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)

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)

ABSTRACT:Drawing upon John Rawls's framework inThe Law of Peoples,this paper argues that MNEs have a responsibility to promote well-ordered social and political institutions in host countries that lack them. This responsibility is grounded in a negative duty not to cause harm. In addition to addressing the objection that promoting well-ordered institutions represents unjustified interference by MNEs, the paper provides guidance for managers of MNEs operating in host countries that lack just institutions. The paper argues for understanding corporate responsibility in relation (...) to the specific institutional environment in which MNEs operate. (shrink)

On the standard view we assess a person’s competence by considering her relevant abilities without reference to the actual decision she is about to make. If she is deemed to satisfy certain threshold conditions of competence, it is still an open question whether her decision could ever be overruled on account of its harmful consequences for her (‘hard paternalism’). In practice, however, one normally uses a variable, risk dependent conception of competence, which really means that in considering whether or not (...) to respect a person’s decision-making authority we weigh her decision on several relevant dimensions at the same time: its harmful consequences, its importance in terms of the person’s own relevant values, the infringement of her autonomy involved in overruling it, and her decision-making abilities. I argue that we should openly recognize the multi-dimensional nature of this judgment. This implies rejecting both the threshold conception of competence and the categorical distinction between hard and soft paternalism. (shrink)

Public health is concerned with increasing the health of the community at whole. Insofar as health is a ‘good’ and the community constitutes a ‘public’, public health by definition promotes a ‘public good’. But ‘public good’ has a particular and much more narrow meaning in the economics literature, and some commentators have tried to limit the scope of public health to this more narrow meaning of a ‘public good’. While such a move makes the content of public health less controversial, (...) it also strips important goals from the realm of public health, goals that traditionally have been, and morally should be, a part of it. Instead, I will argue, while public health should be defined by public goods, it should be defined by a broader conception of public goods that I shall call ‘normative public goods’, goods that ought to be treated as if they were public goods in the more narrow sense. (shrink)

Some writers suggest that corporations should act in ways which reflect a broad concern for the well-being of others, as opposed to a more narrow (Libertarian) conception of responsibility. But this Broad View of moral responsibility puts us on a collision course with our considered intuitions about paternalistic acts. This paper discusses several aspects of this issue: the neutrality of the Standard View of Paternalism, the nature of the defenses of paternalistic interventions allowed by the Standard View of Paternalism and (...) their reliance on consent; and the sort of position on paternalism the Board View would have to endorse in order to justify the benevolence-motivated orientation required by its conception of moral responsibility.The conclusion is that unless we are prepared to take a different, non-standard view of paternalism the Board View of corporate moral responsibility will be untenable. (shrink)

Epistemic paternalism is the thesis that in some circumstances we are justified in interfering with the inquiry of another for their own epistemic good without consulting them on the issue. In this paper, I address the issue of who is rationally entitled to undertake paternalistic interferences, and in virtue of which features one has this entitlement. First, I undermine the view according to which experts are the most apt people to act as paternalist interferers. Then, I argue that epistemic authorities (...) are in a better position to satisfy the requirements of justified epistemic paternalism, when conceived according to the service model of epistemic authority. Finally, I offer a virtue-based account of paternalist interferers and show how it can apply to cases in which the interferer is a group or an institution. (shrink)

In this paper, I criticize two recent and influential arguments for no-platforming advanced by Robert Simpson and Amia Srinivasan and by Neil Levy, respectively. What both arguments have in common is their attempt to reconcile no-platforming with liberal values. For Simpson and Srinivasan, no-platforming does not contradict liberalism if grounded on the distinction between norms of free speech and norms of academic freedom; for Levy, those who defend the practice need not be accused of promoting paternalism. I argue that neither (...) view succeeds: these authors’ views are in strong tension with core tenets of liberalism. I proceed as follows: after introducing some basic liberal principles, I explain Simpson and Srinivasan’s argument in more detail and argue that it is too strong for some their stated purposes; then I proceed to show that both Simpson and Srinivasan and Levy’s arguments would justify extremely closed universities; finally, after arguing that Levy’s stance does not circumvent paternalism, I present some evidence that no-platforming would be captured by censors and probably threaten the very academic freedom that the authors want to protect. (shrink)

In recent years, many scholars have offered innovative accounts of social categories such as gender, race, and disability. By contrast, comparatively little work has been done on the category of children. The goal of our paper is to offer a new account of what children are. We start by discussing the two main accounts that have been put forward so far in the literature: naturalistic accounts and normative accounts. According to the former, to be a child is a matter of (...) possessing, or lacking, some ‘natural’ and ‘objective’ properties. According to the latter, to be a child is to possess a particular normative status. We argue that both naturalistic and normative accounts are subject to a variety of objections. We then propose our own social constructivist account. According to it, to be a child in any given society is to be regarded by the dominant ideology of that society as the target of a set of broadly paternalistic norms, in virtue of the possession of a cluster of natural properties such that, according to the dominant ideology of that society, it is justified to subject that individual to such norms. We conclude our paper by showing that our account meets the criteria of success for an account of what it is to be a child and by addressing some objections. (shrink)

After describing some key features of life in an underground railroad and the nature of gray agency, Concepción illustrates how survivors of relationship slavery can stop levying misplaced blame on themselves without giving up the valuable practice of blaming. Concepción concludes that by choosing a relatively non-oppressive account of self-blame, some amount of internalized oppression can be overcome and the double bind of agency-denial and self-loathing associated with being an oppressively grafted agent can be reduced.

I argue that it can be morally permissible to coerce people into doing what is good for their own health. I discuss recent initiatives in New York City that are designed to take away certain unhealthy options from local citizens, and argue that this does not impose on them in unjustifiable ways. Good paternalistic measures are designed to promote people's long-term goals, and to prevent them from making short-term decisions that interfere with reaching those, and New York's attempts to ban (...) the sale of sugary drinks larger than 16 ounces and the use of trans fats fall within those parameters. Given our tendency to cognitive bias, we need help in making choices that truly instantiate our values. (shrink)

Beneficence and respect for autonomy are two of the most fundamental moral duties in general and in bioethics in particular. Beyond the usual questions of how to resolve conflicts between these duties in particular cases, there are more general questions about the possible forms of the interactions between them. Only recognition of the full spectrum of possible interactions will ensure optimal moral deliberation when duties potentially conflict. This paper has two simultaneous objectives. The first is to suggest a typological scheme (...) of all possible modes of interaction; these will be classified under the “discrete,” “semi-discrete,” and “non-discrete” categories, according to whether the meaning and/or forms of expression of each duty are treated as independent from or rather as constrained by the other. The second objective is to show that all logical possibilities of interaction indeed have real expressions in medical ethics, to provide clear illustrations of each, and in particular to stress those that have usually escaped recognition. (shrink)

This paper analyses J.S. Mill's theory on the relationships between individual autonomy and State powers. It will be argued that there is a significant discrepancy between Mill's general liberal statements aimed to secure individual largest possible autonomy and the specific examples which provide the government with quite wide latitude for interference in the public and private spheres. The paper outlines the boundaries of government interference in the Millian theory. Subsequently it describes Mill's elastic paternalism designed to prevent people from inflicting (...) harm upon others as well as upon themselves, from soft paternalism on issues like compulsory education to hard paternalism on very private matters such as marriage, having children, and divorce by consent. (shrink)

A capability approach prescribes paternalist government actions to the extent that it requires the promotion of specific functionings, instead of the corresponding capabilities. Capability theorists have argued that their theories do not have much of these paternalist implications, since promoting capabilities will be the rule, promoting functionings the exception. This paper critically surveys that claim. From a close investigation of Nussbaum's statements about these exceptions, it derives a framework of five categories of functionings promotion that are more or less unavoidable (...) in a capability theory. It argues that some of these categories may have an expansionary dynamic; they may give rise to widespread functionings promotion, which would defeat the capabilitarian promise that paternalist interventions will be exceptions to the rule of a focus on capabilities. Finally, the paper discusses three further theoretical issues that will be decisive in holding this paternalist tendency in check: how high one sets threshold levels of capability protection, how lengthy one's list of basic capabilities is, and how one deals with individual responsibility for choices resulting in a loss of one's capabilities. (shrink)

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

In a stimulating recent article for this journal (van Wynsberghe and Robbins in Sci Eng Ethics 25(3):719–735, 2019), Aimee van Wynsberghe and Scott Robbins mount a serious critique of a number of reasons advanced in favor of building artificial moral agents (AMAs). In light of their critique, vW&R make two recommendations: they advocate a moratorium on the commercialization of AMAs and suggest that the argumentative burden is now shifted onto the proponents of AMAs to come up with new reasons for (...) building them. This commentary aims to explore the implications vW&R draw from their critique. In particular, it will raise objections to the moratorium argument and propose a presumptive case for commercializing AMAs. (shrink)

Informed consent is normally understood as something that a patient gives prior to a medical intervention that can render it morally permissible. Whether or not it must be given prior to the intervention is debated. Some have argued that subsequent consent—that is, consent given after a medical intervention—can also render an otherwise impermissible act permissible. If so, then a patient may give her consent to an intervention that has already been performed and thereby justify a physician’s act retroactively. The purpose (...) of this paper is to argue that even if subsequent consent can render an otherwise impermissible act permissible, doctors are still blameworthy if they rely on it when prior consent could be given, because they would be banking on the justification of their interventions. Since doctors can only guess if patients will consent after the fact, they would be placing their patients at unreasonable risk of being disrespected as persons. (shrink)

1. IntroductionA paternalistic act is one in which the protection or promotion of a subject's welfare is the primary reason for attempted or successful coercive interference with an action or state of that person. My aim in this paper is to determine the conditions under which such acts are Justified. The route I take is through the concept of consent, with actual consent providing the foundation for a rather complex condition which I claim is necessary and sufficient for the Justification (...) of paternalism.Because a paternalistic act apparently violates a subject's right to non-interference, it constitutes a problem in the general area of rights. Ideally, then, one should have a developed and convincing theory of rights — that is, a theory which contains an analysis of the concept of a right, and offers solutions to the central problems, e.g. who has rights and why, what considerations override prima facie rights, and how the relative importance of prima facie rights is determined — from which the solutions to various problems about paternalism can be derived. (shrink)

Philosophers disagree about what precisely makes an act paternalistic, and about whether, when, and why paternalistic acts are morally objectionable. Despite these disagreements, it might seem uncontroversial to think that it is permissible to paternalize children. When paternalism seems morally objectionable, that is usually because an adult has been treated in a way that seems appropriate only for children. But, we might think, there can be nothing morally objectionable about treating children as children. In this paper, however, I argue that (...) there are limits to how we may permissibly paternalize children. I begin in Section 1 by describing and endorsing Jonathan Quong’s account of paternalism, which defines paternalistic acts as those that involve particular kinds of judgments that the paternalizer makes about the capacities of the paternalizee. In Section 2, I identify a distinction between two kinds of paternalism: ‘compensatory’ paternalism, and ‘non-compensatory’ paternalism. In Section 3, I argue that compensatory paternalism is usually permissible in the case of children. In section 4, I argue that non-compensatory paternalism is much harder to justify than compensatory paternalism, and because of this, it is sometimes impermissible even when directed at children. (shrink)

Medical practitioners are duty-bound to tell their patients the truth about their medical conditions, along with the risks and benefits of proposed treatments. Some patients, however, would rather not receive medical information. A recent response to this tension has been to argue that that the disclosure of medical information is not optional. As such, patients do not have permission to refuse medical information. In this paper I argue that, depending on the context, the disclosure of medical information can undermine the (...) patient’s ability to exercise her autonomy or have therapeutically detrimental effects. In the light of these insights I go on to develop a context-sensitive approach to medical disclosure. The advantage of this account is that it addresses concerns on both sides of the debate; whilst it acknowledges that patients do not have an exercisable ‘right not to know,’ it allows that in some cases medical information ought to be withheld. (shrink)

Epistemic paternalism is the thesis that a paternalistic interference with an individual's inquiry is justified when it is likely to bring about an epistemic improvement in her. In this article I claim that in order to motivate epistemic paternalism we must first account for the value of epistemic improvements. I propose that the epistemic paternalist has two options: either epistemic improvements are valuable because they contribute to wellbeing, or they are epistemically valuable. I will argue that these options constitute the (...) foundations of a dilemma: either epistemic paternalism collapses into general paternalism, or a distinctive project of justified epistemic paternalism is implausible. (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)

Some contemporary paternalists argue in favor of government interventions based on how experimental psychologists and behavioral economists have found that our behavior often diverges from what would be predicted by rational-choice models. In this article it is argued that these findings can, more specifically, be used to identify decisional trouble spots where paternalist interventions may be legitimate. It is further argued that since the epistemic legitimacy of government paternalism ultimately rests on centralized decision-making having a comparative advantage, it also depends (...) on the possibility of such interventions being governed by an ideal of evidence-based policy-making. The article asks how stringently this requirement should be understood, and to what extent government can legitimately engage in what might be called experimental policy-making of a paternalistic character. (shrink)

In this article, I propose a new model for understanding the function of representation in bioethics. Bioethicists have traditionally judged representations according to a mimetic paradigm, in which representations of bioethical dilemmas are assessed based on their correspondence to the “reality” of bioethics itself. In this article, I argue that this mimetic paradigm obscures the interaction between representation and reality and diverts bioethicists from analyzing the tensions in the representational object itself. I propose an anti-mimetic model of representation that is (...) attuned to how representations can both maintain and potentially subvert dominant conceptions of bioethics. I illustrate this model through a case study of Clint Eastwood’s film Million Dollar Baby. By focusing attention on the film’s lack of adherence bioethical procedures and medical science, critics missed how an analysis of its representational logic provides a means of reimagining both bioethics and medical practice. In my conclusion, I build off this case study to assess how an incorporation of representational studies can deepen—and be deepened by—recent calls for interdisciplinarity in bioethics. (shrink)

Robots are becoming an increasingly pervasive feature of our personal lives. As a result, there is growing importance placed on examining what constitutes appropriate behavior when they interact with human beings. In this paper, we discuss whether companion robots should be permitted to “nudge” their human users in the direction of being “more ethical”. More specifically, we use Rawlsian principles of justice to illustrate how robots might nurture “socially just” tendencies in their human counterparts. Designing technological artifacts in such a (...) way to influence human behavior is already well-established but merely because the practice is commonplace does not necessarily resolve the ethical issues associated with its implementation. (shrink)

The mission of public health is to assure the conditions in which people can be healthy and to reduce the occurrence of death and disability attributable to disease and injury. From the distinctive perspective of public health, the target is the health of the population as a whole, with a particular concern for vulnerable populations within the whole. Although public health is grounded in science, the mission and perspective of the field are shaped by the ever-evolving values of the society. (...) Ethics and law are therefore constituent disciplines of public health policy and practice. One of the major challenges confronting contemporary practitioners of public health is the need to broaden and deepen their understanding of legal and ethical aspects of their work. This special issue of the Joumal of Law, Medicine & Ethics responds to this challenge. This article describes how the mission of public health has come to encompass the prevention and treatment of injury and highlights some of the political and ethical controversies now confronting the field. (shrink)

The mission of public health is to assure the conditions in which people can be healthy and to reduce the occurrence of death and disability attributable to disease and injury. From the distinctive perspective of public health, the target is the health of the population as a whole, with a particular concern for vulnerable populations within the whole. Although public health is grounded in science, the mission and perspective of the field are shaped by the ever-evolving values of the society. (...) Ethics and law are therefore constituent disciplines of public health policy and practice. One of the major challenges confronting contemporary practitioners of public health is the need to broaden and deepen their understanding of legal and ethical aspects of their work. This special issue of the Joumal of Law, Medicine & Ethics responds to this challenge. This article describes how the mission of public health has come to encompass the prevention and treatment of injury and highlights some of the political and ethical controversies now confronting the field. (shrink)

Paternalistic behaviour directed towards a person’s informed and competent decisions is often thought to be morally impermissible. This view is supported by what we can call the Anti-Paternalism Principle. While APP might seem plausible when employed to show the wrongness of paternalism by the state, there are some cases of paternalistic behaviour between private, informed, and competent individuals where APP seems mistaken. This raises a difficulty for supporters of APP. Either they need to reject APP to accommodate our intuitions in (...) these cases, or provide grounds for thinking that paternalistic behaviour between certain private individuals is different in a morally relevant sense. In this paper, I explore several possible morally relevant differences, and find all of them unsatisfactory as grounds for maintaining the plausibility of APP. (shrink)

Public health ethicists face two difficult questions. First, what makes something a matter of public health? While protecting citizens from outbreaks of communicable diseases is clearly a matter of public health, is the same true of policies that aim to reduce obesity, gun violence or political corruption? Second, what should the scope of the government’s authority be in promoting public health? May government enact public health policies some citizens reasonably object to or policies that are paternalistic? Recently, some theorists have (...) attempted to address these questions by arguing that something is a matter of public health if and only if it involves a health-related public good, such as clean water or herd immunity. Relatedly, they have argued that appeals to the promotion of public health should only be used to justify the provision of health-related public goods. This public goods conception of public health (PGC) is meant to enjoy advantages over its rivals in three respects: it provides a better definition of public health than rival views, it respects moral disagreement, and it avoids licensing objectionably paternalistic public health policies. We argue, however, that the PGC does just as poorly, or worse, than its rivals in all three respects. (shrink)

Many believe that paternalism is less wrong in intimate relationships. In this paper, we argue that this view cannot be justified by appeal to (i) beneficence, (ii) shared projects, (iii) vulnerability, (iv) epistemic access, (v) expressivism, or (vi) autonomy as nonalienation. We finally provide an error theory for why many may have believed that paternalism is less wrong in intimate relations.

Many people feel that respecting a person’s autonomy is not sufficiently important to obligate us to stay out of their affairs in all cases; but the ground for interference may often turn out to be a hunch that the agent cannot really be competent, or cannot really know what her decision implies; for if she were both of these things, surely she would not make such a foolish decision. This paper suggests a justification of paternalism that does not rely on (...) such appeals. I argue that in cases where an agent will undergo a significant alteration in their evaluative outlook – ‘evaluative shift’ – three central, persuasive objections to paternalism lose their force, and offer a prima facie case for paternalism in some of these cases. I then suggest that we can extend this argument to some cases where evaluative alteration is not predictable, but where the risk and harm are both significant. In such cases, paternalism may be justified. (shrink)

This article argues that it is possible to act paternalistically towards future people, as long as the following requirements are met: the act/choice is not such that it will prevent the future person from coming into existence; the action/choice is such that it can be taken by the future person herself without significant disadvantage to her; and the act/choice is not such that there is significant uncertainty at the time of choice about the preferences of the future person. I argue (...) that the possibility of acting paternalistically towards future people is of practical as well as theoretical importance. This is true since some of the policies we might choose to pursue on behalf of future people are paternalistic, in particular constitutional policies implemented because we do not trust future people to choose wisely. I end the paper by pointing out why it is valuable to approach intergenerational issues through both the paternalistic prism and the prism of theories of justice. (shrink)

I introduce a new distinction between two types of paternalism, which I call ‘internal’ and ‘external’ paternalism. The distinction pertains to the question of whether the paternalized subject’s current evaluative judgments are mistaken relative to a standard of correctness that is internal to her evaluative point of view—which includes her ‘true’ or ‘ideal’ self—as opposed to one that is wholly external. I argue that this distinction has important implications for (a) the distinction between weak and strong paternalism; (b) the distinction (...) between soft and hard paternalism; and (c) medical practice, where internal paternalism can, and probably often does, occur. (shrink)

Anonymising technologies are cyber-tools that protect people from online surveillance, hiding who they are, what information they have stored and what websites they are looking at. Whether it is anonymising online activity through ‘TOR’ and its onion routing, 256-bit encryption on communications sent or smart phone auto-deletes, the user’s identity and activity is protected from the watchful eyes of the intelligence community. This represents a clear challenge to intelligence actors as it prevents them access to information that many would argue (...) plays a vital part in locating and preventing threats from being realised. Moreover, such technology offers more than ordinary information protections as it erects ‘warrant-proof’ spaces, technological black boxes that no matter what some authority might deem as being legitimately searchable is protected to the extent that there are very limited or non-existent means of forcing oneself in. However, it will be argued here that not only is using such anonymising technology and its extra layer of protection people’s right, but that it is ethically mandatory. That is, due to the en masse surveillance—from both governments and corporations—coupled with people’s limited awareness and ability to comprehend such data collections, anonymising technology should be built into the fabric of cyberspace to provide a minimal set of protections over people’s information, and in doing so force the intelligence community to develop more targeted forms of data collection. (shrink)

This paper aims to clarify the status of capability in Sen’s idea of justice. Sen’s name is so widely associated with the concept of capability that commentators often assume that his contribution to the study of justice amounts to a capability theory, albeit underdeveloped. We argue that such a reading is misleading. Taking Sen’s reticence about operationalization seriously, we show that his contribution is inconsistent with a capability theory. Instead, we defend the idea that the capability approach plays a heuristic (...) role: capability is a step in his argument against alternative materials, but is not meant as a definitive end. Sen defends a critical perspective primarily to encourage public reasoning and respect for agency as regards the definition of what should count in the evaluation of social states. (shrink)

Involuntary psychiatric commitment for suicide prevention and physician aid-in-dying (PAD) in terminal illness combine to create a moral dilemma. If PAD in terminal illness is permissible, it should also be permissible for some who suffer from nonterminal psychiatric illness: suffering provides much of the justification for PAD, and the suffering in mental illness can be as severe as in physical illness. But involuntary psychiatric commitment to prevent suicide suggests that the suffering of persons with mental illness does not justify ending (...) their own lives, ruling out PAD. Since both practices have compelling underlying justifications, the most reasonable accommodation might seem to be to allow PAD for persons with mental illness whose suffering is severe enough to justify self-killing, but prohibit PAD for persons whose suffering is less severe. This compromise, however, would require the articulation of standards by which persons’ mental as well as physical suffering could be evaluated. Doing so would present a serious philosophical challenge. (shrink)

:Contemporary global governance is organized around an odd pairing: care and control. On the one hand, much of global governance is designed to reduce human suffering and improve human flourishing, with the important caveat that individuals should be allowed to decide for themselves how they want to live their lives. On the other hand, these global practices of care are also entangled with acts of control. Peacebuilding, public health, emergency aid, human rights, and development are expressions of this tension between (...) care and control. There is a concept that captures this tension: paternalism. Drawing on our moral intuitions, I argue that paternalism is the attempt by one actor to substitute his judgment for another actor's on the grounds that such an imposition will improve the welfare of the target actor. After discussing and defending this definition, I note how our unease with paternalism seems to grow as we scale up from the interpersonal to the international, which I argue owes to the evaporation of community and equality. After exploring the implications of this definition and distinguishing it from other forms of intervention, I consider how different elements of paternalism combine to generate different configurations. Specifically, I point to five dimensions that are most relevant for examining the paternalism found in contemporary global and humanitarian governance: the tools used to restrict another actor’s liberty ; the scope of the interference ; the purpose of the intervention ; the source of the paternalizer’s confidence ; and the mechanisms of accountability. These different elements often correlate historically, suggestive of two ideal types of global paternalism: strong and weak. Contemporary global and humanitarian governance is largely the weak variety: force is severely proscribed, interference is relatively restricted, the paternalizer’s confidence has epistemic roots, and accountability to local populations remains a noble but rarely practiced goal. I further speculate that a major reason for this difference is the effects of liberalism and rationalization. I use this taxonomy to suggest how two different global efforts to improve the lives of those peoples living in what were perceived to be unstable and illiberal territories — the civilizing missions of the nineteenth century and the peacebuilding operations of the post-Cold War period — exhibited different kinds of paternalism. I conclude by reflecting on the ethics of international paternalism. (shrink)

I investigate whether tobacco health warnings’ interference with autonomy is ethically justifiable in order to deter people from smoking. I dissociate first the informational role and the persuasive role of tobacco health warnings and show that both roles enable typical addicted smokers to better rule themselves, fostering their autonomy. The fact that some messages address people’s non-deliberative faculties is therefore compensated by a larger positive influence on their autonomy. However, misleading messages are not ethically justified and should be avoided. Tobacco (...) health warnings’ effect on autonomy highlights an important difference between libertarian paternalism and classical paternalism. (shrink)

State-sponsored breastfeeding promotion campaigns have become increasingly common in developed countries. In this article, by using the tools of liberal political theory, as well as public health and health promotion ethics, we argue that such campaigns are not justified. They ignore important costs for women, including undermining autonomy, fail to distribute burdens fairly, cannot be justified neutrally and fail a basic efficacy test. Moreover, our argument demonstrates that breastfeeding campaigns are a rare case that bridges the fields of public health (...) ethics and the ethics of health promotion campaigns. This demonstrates the need to consider the ethics of state promotion of both voluntary and coercive behavioural change that benefits third parties. (shrink)

Works of art can be difficult in several ways. One important way is by making us face up to unsettling truths. Such works typically receive praise. I maintain, however, that sometimes they deserve moral censure. The crux of my argument is that, just as we have a right to know the truth in certain contexts, so too we have a right not to know it. Provided our ignorance does not harm or seriously endanger others, the decision about whether to know (...) the truth ought to be left to us. Within this limit, therefore, difficult art is morally problematic if it intentionally targets those who have chosen not to know. To illustrate the problem, I discuss the literary writings of Søren Kierkegaard, which aim to deceive readers into seeing unpleasant truths about themselves that they seek to ignore. (shrink)