Am Beispiel von Adipositas werden in diesem Beitrag die Konflikte diskutiert, die zwischen elterlichen Rechten und den aus Gerechtigkeitserwägungen erwachsenden Ansprüchen von Kindern entstehen können. Es wird angenommen, dass Kinder Anspruch auf Gesundheit haben, und dass Adipositas sie in ihrer Gesundheit gefährdet. Die Frage lautet, was zu tun ist, wenn das Handeln der Eltern die Entstehung von Adipositas begünstigt. Es werden drei verschiedene Konzeptionen elterlicher Rechte diskutiert. Nach der ersten Konzeption sind elterliche Rechte in den Interessen oder Freiheiten der Eltern (...) fundiert. Gemäß der zweiten Auffassung ergeben sich elterliche Rechte aus elterlichen Pflichten, während der dritte Ansatz die Bedeutung sogenannter Beziehungsgüter hervorhebt. Vor diesem Hintergrund werden zwei Thesen vertreten: Die erste lautet, dass Eltern nicht berechtigt sind, ihre Kinder in einer Weise aufzuziehen, die zu Adipositas führt. Die zweite These ist, dass es trotzdem gute Gründe für Zurückhaltung bei Eingriffen in die Familie gibt. (shrink)

Analytic Philosophy, Volume 63, Issue 2, Page 73-89, June 2022.

: In this essay, I examine the arguments against physician - assisted suicide Susan Wolf offers in her essay, "Gender, Feminism, and Death : Physician - Assisted Suicide and Euthanasia." I argue that Wolf's analysis of PAS, while timely and instructive in many ways, does not require that feminists reject policy approaches that might permit PAS. The essay concludes with reflections on the relationship between feminism and questions of agency, especially women's agency.

In this essay, I examine the arguments against physician-assisted suicide Susan Wolf offers in her essay, “Gender, Feminism, and Death: Physician-Assisted Suicide and Euthanasia.” I argue that Wolf's analysis of PAS, while timely and instructive in many ways, does not require that feminists reject policy approaches that might permit PAS. The essay concludes with reflections on the relationship between feminism and questions of agency, especially women's agency.

In this essay, I examine the arguments against physician-assisted suicide Susan Wolf offers in her essay, "Gender, Feminism, and Death: Physician-Assisted Suicide and Euthanasia." I argue that Wolf's analysis of PAS, while timely and instructive in many ways, does not require that feminists reject policy approaches that might permit PAS. The essay concludes with reflections on the relationship between feminism and questions of agency, especially women's agency.

In this essay, I examine the arguments against physician-assisted suicide Susan Wolf offers in her essay, “Gender, Feminism, and Death: Physician-Assisted Suicide and Euthanasia.” I argue that Wolf's analysis of PAS, while timely and instructive in many ways, does not require that feminists reject policy approaches that might permit PAS. The essay concludes with reflections on the relationship between feminism and questions of agency, especially women's agency.

Abstract:Robert Sugden has suggested a normative standard of freedom as ‘opportunity’ that is supposed to help realign normative economics – with its traditional rational choice orientation – with behavioural economics. While allowing preferences to be incoherent, he wants to maintain the anti-paternalist stance of orthodox welfare economics. His standard, though, presupposes that people respond to uncertainty about their own future preferences by dismissing any kind of self-constraint. We argue that the approach lacks psychological substance: Sugden's normative benchmark – the ‘responsible (...) person’ – can hardly serve as a convincing role model in a contractarian setting. An alternative concept is introduced, and some implications are briefly discussed. (shrink)

The Willowbrook Hepatitis Study is one of the best-known examples of unethical medical research, but the research has always had defenders. One of the more intriguing defenses continually used was that critics did not know the researchers on the study and, therefore, could not assess their ethics. This essay traces the appeal to the researchers’ characters across published research and archival sources from the 1960s through today. These appeals reflect the observation as old as Aristotle that one of the most (...) potent modes of persuasion is ethos or character. The specific types of character in these appeals develop out of the paternalistic nature of clinical and research practice in the mid-twentieth century. If the individual physician is the locus of medical judgment, then the physician’s character becomes a key concern for bioethics. These appeals still appear and have implications for bioethics in the present day. (shrink)

Contemporary research ethics policies started with reflection on the atrocities perpetrated upoconcentration camp inmates by Nazi doctors. Apparently, as a consequence of that experience, the policies that now guide human subject research focus on the protection of human subjects by making informed consent the centerpiece of regulatory attention. I take the choice of context for policy design, the initial prioritization of informed consent, and several associated conceptual missteps, to have set research ethics off in the wrong direction. The aim of (...) this paper is to sort out these confusions and their implications and to offer instead a straightforward framework for considering the ethical conduct of human subject research. In the course of this discussion I clarify different senses of autonomy that have been confounded and present more intelligible justifications for informed consent. I also take issue with several of the now accepted dogmas that govern research ethics. These include: the primacy of informed consent, the protection of the vulnerable, the substitution of beneficence for research's social purpose, and the introduction of an untenable distinction between innovation and research. (shrink)

Paternalism has generally been thought of as forcible or coercive interference with a person's liberty of action which is justified because it will prevent harm to that person's welfare interests or the like. Opposition to paternalistic interference with adults, whether it involves the intervention of the state or another adult individual, has usually been based on a concern to preserve human autonomy or self-determination. More strictly it is opposition to so-called ‘strong’ paternalism - interventions to protect or benefit a person (...) despite the person's informed voluntary consent to the contrary- which has been grounded on such a commitment to self-determination. ‘Weak’ paternalism involves interference where there is a defect in the decision-making capacities of the person interfered with. It is claimed to be justifiable insofar asconsentto the interference would be forthcoming were these capacities restored. (shrink)

Paternalism has generally been thought of as forcible or coercive interference with a person's liberty of action which is justified because it will prevent harm to that person's welfare interests or the like. Opposition to paternalistic interference with adults, whether it involves the intervention of the state or another adult individual, has usually been based on a concern to preserve human autonomy or self-determination. More strictly it is opposition to so-called ‘strong’ paternalism - interventions to protect or benefit a person (...) despite the person's informed voluntary consent to the contrary- which has been grounded on such a commitment to self-determination. ‘Weak’ paternalism involves interference where there is a defect in the decision-making capacities of the person interfered with. It is claimed to be justifiable insofar asconsentto the interference would be forthcoming were these capacities restored. (shrink)

As the assumptions of perpetual economic and population growth no longer stand, the welfare systems built on such promises are in peril. Policymakers must reallocate the responsibility for providing care between generations. Democratic theories can help establish procedures for finding solutions, particularly in ageing democratic countries. By analysing existing representative and deliberative democratic theories, this paper explores how the interests of future generations could be included in such procedures. A hypothetical social health insurance scheme with the pay-as-you-go financial arrangement is (...) selected as an illustrative case. This paper argues that due to the intrinsic bias towards the current generation, both representative and deliberative democratic health policymaking are limited in making decisions that account for future generations. Instead, their interests could be at best represented by benevolent representatives. (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)

Philosophers have talked to each other about moral issues concerning technology, but few of them have talked about issues of technology and the good life, and even fewer have talked about technology and the good life with the public in the form of recommendation. In effect, recommendations for various technologies are often left to technologists and gurus. Given the potential benefits of informing the public on their impacts on the good life, however, this is a curious state of affairs. In (...) the present paper, I will examine why philosophers are seemingly reluctant to offer recommendations to the public. While there are many reasons for philosophers to refrain from offering recommendations, I shall focus on a specific normative reason. More specifically, it appears that, according to a particular definition, offering recommendations can be viewed as paternalistic, and therefore is prima facie wrong to do so. I will provide an argument to show that the worry about paternalism is unfounded, because a form of paternalism engendered by technology is inevitable. Given the inevitability of paternalism, I note that philosophers should accept the duty to offer recommendations to the public. I will then briefly turn to design ethics, which has reconceptualised the role of philosophers and, in my mind, fitted well with the inevitability of paternalism. Finally, I shall argue that design ethics has to be supplemented by the practice of recommendation if it is to sustain its objective. (shrink)

ZusammenfassungEs ist ein Standard-Verfahren der Medizinethik, auf die Möglichkeit des Missbrauchs solcher Instrumente hinzuweisen, die im lege-artis-Gebrauch legitim sein können. Ein etabliertes Instrument der medizinischen Praxis sind paternalistische Handlungen, die bei geringer Reichweite individueller Entscheidungskompetenz, etwa bei Minderjährigen, verantwortliches Handeln absichern sollen. In der bisherigen Debatte wird Paternalismus als Problem eines ungerechtfertigten oder übermäßigen Gebrauchs diskutiert. Bislang erscheint in der medizinethischen Paternalismus-Debatte das Problem des scheinbaren Paternalismus zu wenig reflektiert. Auch die Thematik der sexualisierten Gewalt gegen Minderjährige im medizinischen Setting (...) ist bisher wenig beachtet worden. Für diese spezifische Form der Gewalt gibt es verschiedene Ermöglichungsbedingungen. Eine wichtige liegt in der Akzeptanz paternalistischer Handlungen im medizinischen Kontext. Denn ein scheinbarer Paternalismus im Zusammenhang mit sexualisierter Gewalt gegen Minderjährige profitiert von der Praxis des passageren Übergehens des aktuellen Willens eines Kindes. Der prominente Fall Larry Nassars, der als Teamarzt der US-Kunstturnerinnen in hunderten Fällen junge Patientinnen sexualisierter Gewalt ausgesetzt hat, macht auf die Möglichkeit sexualisierter Gewalt durch medizinisches Personal aufmerksam. Geht es in der Paternalismus-Debatte um die Frage, in welchen Zusammenhängen Paternalismus problematisch oder unproblematisch ist, so trägt diese Studie den Problemaspekt der Täuschung im Zusammenhang mit sexualisierter Gewalt bei. Sie leistet damit einerseits einen Beitrag zur Thematisierung sexualisierter Gewalt im klinischen Kontext, und sie trägt zum anderen zur medizinethischen Diskussion des Paternalismus bei, die nicht von der Möglichkeit des Schein-Paternalismus absehen sollte. Unter Schein-Paternalismus oder fingiertem Paternalismus wird hier eine Haltung und Praxis verstanden, die in der Gestalt eines Paternalismus eigene Interessen des Agierenden zum Schaden der in Abhängigkeit befindlichen Person verfolgt und Fürsorgepflichten ignoriert. Denn die kindliche Gewöhnung an die Unterordnung des eigenen Willens und Körpers im asymmetrischen klinischen Kontext kann dazu genutzt werden, fingierten Paternalismus zu etablieren. Die Rede vom Schein-Paternalismus soll dabei aber nicht darüber hinwegtäuschen, dass die Grenzziehung zwischen Paternalismus und Nicht-Paternalismus in der Praxis ebenso komplex ist wie diejenige zwischen körperlich-asexueller und körperlich-sexueller Gewalt. Ein präzises und transparentes lege-artis-Modell des Paternalismus soll hier als Basis für die Prävention sexualisierter Gewalt im klinischen Kontext diskutiert werden. Methodisch basiert diese Arbeit auf einer Auswertung der interdisziplinären Fachliteratur zur sexualisierten Gewalt im klinischen Kontext und zum Paternalismus. Es folgt dann eine Zusammenfügung der so gewonnenen Erkenntnisse, sodass am Ende eine komplexere Aussage AB über das Verhältnis von sexualisierter Gewalt und Schein-Paternalismus steht. (shrink)

Public health policies which involve active intervention to improve the health of the population are often criticized as paternalistic. This article argues that it is a mistake to frame our discussions of public health policies in terms of paternalism. First, it is deeply problematic to pick out which policies should count as paternalistic; at best, we can talk about paternalistic justifications for policies. Second, two of the elements that make paternalism problematic at an individual level—interference with liberty and lack of (...) individual consent—are endemic to public policy contexts in general and so cannot be used to support the claim that paternalism in particular is wrong. Instead of debating whether a given policy is paternalistic, we should ask whether the infringements of liberty it contains are justifiable, without placing any weight on whether or not those infringements of liberty are paternalistic. Once we do so, it becomes apparent that a wide range of interventionist public health policies are justifiable. (shrink)

This paper examines the moral force of exploitation in developing world research agreements. Taking for granted that some clinical research which is conducted in the developing world but funded by developed world sponsors is exploitative, it asks whether a third party would be morally justified in enforcing limits on research agreements in order to ensure more fair and less exploitative outcomes. This question is particularly relevant when such exploitative transactions are entered into voluntarily by all relevant parties, and both research (...) sponsors and host communities benefit from the resulting agreements. I show that defenders of the claim that exploitation ought to be permitted rely on a mischaracterization of certain forms of interference as unjustly paternalistic and two dubious empirical assumptions about the results of regulation. The view I put forward is that by evaluating a system of constraints on international research agreements, rather than individual transaction-level interference, we can better assess the alternatives to permitting exploitative research agreements. (shrink)

Doctors routinely refuse donation offers from prospective living kidney donors with certain comorbidities such as diabetes or obesity out of concern for donor wellbeing. This refusal occurs despite the ongoing shortage of kidney transplants and the superior performance of living donor kidney transplants compared to those from deceased donors. In this paper, we argue that this paternalistic refusal by doctors is unjustified and that, within limits, there should be greater acceptance of such donations. We begin by describing possible weak and (...) strong paternalistic justifications of current conservative donor acceptance guidelines and practices. We then justify our position by outlining the frequently under-recognised benefits and the routinely overestimated harms of such donation, before discussing the need to respect the autonomy of willing donors with certain comorbidities. Finally, we respond to a number of possible objections to our proposal for more liberal kidney donor acceptance criteria. We use the situation in Australia as our case study, but our argument is applicable to comparable situations around the world. (shrink)

The practice of paternalism has changed along with developments in medicine, philosophy, law, sociology and psychology. Physicians have learned that a patient's values are a factor in determining what is best for that patient. Modern paternalism continues to be guided by the principle that the physician decides what is best for the patient and pursues that course of action, taking into account the values and interests of the patient. In the autonomy model of the doctor-patient relationship, patient values are decisive. (...) In the paternalistic model, they are but one among several factors the physician must consider in making a medical decision. Although difficult to practise because of limitations in empathising with another person, modern paternalism remains a way to achieve maximum patient benefit. (shrink)

In this paper I will deal with two questions. One is the relatively specific issue of whether mandatory retirement is unjust discrimination against the aged. The position taken is that it is not. But in the development of this argument a principle is advanced which appears to have the consequence that nothing, or at least very few of the practices that we are intuitively inclined to regard as unfair discrimination, are discriminatory with respect to age.

The provider–patient relationship is typically regarded as an expert-to-novice relationship, and with good reason. Providers have extensive education and experience that have developed in them the competence to treat conditions better and with fewer harms than anyone else. However, some researchers argue that many patients with long-term conditions (LTCs), such as arthritis and chronic pain, have become “experts” at managing their LTC. Unfortunately, there is no generally agreed-upon conception of “patient expertise” or what it implies for the provider–patient relationship. I (...) review three prominent accounts of patient expertise and argue that all face serious objections. I contend, however, that a plausible account of patient expertise is available and that it provides a framework both for further empirical studies and for enhancing the provider–patient relationship. (shrink)

It is relatively uncontroversial that some public health policies are paternalistic. Furthermore, that they are paternalistic is often taken to show that they are morally wrong. In this article I challenge this position. The article starts by arguing that given standard definitions of paternalism it is unclear why such policies count as paternalistic. Whilst it might appear that they impose restrictions on what individuals can, or cannot, do for their own good, this is not the case. The reason for this (...) is that whilst public health policies focus on achieving benefits at a population or group level, the imposition is made at the level of the individual. If we are to retain the idea that such policies are paternalistic we must characterize them in such a way that both the benefit and imposition are at the same level: either that of the individual or that of the group. I argue that in many cases moving to the group level is the only plausible option. However, if we move to the group level, the features that make a policy paternalistic will not, unlike in those cases where paternalism is targeted at an individual, make the policy morally wrong. (shrink)

Mobile health devices pose novel questions at the intersection of philosophy and technology. Many such applications not only collect sensitive data, but also aim at persuading users to change their lifestyle for the better. A major concern is that persuasion is paternalistic as it intentionally aims at changing the agent’s actions, chipping away at their autonomy. This worry roots in the philosophical conviction that perhaps the most salient feature of living autonomous lives is displayed via agency as opposed to patiency—our (...) lives go well in virtue of what we do, rather than what happens to us. Being persuaded by a device telling us how to conduct our lives seemingly renders the agent passive, an inert recipient of technological commands. This agential bias, however, has led to a marginalization of patiential characteristics that are just as much part of our lives as are agential characteristics. To appreciate the inherent interlocking of acting and being acted upon, it is vital to acknowledge that agency and patiency are correlates, not mutually exclusive opposites. Furthermore, it is unclear whether an action can only count as agential so long as its causes are internal. Drawing on the extended mind and extended will framework, I argue that mHealth applications merely serve as volitional aids to the agent’s internal cognition. Autonomously set goals can be achieved more effectively via technology. To be persuaded by an mHealth device does not mainly—let alone exclusively—emphasize patiency; on the contrary, it can be an effective tool for technologically enhancing agency. (shrink)

When are we morally obligated as a society to help the homeless, and is coercive interference justified when help is not asked for, even refused? To answer this question, we propose a comprehensive taxonomy of different types of homelessness and argue that different levels of autonomy allow for interventions with varying degrees of pressure to accept help. There are only two categories, however, where paternalism proper is allowed, be it heavily qualified. The first case is the homeless person with severely (...) diminished autonomy as a result of mental illness, and the second case is the homeless person who runs a risk of serious and imminent harm to self. In the first case, namely, that of soft paternalism, we argue that coercive intervention in the case of a refusal to accept help should be focused on the provision of housing that meets basic needs—needs that we outline in the article. In the case of imminent and severe harm to self, the case of hard paternalism, we argue that forced intervention can only be allowed if it is temporary and local, namely focused on getting someone out of harm’s way. (shrink)

Paternalism, understood as coercive intervention with the behavior of a person in order to prevent her from causing harm to herself, is a highly controversial issue, because it implies a departure from the widely recognized principle of harm to others. Some conceptual differences between legal paternalism and other forms of state coercion that also depart from the principle of harm to others will be indicated. This is followed by an analysis of the arguments that are usually brought forth against legal (...) paternalism. And finally, the possibility of determining ethically justifiable types of legal paternalism is explored. (shrink)

Mill argues that, apart from the principle of utility, his utilitarianism is incompatible with absolutes. Yet in On Liberty he introduces an exceptionless anti-paternalism principle—his liberty principle. In this paper I address ‘the absolutism problem,’ that is, whether Mill's utilitarianism can accommodate an exceptionless principle. Mill's absolute claim is not a mere bit of rhetoric. But the four main solutions to the absolutism problem are also not supported by the relevant texts. I defend a fifth solution—the competence view—that turns on (...) his attention to decision-making structures and, in particular, on the role of expertise considerations in his account. (shrink)

Lifestyle-induced diseases are becoming a burden on healthcare, actualizing the discussion on health responsibilities. Using data from the National Association for Heart and Lung Diseases ’s 2015 Health Survey, this study examined the public’s attitudes towards personal and social health responsibility in a Norwegian population. The questionnaires covered self-reported health and lifestyle, attitudes towards personal responsibility and the authorities’ responsibility for promoting health, resource-prioritisation and socio-demographic characteristics. Block-wise multiple linear regression assessed the association between attitudes towards health responsibilities and individual (...) lifestyle, political orientation and health condition. We found a moderate support for social responsibility across political views. Respondents reporting unhealthier eating habits, smokers and physically inactive were less supportive of health promotion policies. The idea that individuals are responsible for taking care of their health was widely accepted as an abstract ideal. Yet, only a third of the respondents agreed with introducing higher co-payments for treatment of ‘self-inflicted’ conditions and levels of support were patterned by health-related behaviour and left-right political orientation. Our study suggests that a significant support for social responsibility does not exclude a strong support for personal health responsibility. However, conditional access to healthcare based on personal lifestyle is still controversial. (shrink)

Comprender los dilemas éticos en torno a la subrogación de útero exige un conocimiento preciso de los conceptos de libertad y autonomía reproductiva. Una aproximación pertinente debe reconocer la naturaleza de la opresión sexual, sobre todo de cómo influye en la autonomía de las mujeres, en sus elecciones, en la identidad propia y en las relaciones interpersonales. El objetivo de este ensayo es defender la relevancia de las críticas del feminismo radical a las corrientes liberales progresistas, que a menudo prestan (...) mayor atención a los intereses de los denominados padres intencionales. Considerando lo que varias filósofas igualitaristas han expuesto desde una perspectiva socio-relacional de la autonomía para permitir la subrogación bajo ciertas condiciones -específicamente, sostienen que la regulación es compatible con la autonomía reproductiva de las mujeres si se sigue una modalidad altruista en un ambiente de protección y apoyo ante la revocación del consentimiento-, defiendo que las feministas radicales esclarecen apropiadamente cómo la opresión contra la mujer permanece en el ambiente cultural que aprueba los contratos de subrogación. La metodología macroscópica, basada en la metáfora del ave enjaulada de la filósofa norteamericana Marilyn Frye, es una herramienta provechosa para comprender por qué la subrogación no implica una mejoría para la autonomía reproductiva de las mujeres, incluso si permite que algunas madres gestantes obtengan un ingreso suficiente para sobrellevar la presión económica. (shrink)

When assessing the cost effectiveness of health care programmes, health economists typically presume that distant events should be given less weight than present events. This article examines the moral reasonableness of arguments advanced for positive discounting in cost-effectiveness analysis both from an intergenerational and an intrapersonal perspective and assesses if arguments are equally applicable to health and monetary outcomes. The article concludes that behavioral effects related to time preferences give little or no reason for why society at large should favour (...) the present over the future when making intergenerational choices regarding health. The strongest argument for discounting stems from the combined argument of diminishing marginal utility in the presence of growth. However, this hinges on the assumption of actual growth in the relevant good. Moreover, current modern democracy may be insufficiently sensitive to the concerns of future generations. The second part of the article categorises preference failures (which justify paternalistic responses) into two distinct groups, myopic and acratic. The existence of these types of preference failures makes elicited time preferences of little normative relevance when making decisions regarding the social discount rate, even in an intrapersonal context. As with intergenerational discounting, the combined arguments of growth and diminishing marginal utility offer the strongest arguments for discounting in the intrapersonal context. However, there is no prima facie reason to assume that this argument should apply equally to health and monetary values. To be sure, selecting an approach towards discounting health is a complex matter. However, the life-or-death implications of any approach require that the discussion not be downplayed to merely a technical matter for economists to settle. (shrink)

This article explores the media representation of Muslims using critical discourse analysis. It emphasises the discursive construction of governmental paternalism that forms the dominant ideological disposition of China Daily’s coverage. The results reveal how Chinese official English newspapers facilitate the government’s dissemination of paternalistic discourse in the news of a large population of Chinese Muslims over the period. The investigation combines topic modelling with topos analysis to identify topics and topoi and to exhibit the ideology through the corpus compiled with (...) CD’s news about Chinese Muslims. Our findings both uncover the extent to which CD is used to promote paternalistic discourse by topic and reveal how paternalism is constructed by topoi. CD can be seen to strongly legitimise the paternalistic framework corresponding with the government’s promotion of social development and security in the region. Reciprocally, most Chinese Muslims are portrayed as obedient and dependent Chinese citizens who benefit from the government’s intervention. (shrink)

ABSTRACTThis essay introduces paternalism—a concept widely discussed in political philosophy and applied ethics—into media ethics, given that the concept is frequently mentioned but rarely explicated. The purpose of the essay is to defend paternalism as a normatively positive concept. The essay defines paternalism, outlines normative objections to paternalism grounded in autonomy and rationality, and applies the concept of paternalism to journalism. Theoretical connections to virtue ethics and implications for the practice of journalism are also discussed.

One important ethical issue for health promotion and public health work is to determine what the goals for these practices should be. This paper will try to clarify what some of these goals are thought to be, and what they ought to be. It will specifically discuss two different approaches to health promotion, such as, behavior change and empowerment. The general aim of this paper is, thus, to compare the behavior-change approach and the empowerment approach, concerning their immediate goals or (...) aims, and to morally evaluate the strengths and weaknesses of these two goal models, in relation to the ultimate goal of health promotion. The investigation shows that the behavior-change approach has several moral problems. First of all, it is overly paternalistic and often disregards the individual’s or group’s own perception of what is important—something that also increases the risk of failed interventions. Furthermore, it risks leading to ‘victim blaming’ and stigmatization, and to increased inequalities in health, and it puts focus on the ‘wrong’ problems, i.e., behavior instead of the ‘causes of the causes’. It is thereafter shown that the empowerment approach does not have any of these problems. Finally, some specific problems for the empowerment approach are discussed and resolved, such as, the idea that empowering some groups might lead to power over others, the objection that the focus is not primarily on health, and the fact that empowered people might choose to live lives that risk reducing their health. (shrink)

:This article examines the moralistic language and arguments used in relation to genetics. The focus is on three practices: the claims that there is a duty to know about one’s own genetic makeup, assertions that genetic information should be used to inform reproductive decisions, and the proposition that there are moral reasons to participate in biobank research. With these three, the author contends that there are equally good, if not better, arguments to challenge them from a Millian perspective. Furthermore, especially (...) in the current political climate, there is a need to respect people’s privacy concerns. (shrink)

The development of personal technologies has recently shifted from devices that seek to capture user attention to those that aim to improve user well-being. Digital wellness technologies use the same attractive qualities of other persuasive apps to motivate users towards behaviors that are personally and socially valuable, such as exercise, wealth-management, and meaningful communication. While these aims are certainly an improvement over the market-driven motivations of earlier technologies, they retain their predecessors’ focus on influencing user behavior as a primary metric (...) of success. Digital wellness technologies are still persuasive technologies, and they do not evade concerns over whether their influence on users is ethically justified. In this paper, we describe several ethical frameworks with which to assess the justification of digital wellness technologies’ influence on users. We propose that while some technologies help users to complete tasks and satisfy immediate preferences, other technologies encourage users to reflect on the values underlying their habits and teach them to evaluate their lives’ competing demands. While the former approach to digital wellness technology is not unethical, we propose that the latter approach is more likely to lead to skillful user engagement with technology. (shrink)

In the world of Austrian neonatal intensive care units, the role of ethics is recognized only partially. The normatively tense cases that are at the backdrop of this essay concern the situations around the limit of viability, which is the point in the development of an extremely preterm infant at which there are chances of extra-uterine survival. This essay first outlines the key explicit ethical challenges that are mainly concerned with notions of uncertainty and best interest. Then, it attempts to (...) elucidate the less explicit ethical challenges related to the notion of nudging in the neonatal practice and argue that the role of ethics needs to be recognized more—with the focus on the role of virtue ethics—in order to improve the practice of neonatal medicine. (shrink)

Jeffrey Howard has recently argued that entrapment and similar phenomena are wrongful - and wrong the induced agent - because they violate a regulative obligation of respect for the first moral power According to Howard, this obligation grounds a duty not to foreseeably increase the likelihood that another agent acts wrongly While I accept the existence of the more fundamental obligation, I try to show that it doesn't support DUTY. Therefore, it doesn't support the wrongfulness of entrapment and similar phenomena. (...) I do this by offering a more nuanced account of FMP's value, and one more attuned to certain liberal thoughts about agency. I then suggest a fairly minimalist picture of what respect for FMP involves, but close in a constructive spirit by sketching an alternative argument for DUTY based on the telos of FMP. (shrink)

In 1987, Machan provided a libertarian case against the right to occupational safety. Since before Machan’s essay appeared, many business ethicists and legal scholars have given considerable attention to the overall position Machan endorses: the acceptance of employment at will and the rejection of employee rights. No one yet has given adequate attention, however, to the fact that Machan’s argument against the right to occupational safety actually stands or falls independently of his overall position on employee rights. His argument ultimately (...) rests on two values: the promotion of employee interests and anti-paternalism. Insofar as those who support the right to occupational safety share those values, they must find a strategy for opposing Machan’s argument that preserves those values. In this paper, I demonstrate why Machan’s argument ultimately rests on the promotion of employee interests and anti-paternalism. Then, I develop an objection to Machan’s argument that preserves those values. (shrink)

This paper argues that the concept of paternalism is currently overextended to include a variety of actions that, while resembling paternalistic actions, are importantly different. I use the example of Japanese physicians’ non-disclosures of cancer diagnoses directly to patients, arguing that the concept of maternalism better captures these actions. To act paternalistically is to substitute one's own judgement for that of another person and decide in place of that person for his/her best interest. By contrast, to act maternalistically is to (...) decide for another person based on a reasonable understanding of that person's own preferences. The concept of maternalism allows for a more thorough assessment of the moral justification of these types of actions. I conclude that it is possible, at least in principle, to justify Japanese physicians’ non-disclosures, and that this justification must be based on an understanding of these actions as maternalistic. (shrink)

_GPs serve in a double role of treatment provider and expert in certain social insurance systems, such as the Norwegian one. Some physicians assert that the ethical obligations of the two roles conflict with each other. The objective of this article is to show that social insurance medical ethics, which are based on recognised principles of medical ethics, unite the physicians’ obligations associated with these roles. The method applied is a medical ethics conceptual analysis. The material consists of literature on (...) normative SIME. The study shows that SIME expands the role of the treatment provider to a wider societal context. Here, physicians should attempt to balance the perspectives of sympathy with empathy, as treatment providers, with the impartiality in their role as experts. Five principles of medical ethics are fundamental. Respect for human dignity is the overarching principle of medical ethics. The four others are nonmaleficence, beneficence, autonomy, and social justice. The article discusses two areas where it is asserted that the roles of treatment provider and expert conflict with each other: the application of beneficence and justice, and the duty of confidentiality versus the duty to provide information to the National Insurance service. The study concludes that there are no basic ethical conflicts between the two roles. The ethical problems that may arise when exercising this duality should be viewed in the same way as other ethical problems in medicine. Actual application and balancing of the principles may necessitate negotiations between patients and physicians. _ _Keywords_: dual roles, professionalism, deliberation, impartiality, medical principle ethics, values of welfare state. (shrink)

In this paper, by applying a feminist bioethical perspective, we identify a new form of medical paternalism that still shapes contemporary legal policies on human egg cryopreservation performed without medical reasons. The fear of negligent, careless women who opt to delay their pregnancy for mere convenience is a widely known gender biased stereotype. Nevertheless, the opinions and judgments of medical professionals on this issue have not yet been sufficiently explored by in-depth research. In this essay, therefore, first we look at (...) the broader bioethical, legal, and social aspects of human egg cryopreservation. In the second part of the paper we discuss a unique qualitative study conducted with professionals working at Hungarian IVF clinics. We argue, based on a bioethical analysis of the collected data, that when new reproduction technologies provide opportunities for women to widen their range of reproductive choices, the traditional forms of medical paternalism can be reinforced by gendered paternalism, as well. We identify several elements of gendered paternalism that characterized the attitudes of the IVF staff and discuss the professionals’ resistance to elective egg freezing and vitrification of eggs for the future. We conclude by suggesting directions for future policy. Although we focus on the Hungarian case in this paper, we are aware that similar attitudes can be observed in some other countries where this technology has become available and requested by women, but where they also face difficulties in their access to it. (shrink)

This essay argues that Dworkin, Feinberg and others who claim exceptions against the principle of paternalism for the sake of preventing seroius physical harm are forced to treat mature adults as mental incompetents and that they are forced to do so by the prevailing concept of paternalism itself. The essay then shows how we can get around this dilemma by re-thinking paternalism as part of distinctly paternal relationships of domination and inequality.

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 draws on scientific explanations of obesity to motivate the creation of a system of paternalistic public health interventions into the obesity epidemic. Libertarian paternalists argue that paternalism is warranted in light of the cognitive limits of human decision-making abilities. There are further, specific biological limits on our capacity to choose and maintain a healthy diet. These biological facts strengthen the general motivation for libertarian paternalism. As a consequence, the creation of a system of paternalistic public health interventions into (...) the obesity epidemic is warranted. (shrink)

The commonly occurring metaphors and models of the doctor–patient relationship can be divided into three clusters, depending on what distribution of power they represent: in the paternalist cluster, power resides with the physician; in the consumer model, power resides with the patient; in the partnership model, power is distributed equally between doctor and patient. Often, this tripartite division is accepted as an exhaustive typology of doctor–patient relationships. The main objective of this paper is to challenge this idea by introducing a (...) fourth possibility and distribution of power, namely, the distribution in which power resides with neither doctor nor patient. This equality in powerlessness—the hallmark of “the age of bureaucratic parsimony”—is the point of departure for a qualitatively new doctor–patient relationship, which is best described in terms ofsolidaritybetweencomrades. This paper specifies the characteristics of this specific type of solidarity and illustrates it with a case study of how Swedish doctors and patients interrelate in the sickness certification practice. (shrink)