I take as my starting point the “one very simple principle” proclaimed by Mill in On Liberty … “That principle is, that the sole end for which mankind are warranted, individually or collectively, in interfering with the liberty of action of any of their number, is self-protection. That the only purpose for which power can be rightfully exercised over any member of a civilized community, against his will, is to prevent harm to others. He cannot rightfully be compelled to do (...) or forbear because it will be better for him to do so, because it will make him happier, because, in the opinion of others, to do so would be wise, or even right.”. (shrink)

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

Mill predicted that "[t]he Liberty is likely to survive longer than anything else that I have written...because the conjunction of [Harriet Taylor’s] mind with mine has rendered it a kind of philosophic text-book of a single truth, which the changes progressively taking place in modern society tend to bring out in ever greater relief." Indeed, On Liberty is one of the most influential books ever written, and remains a foundational document for the understanding of vital political, philosophical and social issues. (...) In addition to its many useful appendices, this new edition includes a chronology, bibliography, and a substantial introduction which outlines Mill’s life and works, and sets this central work of 1859 in the context of both his own intellectual development and of the play of ideas and political forces in Victorian society. (shrink)

Joel Feinberg was a brilliant philosopher whose work in social and moral philosophy is a legacy of excellent, even stunning achievement. Perhaps his most memorable achievement is his four-volume treatise on The Moral Limits of the Criminal Law, and perhaps the most striking jewel in this crowning achievement is his passionate and deeply insightful treatment of paternalism.1 Feinberg opposes Legal Paternalism, the doctrine that “it is always a good reason in support of a [criminal law] prohibition that it is necessary (...) to prevent harm (physical, psychological, or economic) to the actor himself.” Against this doctrine Feinberg asserts that when an agent’s sufficiently voluntary choice causes harm to herself or risk of harm to herself, this category of harm-to-self is never a good reason in support of criminal law prohibition of that type of conduct. (shrink)

The philosophical debate on paternalism is conducted as if the property of being paternalistic should be attributed to actions. Actions are typically deemed to be paternalistic if they amount to some kind of interference with a person and if the rationale for the action is the good of the person interfered with. This focus on actions obscures the normative issues involved. In particular, it makes it hard to provide an analysis of the traditional liberal resistance to paternalism. Given the fact (...) that actions most often have mixed rationales, it is not clear how we should categorize and evaluate interfering actions for which only part of the rationale is the good of the person. The preferable solution is to attribute the property of being paternalistic not to actions, but to compounds of reasons and actions. The framework of action–reasons provides the tools for distinguishing where exactly paternalism lies in the complex web of reasons and actions. (shrink)

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

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)

It is universally accepted in bioethics that doctors and other medical professionals have an obligation to procure the informed consent of their patients. Informed consent is required because patients have the moral right to autonomy in furthering the pursuit of their most important goals. In the present work, it is argued that evidence from psychology shows that human beings are subject to a number of biases and limitations as reasoners, which can be expected to lower the quality of their decisions (...) and which therefore make it more difficult for them to pursue their most important goals by giving informed consent. It is further argued that patient autonomy is best promoted by constraining the informed consent procedure. By limiting the degree of freedom patients have to choose, the good that informed consent is supposed to protect can be promoted. (shrink)