These paperback editions preserve the original texts of these important books while presenting them in durable paperback editions.

In this article, we address the relevance of J.S. Mill’s political philosophy for a framework of public health ethics. In contrast to some readings of Mill, we reject the view that in the formulation of public policies liberties of all kinds enjoy an equal presumption in their favor. We argue that Mill also rejects this view and discuss the distinction that Mill makes between three kinds of liberty interests: interests that are immune from state interference; interests that enjoy a presumption (...) in favor of liberty; and interests that enjoy no such presumption. We argue that what is of focal importance for Mill in protecting liberty is captured by the essential role that the value of self-determination plays in human well-being. Finally, we make the case for the plausibility of a more complex and nuanced Millian framework for public health ethics that would modify how the balancing of some liberty and public health interests should proceed by taking the thumb off the liberty end of the scale. Mill’s arguments and the legacy of liberalism support certain forms of state interference with marketplace liberties for the sake of public health objectives without any presumption in favor of liberty. (shrink)

This book introduces the moral philosophy of Immanuel Kant—in particular, the concepts of autonomy, dignity, and character—to economic theory, explaining the importance of integrating these two streams of intellectual thought. Mainstream economics is rooted in classical utilitarianism, recommending that decision makers choose the options that are expected to generate the largest net benefits. For individuals, the standard economic model fails to incorporate the role of principles in decision-making, and also denies the possibility of true choice, which can be independent of (...) preferences and principles altogether. For policymakers, standard decision-making frameworks recommend tradeoffs that are beneficial in terms of material goods or wealth, but may be morally questionable from a more person-centered perspective. Integrating Kantian ethics affects economics in three important ways. This integration allows for a more complete understanding of human choice, incorporating not just preferences and constraints, but also principles and strength of will or character. It demonstrates the broader impact of welfare economics, which generates policies that affect not only persons' well-being, but also their dignity and autonomy. Finally, it reconciles the traditional, individualist stance in economic models of choice with the social responsibility emphasized by many systems of philosophical ethics and heterodox schools of economics. (shrink)

The present book makes a particularly engaging case for a whole range of policy implications of behavioural economics. The rhetoric is highly compelling, and their approach is already having a significant impact. However, while the wider audience for whom the book is written may not be interested in the justification of the underlying principles, it is precisely the cracks in the foundations that pose the greatest threat to the project. For example, if Thaler and Sunstein are to have any chance (...) of their 'libertarian paternalism' meriting ‘libertarian’ credentials, it is essential that the re-engineering of choice architecture not be guided by any particular political or moral agenda. Their claim here is that what makes a nudge beneficial is not that it steers people in the direction of behaviour that is objectively ‘good’ but rather in the direction of behaviour that they won’t regret. That said, there are a number of points where it is hard to shake the suspicion that Thaler and Sunstein help themselves rather conveniently to the idea that, if a person’s choices are largely a function of various framing effects, say, then overriding those choices violates no autonomy, since there was no autonomy there to be violated. -/- In this review, I raise four concerns not adequately addressed in the book. -/- (1) Thaler and Sunstein are misleading in their use of the term ‘paternalism’, which is standardly defined as a matter of interfering with a competent person’s choices out of a motivation to improve that person’s welfare. As Thaler and Sunstein use the term, however, it becomes equivalent to beneficence: when the government acts to improve people’s welfare by influencing choices in any way, according to them, it is engaging in paternalism. -/- (2) Their appeal to the resistibility of nudges is a centrepiece of the account and particularly of its claim to be ‘libertarian’, but given what they themselves write about how effective nudges are and how poor we are at even noticing the influences to which we are subject, it is entirely unclear why we should expect nudges to be easily resisted. -/- (3) Thaler and Sunstein generally align themselves with the perspective of planners who half-pose the presumptuously rhetorical question, ‘Who would really mind?’ But the question is not just whether people would object, if they were consulted. People also care about whether they are consulted and whether they understand the influences to which they are subject. Thaler and Sunstein advise choice architects against being secretive about nudges, but this espousal of principle, in a late chapter responding to objections, is not borne out by the discussion in the rest of the book, which focuses almost exclusively and rather effusively on the possibilities for channelling individuals’ choice-behaviour toward better outcomes. -/- (4) Thaler and Sunstein tend to downplay alternative approaches to improving decision making that are perfectly compatible with the behavioural economics and social psychology discussed by Thaler and Sunstein, but less paternalistic. For example, there is a growing body of research on how to construct contexts of interpersonal deliberation to generate stable solutions to collective action problems, by improving people’s collective decision-making capacities, rather than subjecting them to nudges. More generally, one comes up with very different recommendations if one thinks of the problems to which nudges are supposed to be a solution not as a matter of human failings per se, but rather as a socially and historically contingent misfit between the decision-making capacities that particular policies and institutions require of individuals and the capacities that people actually have. Conceived in the latter way – in terms of what I have elsewhere dubbed ‘autonomy gaps’, it becomes an open question whether what is called for is a choice architecture that makes it easier to avoid regrettable decisions or, rather, various measures to improve individuals’ decision-making capacities, say, through education, ‘buddy’ arrangements, decision-making heuristics, etc. (shrink)

Readers of this book are sure to view the ethics of incentives in a new light.

Policymakers, employers, insurance companies, researchers, and health care providers have developed an increasing interest in using principles from behavioral economics and psychology to persuade people to change their health-related behaviors, lifestyles, and habits. In this article, we examine how principles from behavioral economics and psychology are being used to nudge people (the public, patients, or health care providers) toward particular decisions or behaviors related to health or health care, and we identify the ethically relevant dimensions that should be considered for (...) the utilization of each principle. (shrink)

I warmly thank Richard Ashcroft, Luc Bovens, Gerald Dworkin, Brynn Welch, and Alan Wertheimer for their insightful comments on my article. As I do not have the space to discuss all the questions they raise, I will focus on four concerns that run through my commentators’ responses...