that, suitably modified, the three conditions can remain significant in the assessment of voluntary consent as well. However, the needed modifications are very substantial and result in a rather complicated view. To propose a tidier solution, I argue that nudging undermines voluntary consent if and only if it cannot be ‘interpersonally justified’ to the patient. I use the three modified conditions to motivate the idea of interpersonal justification and also to further specify the principles it involves. My resulting view is especially attractive because it builds on already existing insights from the debate on nudging, updates those insights with an eye to medical consent, and finally unites them in an elegant and simple framework. (shrink)

This paper explores the extent to which behavioral public policies can be both efficient and democratic by reflecting on the conditions under which individuals could rationally consent to them. Consent refers to a moral requirement that a behavioral public policy should respect what I call a person’s value autonomy and conception of the good. Behavioral public policies can take many forms. Based on a social choice framework, I argue that fully paternalistic and prudential behavioral public policies are unlikely to trigger (...) a hypothetical form of rational consent. Non-fully paternalistic behavioral public policies with partially non-prudential motivations are less problematic in this perspective. In any case, a public deliberative stage preceding the implementation of policies seems to be the best democratic way to justify them. (shrink)

Medical clinicians – doctors, nurses, nurse practitioners etc. – are charged to act for the good of their patients. But not all ways of acting for a patient's good are on par: some are paternalistic; others are not. What does it mean to act paternalistically, both in general and specifically in a medical context? And when, if ever, is it permissible for a clinician to act paternalistically? -/- This paper deals with the first question, with a special focus on paternalism (...) in medicine. While it is easy to give a rough characterization of paternalism (i.e. acting for another's good against that person's will), it is surprisingly difficult to provide a unified account of the myriad of actions that seem to count as paternalistic. After surveying four accounts of paternalism, I argue that two – what I call the authority and beneficence accounts – are the strongest on offer. According to the authority account, a clinician acts paternalistically when, for her patient's good, she usurps his decision-making authority. According to the beneficence account, a clinician acts paternalistically when, for her patient's good, she acts only or overrindingly out of concern for his good. I show how the difference between these accounts matters (in part) for how we should think about the nature of surrogate decision making in medicine. I argue that there are reasons – albeit hardly decisive – to prefer the beneficence account to the authority account. I conclude by considering whether attempts by clinicians to rationally persuade their patients to pursue a particular course of action should be thought of as paternalistic. (shrink)

In contemporary paternalism literature, persuasion is commonly not considered paternalistic. Moreover, paternalism is typically understood to be problematic either because it is seen as coercive, or because of the insult of the paternalist considering herself superior. In this paper, I argue that doctors who persuade patients act paternalistically. Specifically, I argue that trying to persuade a patient (here understood as aiming for the patient to consent to a certain treatment, although he prefers not to) should be differentiated from trying to (...) convince him (here understood as aiming for the patient to want the treatment) and recommending (the doctor merely providing her professional opinion). These three forms of influence are illustrated by summaries of video-recorded hospital encounters. While convincing and recommending are generally not paternalistic, I argue that persuasion is what I call communicative paternalism and that it is problematic for two reasons. First, the patient’s preferences are dismissed as unimportant. Second, the patient might wind up undergoing treatment against his preferences. This does not mean that persuasion always should be avoided, but it should not be undertaken lightly, and doctors should be aware of the fine line between non-paternalism and paternalism. The fact that my analysis of paternalism differs from traditional accounts does not imply that I deem these to be wrong, but rather that paternalism should be considered as a more multi-faceted concept than previous accounts allow for. (shrink)

This article argues that governments in countries that currently permit intensive animal agriculture - especially but not exclusively high-income countries - are, in principle, morally justified in taking steps to restrict or even eliminate intensive animal agriculture to protect public health from the risk of zoonotic pandemics. Unlike many extant arguments for restricting, curtailing, or even eliminating intensive animal agriculture which focus on environmental harms, animal welfare, or the link between animal source food (ASF) consumption and noncommunicable disease, the argument (...) in this article appeals to the value of protecting populations from future global health emergencies and their broad social, economic, and health impacts, taking the SARS-CoV-2 virus as a particularly salient example. The article begins by identifying how intensive animal agriculture contributes to the outbreak (and risk of future outbreaks) of zoonotic diseases. Next, we explore three specific policy options: 1. Incentivizing plant-based and cell-based ASF alternatives through government subsidies; 2. Disincentivizing intensive ASF production through the adoption of a “zoonotic tax”; and 3. Eliminating intensive ASF production through a total ban. We argue that all three of these measures are permissible, although we remain agnostic as to whether these measures are obligatory. We argue for this conclusion on the grounds that each measure is justified by the same sorts of considerations that justify other widely accepted public health interventions, and each is compatible with a variety of theories of justice. We then address potential objections. Finally, we discuss how our novel argument relates to extant ethical arguments in favor or curtailing ASF production and consumption. (shrink)

This paper is concerned with the practical importance of different forms of paternalism for educational theory and practice. Contrary to the traditional treatment of paternalism as a sometimes necessary and rather messy aspect of educational practices, I demonstrate that paternalism is to be regarded as an “indigenous concept” of educational theory and as the ‘indigenous model of justification’ that underlies the structure of educational practices. Based on an analysis of the intricate nexus between autonomy-oriented forms of paternalism and educational forms (...) of autonomy-based perfectionism I furthermore argue that a perfectionistically structured conception of autonomy provides a more adequate evaluative framework for justifying autonomy as an educational aim than alternative educational regimes of autonomy can deliver. Finally, I discuss some major theoretical problems of bridging the gap between general ethical principles and their application in practical fields. (shrink)

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)

Making decisions is an important component of everyday living, and issues surrounding autonomy and self-determination are crucial for persons with intellectual disabilities. Article 12 (Equal Recognition before the Law) of the UN Convention on the Rights of Persons with Disabilities addresses this issue of decision-making for persons with disabilities: the recognition of legal capacity. Legal capacity means recognizing the right to make decisions for oneself. Article 12 is also moving in the direction of supported decision-making, as an alternative to substituted (...) decision-making. The objective of this paper is to show conceptually the connection between supported decisionmaking and the preservation of personal autonomy for persons with intellectual disabilities. This paper discusses supported decision-making based on Bach and Kerzner's model: (a) legally independent status, (b) supported decision- making status, and (c) facilitated decision-making status. Arguments will be made based on John Stuart Mill's concept of autonomy and arguments against it using Sarah Conly's argument for paternalism. (shrink)

Making decisions is an important component of everyday living, and issues surrounding autonomy and self-determination are crucial for persons with intellectual disabilities. Adults with intellectual disabilities are characterized by the limitations in their intellectual functioning and in their adaptive behavior, which compromises three skill types, and this starts before the age of 18. Though persons with intellectual disabilities are characterized by having these limitations, they are thought to face significant decisionmaking challenges due to their disability. Moving away from this generalization, (...) Article 12 of the United Nations Convention on the Rights of Persons with Disabilities addresses this issue of decision-making for persons with disabilities, recognizing the right to legal capacity. (shrink)

This paper argues that common social narratives about unhealthy eaters can cause significant damage to agency. I identify and analyze a narrative that combines a “control model” of eating agency with the healthist assumption that health is the ultimate end of eating. I argue that this narrative produces and enables four types of damage to the agency of those identified as unhealthy eaters. Due to uncertainty about what counts as healthy eating and various forms of prejudice, the unhealthy eater label (...) and its harms to agency are more likely to stick to some people than others and may reinforce patterns of oppression. I argue that fat people are especially vulnerable to this identification and the damage it can do. I then consider possible “counterstories” about unhealthy eaters, alternative narratives that might be less damaging to agency than the control narrative. I identify one promising counterstory but suggest that it may be limited when it comes to repairing damage to the agency of fat people. Overall, this paper illustrates some of the complex ways that healthism about eating affects agency, and emphasizes the ethical importance of the ways we think about and discuss eating and eaters. (shrink)

Critical literatures, and public discourses, on public health policies and practices often present fixated concerns with paternalism. In this paper, rather than focus on the question of whether and why intended instances of paternalistic policy might be justified, we look to the wider, real-world socio-political contexts against which normative evaluations of public health must take place. We explain how evaluative critiques of public health policy and practice must be sensitive to the nuance and complexity of policy contexts. This includes sensitivity (...) to the ‘imperfect’ reach and application of policy, leading to collateral effects including collateral paternalism. We argue that theoretical critiques must temper their demandingness to real-world applicability, allowing for the detail of social and policy contexts, including harm reduction: apparent knock-down objections of paternalism cannot hold if they are limited to an abstract or artificially-isolated evaluation of the reach of a public health intervention. (shrink)

Jessica Flanigan argues that individuals have the right to self-medicate. Flanigan presents two arguments in defense of this right. The first she calls the epistemic argument and the second she calls the rights-based argument. I argue that the right to self-medicate hangs and falls on the rights-based argument. This is because for the epistemic argument to be sound agents must be assumed to be epistemically competent. But, Flanigan’s argument for a constitutionally mandated right to self-medicate models agents as epistemically incompetent. (...) For Flanigan, agents are different at the pharmacy than they are at the polls. I identify this behavioral asymmetry and advocate a symmetric and realistic behavioral postulate for both arguments. The result, however, is that the success of the epistemic argument becomes contingent which fails to justify a constitutionally mandated right. I proceed to raise skepticism about the rights-based argument as well. I conclude that there is reason to be skeptical that these arguments can justify a constitutionally mandated right to self-medicate. Ultimately, a bottom-up approach to pharmaceutical ethics is preferable. (shrink)

This article proposes a novel defense of vaccine mandates: such policies are justifiable because they protect the capabilities of individuals who cannot cultivate individual immunity against infection. We begin by considering a nearby argument that has recently enjoyed popularity, which claims individuals have an enforceable obligation to get vaccinated because they have benefited from community protection (often referred to as ‘herd immunity’), and thus they ought to do their fair share in sustaining that public good by getting vaccinated. We object, (...) however, that this kind of argument misstates the ethical basis for vaccine mandates because community protection primarily protects unvaccinated people. We contend that the duty to vaccinate is not fundamentally an obligation to make a fair contribution to a public good from which vaccinated people benefit, but a duty to protect the wellbeing of otherwise vulnerable third parties. We flesh out our view by drawing on Martha Nussbaum's capabilities approach. (shrink)