Mini-SymposiumRelational conceptions of paternalism: a way to rebut nanny-state accusations and evaluate public health interventions
Section snippets
Paternalism: the basic concept
The literature on paternalism is dominated by efforts to differentiate descriptively between paternalistic and non-paternalistic acts.13, 14, 15 Two conditions feature in most standard accounts of paternalism:15
- 1.
The paternalist in some way undermines, constricts or limits the autonomy, freedom or liberty of the subject; and
- 2.
The paternalist justifies this action on the grounds that it promotes what she understands to be the good, welfare or benefit of the subject.
On most accounts, both the first
The welfare-justification condition
The welfare-justification condition will be satisfied when an actor attempts to justify an intervention on the grounds that it will promote some aspect of subjects' welfare, or prevent their welfare from diminishing. Assessment of whether or not the welfare-justification condition has been met is relatively straightforward. There is no requirement that a paternalist is either genuine or single-minded about the pursuit of subjects' welfare. There is also no requirement that the welfare is
The autonomy-undermining condition and paternalistic actions
Some notion of autonomy, liberty or freedom is fundamental to any discussion of paternalism, but these terms are often used in interchangeable or unexplained ways. Accusations of paternalism will be more serious the greater the moral significance of the aspects of autonomy, liberty or freedom that are undermined. A case can be made that richer notions of autonomy, not just narrow conceptions of liberty or choice, are most significant.19
We now draw on and extend the work of Catriona Mackenzie,
Discussion
We noted at the outset that paternalism is a paradoxical concept, entailing a wrong (undermining autonomy) ostensibly justified by a good (increasing welfare). A well-founded accusation of paternalism must be based on an appropriate conception of autonomy. We have summarised the key features of libertarian, decisional and relational conceptions of autonomy (as elucidated by Mackenzie), and delineated three associated conceptions of paternalism: nanny-state, decisional and relational paternalism.
Acknowledgements
An early version of this work was presented at a workshop on paternalism held on Friday 8 November 2013 at the Centre for Agency, Values and Ethics at Macquarie University. We thank participants in that workshop for their helpful comments. Thanks also to Prof Catriona Mackenzie for her helpful comments on an earlier draft of this manuscript and to Prof Paul Benson for providing us with an early version of his work on stereotype threat.
Ethical approval
Because this is conceptual rather than empirical research,
References (39)
Nanny or steward? The role of government in public health
Public Health
(2006)Stigma, ethics and policy: a commentary on Bayer's “Stigma and the ethics of public health: not can we but should we”
Soc Sci Med
(2008)- et al.
Stigma and its public health implications
Lancet
(2006) Bloomberg's health legacy: urban innovator or meddling nanny?
Hastings Cent Rep
(2013)‘Nanny Bloomberg’ ad in New York times targets N.Y. Mayor's Anti-soda Crusade
(2012;June 4)- et al.
Who's your nanny?: choice, paternalism and public health in the age of personal responsibility
J Law Med Ethics
(2013) Framing: toward clarification of a fractured paradigm
J Commun
(1993)- et al.
Public health ethics
Why it's time to stop worrying about paternalism in health policy
Public Health Ethics
(2011)