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)

A central reason to worry that managers should not use nudges to influence employees is that doing so fails to treat employees as _rational_ and/or _autonomous_ (RA). Recent nudge defenders have marshaled a powerful line of response against this worry: in general, nudges treat us as the kind of RA agents we are, because nudges are apt to enhance our limited capacities for RA agency by improving our decision-making environments. Applied to managerial nudges, this would mean that when managers nudge (...) their employees, they generally bolster their employees’ limited RA agency and, thus, treat employees as the kinds of RA agents they are. My aim is to vindicate a qualified version of the initial worry from the nudge-defender response and, as a result, provide a clearer, more plausible framework for evaluating managerial nudges than what nudge critics have previously given. I do this, first, by showing how nudge defenders rely on equivocation between two different senses of “treating someone as RA.” The _value-preserving_ notion that supports the nudge-defender prescription to protect and enhance RA capacities is different from the _authority-recognizing_ notion that underwrites the initial worry about nudging. Second, I argue that the authority-recognizing notion of treating someone as RA implies that managerial nudges treat employees as RA just when the nudges are compatible with relating to employees as equals. Third, I explain how, to determine when managerial nudges are compatible with relating to employees as equals, we need to consider how employees surrender aspects of their equal, agency-grounded authority to managers. (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)

In _Pharmaceutical Freedom_ Professor Flanigan argues we ought to grant people self-medication rights for the same reasons we respect people’s right to give (or refuse to give) informed consent to treatment. Despite being the most comprehensive argument in favour of self-medication written to date, Flanigan’s _Pharmaceutical Freedom_ leaves a number of questions unanswered, making it unclear how the safe-guards Flanigan incorporates to protect people from harming themselves would work in practice. In this paper, I extend Professor Flanigan’s account by discussing (...) a hypothetical case to illustrate how these safe-guards could work together to protect people from harms caused by their own ignorance or incompetence. (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)

Sarah Conly defends paternalistic public health policies, such as New York City’s soft drink ban, on the grounds that they promote values that people accept but have difficulty realizing, owing to their cognitive biases. In this commentary, I criticize Conly’s defense of the soft drink ban and offer my own view of the justification for paternalistic food and beverage policies. I propose that paternalistic government restrictions on food and beverage choices should address a significant health problem pertaining to a specific (...) type or class of food or beverage. There should also be substantial evidence that the restrictions are likely to be effective at dealing with the problem and that alternative ways of dealing with it, which do not involve coercion, are likely to be ineffective. (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)

Recent observations associate naturally occurring trace levels of Lithium in ground water with significantly lower suicide rates. It has been suggested that adding trace Lithium to drinking water could be a safe and effective way to reduce suicide. This article discusses the many ethical implications of such population-wide Lithium medication. It compares this policy to more targeted solutions that introduce trace amounts of Lithium to groups at higher risk of suicide or lower risk of adverse effects. The question of mass (...) treatment with Lithium recalls other choices in public health between population-wide and more targeted interventions. The framework we propose could be relevant to some of these other dilemmas. (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)

Order ethicists favour incentives as a means for making moral progress but largely ignore an alternative method, namely, nudging, which has come to prominence through the work of behavioural scientists in recent years. In this paper, we suggest that this is a mistake. Order ethicists have no reason to ignore nudging as an alternative method. Arguments they might press against it include worries about paternalism, manipulation, autonomy, and unintended bad consequences. These are, we argue, largely unfounded insofar as they involve (...) misconceptions or affect incentives as well. In particular, we contend that only some, but not all, nudges are paternalistic, manipulative, and autonomy-reducing. The same is true of incentives. Also, both nudges and incentives can have unintended bad consequences. Therefore, order ethicists cannot endorse arguments against nudges without undermining their favourable view of incentives. In addition, there might be positive reasons to prefer nudges to incentives, for instance, when they are more freedom-preserving, more effective, cheaper, easier to implement, or less inequality-inducing than the latter. (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)

Choice architecture is heralded as a policy approach that does not coercively reduce freedom of choice. Still we might worry that this approach fails to respect individual choice because it subversively manipulates individuals, thus contravening their personal autonomy. In this article I address two arguments to this effect. First, I deny that choice architecture is necessarily heteronomous. I explain the reasons we have for avoiding heteronomous policy-making and offer a set of four conditions for non-heteronomy. I then provide examples of (...) nudges that meet these conditions. I argue that these policies are capable of respecting and promoting personal autonomy, and show this claim to be true across contrasting conceptions of autonomy. Second, I deny that choice architecture is disrespectful because it is epistemically paternalistic. This critique appears to loom large even against non-heteronomous nudges. However, I argue that while some of these policies may exhibit epistemically paternalistic tendencies, these tendencies do not necessarily undermine personal autonomy. Thus, if we are to find such policies objectionable, we cannot do so on the grounds of respect for autonomy. (shrink)

Critics have long dismissed paternalistic choice architecture as conceptually muddled at best and oxymoronic at worst. In this article, I argue that this criticism remains true despite recent replies to the contrary. Further, I suggest that a similar conceptual criticism also applies to non-paternalistic choice architecture. This is due to a three-way tension between the effectiveness, avoidability, and distinctiveness of each nudge. To illustrate this tension, I provide a novel explanation of the mechanics of nudging and a taxonomy of these (...) interventions. I then argue that choice architects who defend the distinctiveness of nudging according to how it guides our behaviour via our unreflective intuitive reasoning encounter a trilemma because the distinctiveness of nudging hinges on interventions being both avoidable and effective. Choice architects cannot achieve this aim without harnessing both our automatic and reflective systems of thought in tandem. However, this diminishes the distinctive character of nudging by bringing it closer to other traditional policy interventions. This establishes the choice architect’s trilemma: a nudge is likely to be either ineffective, effective via some morally unacceptable means, or effective in a manner that is conceptually indistinct from other evidence-based policy interventions. (shrink)

Deceased organ donation is widely considered as a case of easy rescue―that is, a case in which A may bestow considerable benefits on B while incurring negligent costs herself. Yet, the policy implications of this observation remain unclear. Drawing on Christopher H. Wellman’s samaritan account of political obligations, the paper develops a case for a so-called opt-out system, i.e., a scheme in which people are defaulted into being donors. The proposal’s key idea is that we may arrange people’s options in (...) specific ways for the sake of others. (shrink)

ABSTRACT Isaiah Berlin’s criticisms of positive liberty are often read as mere artefacts of his Cold War context. But are they good criticisms? This article evaluates Berlin’s three main worries about positive liberty—the inner-citadel worry, the moralization worry, and the tyranny worry. I find that while they may be reasonable worries to have about any concept of liberty, they are not compelling criticisms of positive liberty in particular.

Governments often aim to improve children’s wellbeing by targeting the decision-making of their parents. In this paper, I explore this phenomenon, providing an ethical evaluation of the ways in which governments target parental decision-making in the context of anti-poverty policies. I first introduce and motivate the concept of parent-targeted paternalism to categorize such policies. I then investigate whether parent-targeted paternalism is ever pro tanto wrong, arguing that it is when directed at parents who meet a threshold of parental competency. I (...) next explore the factors that affect the degree of pro tanto wrongness of paternalistic anti-poverty policies targeting parents, and provide an account of the conditions under which such policies are on balance permissible, and when they are not. Finally, I illustrate the plausibility and usefulness of my framework by considering a case. (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)

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)

This paper discusses the validity of nudges to tackle time-inconsistent behaviours. I show that libertarian paternalism is grounded on a peculiar model of personal identity, and that the argument according to which nudges may improve one’s self-assessed well-being can be seriously questioned. I show that time inconsistencies do not necessarily reveal that the decision maker is irrational: they can also be the result of discounting over the degree of psychological connectedness between our successive selves rather than over time. Time inconsistency (...) can call for paternalism if and only if we accept that an individual is characterised by stable “true” preferences over time-dependent outcomes, and that she is rationally required to make time-consistent choices. This model is descriptively and normatively questionable. I then argue that behavioural findings may still justify paternalistic interventions, but on a non-welfarist basis. (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)

Preventive vaccination can protect not just vaccinated individuals, but also others, which is often a central point in discussions about vaccination. To date, there has been no systematic study of self- and other-directed motives behind vaccination. This article has two major goals: first, to examine and distinguish between self- and other-directed motives behind vaccination, especially with regard to vaccinating for the sake of third parties, and second, to explore some ways in which this approach can help to clarify and guide (...) vaccination debates and policy. I propose conceiving of vaccination in terms of three basic elements: the vaccination decision-maker, the vaccine recipient and the primary beneficiary. I develop a taxonomy based on the relations between these elements to distinguish four kinds of vaccination: self-protective, paternalistic, altruistic and indirect. I finally discuss the case of human papillomavirus vaccine regulation for men and women to show how each kind of vaccination is associated with and raises specific ethical questions. (shrink)

Luke Semrau argues that the documented harms of existing organ markets do not undermine the case for establishing regulated systems of paid kidney donation. He offers two arguments in support of this conclusion. First, Semrau argues that the harms of kidney selling are straightforwardly amenable to regulatory solution. Second, Semrau argues that even in existing black markets, sellers would likely have experienced greater harm if the option of selling a kidney were not available. This commentary challenges both of Semrau’s claims. (...) I argue that there is no reason to believe that kidney sellers benefit from the current black market trade in organs, and highlight a number of potential issues regarding the effectiveness and feasibility of Semrau’s proposed market regulations. (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)

Lifelong smokers lose on average a decade of life vis-à-vis non-smokers. Globally, tobacco causes about 5–6 million deaths annually. One billion tobacco-related deaths are predicted for the 21st century, with about half occurring before the age of 70. In this paper, we consider a complete ban on the sale of cigarettes and find that such a ban, if effective, would be justified. As with many policy decisions, the argument for such a ban requires a weighing of the pros and cons (...) and how they impact on different individuals, both current and future. The weightiest factor supporting a ban, we argue, is the often substantial well-being losses many individuals suffer because of smoking. These harms, moreover, disproportionally affect the disadvantaged. The potential gains in well-being and equality, we argue, outweigh the limits a ban places on individuals’ freedom, its failure to respect some individuals’ autonomous choice and the likelihood that it may, in individual cases, reduce well-being. (shrink)

When libertarian political philosophy attracted wide public notice in the 1970s, a common view was that the distinctive individual rights advocated in libertarian theory required grounding in a theory of ethics. Recently, this view has come under challenge. It has been argued that resort to such grounding in ethical theory is unneeded. An appeal to common sense intuitions suffices to justify libertarianism. First, a brief account of libertarianism will be presented. Then, some examples of the older, pro-grounding position will be (...) discussed. Then, the principal defense of the newer view, Michael Huemer’s The Problem of Political Authority, will be examined. This discussion constitutes the substance of the present paper. The principal contention of the present article will be that the argument to libertarianism from intuitions does not succeed. In conclusion, it will be suggested that a return to the earlier, grounding view is indicated for philosophers who wish to defend libertarianism. (shrink)

Although the principle of respect for personal autonomy has been the subject of debate for almost 40 years, the conversation has often suffered from lack of clarity regarding the philosophical traditions underlying this principle. In this article, I trace a genealogy of autonomy, first contrasting Kant’s autonomy as moral obligation and Mill’s teleological political liberty. I then show development from Mill’s concept to Beauchamp and Childress’ principle and to Julian Savulescu’s non-teleological autonomy sketch. I argue that, although the reach for (...) a new principle to guide choices in physician–patient relationships can rightfully be seen as important, the notion that is now called autonomy within bioethics has corollaries that undermine critical aspects of medical care. As such, there is need for a richer account of the interplay between the free choice of patients and the informed recommendations of doctors. (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)

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)

In this paper, I examine the question of whether there is justification for regulations that place limits on food choices. I begin by discussing Sarah Conly’s recent defense of paternalist limits on food choice. I argue that Conly’s argument is flawed because it assumes a particular conception of health that is not universally shared. I examine this conception of health in some detail, and I argue that we need to shift our focus from individual behaviors and lifestyle to the broader (...) social and environmental context. Such a shift allows us to see the ways in which industry practices are negatively impacting our well-being (a broader concept than “health”). I argue that state regulatory activity surrounding the conditions under which food is grown, processed, marketed, and sold needs to be strengthened. As a result, there are likely to be some indirect limitations on food choice. These indirect limitations are justified, but regulations in which the goal is to change individual behavior or lifestyle are not. (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)