Erik Malmqvist defends the prohibition on kidney sales as a justifiable measure to protect individuals from harms they have not autonomously chosen. This appeal to ‘group soft paternalism’ requires that three conditions be met. It must be shown that some vendors will be harmed, that some will be subject to undue pressure to vend, and that we cannot feasibly distinguish between the autonomous and the non-autonomous. I argue that Malmqvist fails to demonstrate that any of these conditions (...) are likely to obtain. His argument involves two common errors. First, he, like many, proceeds on a mistaken understanding of how to assess harm. What matters is not the balance of costs and benefits of vending, but a comparison of potential vendors’ welfare across two possible courses of action. Second, Malmqvist's concerns about third-party pressure are predicated on an empirically unrealistic understanding of the operation of a regulated market. A widely underappreciated fact is that kidney sales will be relatively rare, and most who try to vend will be unable to. Because pressure on another to vend will not result in the desired outcome, few will exert it. (shrink)

Erik Malmqvist defends the prohibition on kidney sales as a justifiable measure to protect individuals from harms they have not autonomously chosen. This appeal to ‘group soft paternalism’ requires that three conditions be met. It must be shown that some vendors will be harmed, that some will be subject to undue pressure to vend, and that we cannot feasibly distinguish between the autonomous and the non-autonomous. I argue that Malmqvist fails to demonstrate that any of these conditions (...) are likely to obtain. His argument involves two common errors. First, he, like many, proceeds on a mistaken understanding of how to assess harm. What matters is not the balance of costs and benefits of vending, but a comparison of potential vendors’ welfare across two possible courses of action. Second, Malmqvist's concerns about third-party pressure are predicated on an empirically unrealistic understanding of the operation of a regulated market. A widely underappreciated fact is that kidney sales will be relatively rare, and most who try to vend will be unable to. Because pressure on another to vend will not result in the desired outcome, few will exert it. (shrink)

This paper challenges the view that bans on kidney sales are unjustifiably paternalistic, that is, that they unduly deny people the freedom to make decisions about their own bodies in order to protect them from harm. I argue that not even principled anti-paternalists need to reject such bans. This is because their rationale is not hard paternalism, which anti-paternalists repudiate, but soft paternalism, which they in principle accept. More precisely, I suggest that their rationale is what Franklin (...) Miller and Alan Wertheimer call ‘group soft paternalism’. Group soft paternalistic policies restrict the freedom of autonomous individuals, not for their own good (hard paternalism), but as an unavoidable consequence of seeking to protect other, non-autonomous individuals from harms that they have not voluntarily chosen (soft paternalism). Group soft paternalism supports prohibiting kidney sales on three conditions: (1) that such sales are potentially harmful to vendors, (2) that many vendors would suffer impaired autonomy, and (3) that distinguishing between autonomous and non-autonomous vendors and interfering only with the latter is unfeasible. I provide reasons for thinking that these conditions will often hold. (shrink)

BackgroundWe aim to further develop an index for detecting disguised paternalism, which might influence physicians’ evaluations of whether or not a patient is decision-competent at the end of life. Disguised paternalism can be actualized when physicians transform hard paternalism into soft paternalism by questioning the patient’s decision-making competence. MethodsA previously presented index, based on a cross-sectional study, was further developed to make it possible to distinguish between high and low degrees of disguised paternalism using (...) the average index of the whole sample. We recalculated the results from a 2007 study for comparison to a new study conducted in 2020. Both studies are about physicians’ attitudes towards, and arguments for or against, physician-assisted suicide. ResultsThe 2020 study showed that geriatricians, palliativists, and middle-aged physicians (46–60 years old) had indices indicating disguised paternalism, in contrast with the results from the 2007 study, which showed that all specialties (apart from GPs and surgeons) had indices indicating high degrees of disguised paternalism.ConclusionsThe proposed index for identifying disguised paternalism reflects the attitude of a group towards physician assisted suicide. The indices make it possible to compare the various medical specialties and age groups from the 2007 study with the 2020 study. Because disguised paternalism might have clinical consequences for the rights of competent patients to participate in decision-making, it is important to reveal disguised hard paternalism, which could masquerade as soft paternalism and thereby manifest in practice. Methods for improving measures of disguised paternalism are worthy of further development. (shrink)

The US federal research regulations prohibit informed consent, whether written or oral, from including provisions in which human subjects waive or appear to waive legal rights. We argue that policies that prevent human subjects from waiving legal rights in research can be ethically justified under the rationale of group, soft paternalism. These policies protect competent adults from making adverse decisions about health and legal matters that they may not understand fully. However, this rationale is less defensible if (...) there is a comprehensive compensation for injury programme available in which subjects are asked to waive some legal rights in order to participate in the programme. In this situation, subjects should be allowed to waive some legal rights to obtain the benefits of the programme. (shrink)

Effective altruists aim to do the most good that they can do with the resources available to them, without causing themselves or their dependents significant harm thereby. The argument presented in this paper demonstrates that there are no morally relevant dissimilarities between living kidney donation and living kidney selling for effective altruistic reasons. Thus, since the former is allowed, the latter ought to be allowed as well. And, there are important moral differences between living kidney selling for effective altruistic reasons (...) and other reasons for kidney vending, such that standard objections against markets in human kidneys do not attach to those markets designed around principles of effective altruism. The reasonable conclusion to draw from this is that eligible effective altruist kidney donors ought to be allowed to sell their kidneys to others in need, if they so desire. Because of this, law and policy ought to be changed to allow for this exceptional case: current laws that ban kidney selling for everyone, irrespective of their reason for selling, are unjustified. (shrink)

When new drugs are approved by the Food and Drug Administration, the default assumption is that they will be available by prescription only, safe for use exclusively under clinical supervision. The paternalism underlying this default must be interrogated in order to ensure appropriate respect for patient autonomy. Upon closer inspection, prescription requirements are justified when nonprescription status would risk harm to third parties and when a large segment of the population would struggle to exercise their autonomy in using a (...) drug safely and effectively on their own. Although these justifications can support prescription status for many drugs, we propose that reversing the FDA's current default to instead begin with a presumption in favor of over‐the‐counter status is the best way to avoid interference with valid claims of patient autonomy. Under this approach, a range of drug products could be considered for an OTC switch, including oral contraceptives, statins, and HIV‐prevention drugs. (shrink)

Incidental findings and secondary findings, being results that are unrelated to the diagnostic question, are the subject of an important debate in the practice of clinical genomic medicine. Arguments for reporting these results or not doing so typically relate to the principles of autonomy, non-maleficence and beneficence. However, these principles frequently conflict and are insufficient by themselves to come to a conclusion. This study investigates empirically how ethical principles are considered when actually reporting IFs or SFs and how value conflicts (...) are weighed. A qualitative focus group study has been undertaken, including a multidisciplinary group of professionals from Belgian centres for medical genetics. The data were analysed thematically. All eight Belgian centres participated in this study. Ethical values were frequently referred to for disclosure policies on IFs and SFs. Participants invoked respect for patient autonomy to support the disclosure of IFs and opt-out options for IFs and SFs, non-maleficence for the professional delineation of reportable IFs and opt-out options for IFs and SFs and beneficence for the mandatory reporting of actionable IFs, the delineation of reportable IFs and a current decline of actively pursued SFs. Professional assumptions about patients’ genetic literacy were an important factor in the weighing of values. In line with the traditional bioethical discourse, the mandatory reporting of actionable IFs might be interpreted as a “technological, soft paternalism”. Restricting patients’ choices might be acceptable, but then its motives should be valid and its beneficent outcomes highly plausible. Hence, the presuppositions of technological, soft paternalism - patients’ inability to make informed decisions, normative rationality, the efficacy of beneficent outcomes and the delineated spectrum of beneficence - should be approached critically. Moreover, distributive justice should be considered an important value in the delineation of the current scope of the ethical debate on IFs and SFs. This study of guiding values may stimulate the debate on the ethical grounds for a solid policy on IFs and SFs internationally. (shrink)

Living in an era of technological innovations, we must understand and trust them to benefit from these new technologies. In this context, paternalism is renewed as the so-called “soft-” or “Libertarian paternalism”. How can we face it and ensure freedom in the vortex of wellmeaning advice and persuasion? This paper will discuss 1. the characteristics of freedom since the 18th century from the perspective of the Enlightenment discourse in Germany by Mendelssohn and Kant, 2. the conditions for (...) freedom in the contemporary age of accelerating technological innovation, and 3. from trans-modernism, rethinking the dichotomy between otherness and autonomy, coercion and freedom, by the idea of 融通無碍 Yuzu-Muge, tactfulness in 華厳学 Hua-Yan Philosophy. (shrink)

Many philosophers distinguish between "hard" paternalism, which supposedly violates autonomy, and "soft" paternalism, which does not. This chapter begins by critically assessing Joel Feinberg's account of the distinction, according to which hard paternalism interferes with voluntary self-regarding choices while soft paternalism interferes with substantially nonvoluntary self-regarding choices. It then considers several other ways to draw the hard/soft distinction. Ultimately, the chapter concludes that although the hard/soft distinction is a crucially important component of (...) most antipaternalist views, it is surprisingly difficult to draw in a satisfying way. (shrink)

Legal restrictions of the right to self-determination increasingly pretend to be compatible with the liberal concept of autonomy: they act upon a ‘soft’ or autonomy-orientated paternalistic rationale. Conventional liberal critique of paternalism turns out to be insensitive to the intricate normative problems following from ‘soft’ or ‘libertarian’ paternalism. In fact, these autonomy-oriented forms of paternalism could actually be even more problematic and may infringe liberty rights even more intensely than hard paternalistic regulation. This paper contributes (...) to the systematic differentiation of soft and hard paternalism by discussing the (legal) concept of autonomy and elaborates the moral and legal limits of autonomy-orientated paternalism. (shrink)

In many or most instances of paternalism, more than one person acts paternalistically, or more than one person is treated paternalistically. This chapter discusses some complications that arise in such group cases, which are largely ignored in the conceptual debate. First, a group of people who together perform an action may do so for different reasons, which makes it more challenging to determine whether the action is paternalistic. This gives us some reason not to pin the property (...) of being paternalistic on actions, since we may alternatively pin it on reasons for actions and allow that these differ between members in the group. Second, the prevention of harmful consensual interactions is sometimes paternalism towards both or all involved, but only if all benefit from interference with themselves rather than with other members in the group, or if all want the harm or risk (more or less) for its own sake. Third, interrelations between three components of paternalism - interference, benevolence and consent - gives us reason to allow that an action can be paternalistic towards some but not others of those affected. This makes it even more difficult, and less relevant, to determine whether or not actions are paternalistic. (shrink)

In this paper we extend the neutrosophic group and subgroup to soft neutrosophic group and soft neutrosophic subgroup respectively. Properties and theorems related to them are proved and many examples are given.

Soft neutrosophic group and soft neutrosophic subgroup are generalized to soft neutrosophic bigroup and soft neutrosophic N-group respectively in this paper. Different kinds of soft neutrosophic bigroup and soft neutrosophic N-group are given. The structural properties and theorems have been discussed with a lot of examples to disclose many aspects of this beautiful man made structure.

Epistemic paternalism occurs when a decision is made for an agent which helps them arrive at the truth, though they didn’t consent to that decision (and sometimes weren’t even aware of it). Common defenses of epistemic paternalism claim that it can help promote positive veritistic results. In other words, epistemic paternalism is often good for inquiry. I argue that there is often a better alternative available to epistemic paternalism in the form of what I call Open (...) Group Inquiry. I then examine how Open Group Inquiry can be applied to cases of religious inquiry, while noting that epistemic paternalism is impermissible in cases of general religious inquiry. I argue that in the case of religious inquiry, there are serious questions about what constitutes evidence along with how to evaluate it. Rather than posing a particular worry for Open Group Inquiry, I suggest these questions pose a problem for religious inquiry in general. I conclude that while it very much matters how concepts like religious knowledge, religious faith, scepticism, etc., are defined, these considerations may well pave the way for a novel argument for religious scepticism. (shrink)

According to rational will views of paternalism, the wrongmaking feature of paternalism is that paternalists disregard or fail to respect the rational will of the paternalized, in effect substituting their own presumably superior judgments about what ends the paternalized ought to pursue or how they ought to pursue them. Here I defend a version of the rational will view appealing to three rational powers that constitute rational agency, which I call recognition, discrimination, and satisfaction. By appealing to these (...) powers, my version of the rational will view can rank the wrongfulness of paternalistic acts in terms of the extent to which such acts (a) amount to supplanting the paternalized individual’s identity as a rational agent with that of the paternalist, and (b) the degree of mistrust the paternalistic act shows in the paternalized individual’s rational agency. My rational powers account thus provides a more complete account of why paternalism is a powerful, but not decisive or absolute, objection to an act or policy. My rational powers account also provides powerful explanations of why rational suasion deflects charges of paternalism; why consenting to intercessions in one’s rational agency negates paternalism; why we ordinarily believe that strong paternalism is more objectionable than weak paternalism; and why we ordinarily believe that hard paternalism is more objectionable than soft paternalism. (shrink)

The ethical standards that regulate clinical research have multiple rationales. Among them is the need to protect potential subjects from making imprudent decisions, which extends beyond the soft paternalistic concern to protect people from making uninformed decisions to participate in trials. This article argues that a plausible risk/benefit restriction on clinical trials is presumptively justified by hard paternalism, which in turn is supported by a deeper fairness-based rationale. This presumptive case for hard paternalism in research is not (...) defeated by the alleged right to participate in clinical trials, by concerns about insult or status, by the need to conduct early phase trials that promise little to no benefit to participants, or by the recognition that some potential subjects are altruistically motivated. (shrink)

Most anti-paternalists claim that informed and competent self-regarding choices are protected by autonomy, while ill-informed or impaired self-regarding choices are not. Joel Feinberg, among many others, argues that we can in this way distinguish impermissible “hard” paternalism from permissible “soft” paternalism. I argue that this view confronts two related problems in its treatment of ill-informed decision-makers. First, it faces a dilemma when applied to decision-makers who are responsible for their ignorance: it either permits too much, or else (...) too little, intervention to satisfy its proponents. Second, the most promising rationales in favor of the view ignore the distinction between an agent’s voluntarily bringing about some state of affairs, on the one hand, and an agent’s voluntarily assuming a risk, on the other. I conclude that a decision-maker’s ignorance is irrelevant to the permissibility of intervention on her behalf. If it is permissible to intervene in a given ill-informed choice, it would be permissible to intervene in an otherwise similar but informed choice, at least provided that intervention would produce similar benefits in both cases. This shows that we should sometimes accept straightforwardly paternalistic rationales. (shrink)

My thanks to Professors Hawkins and Szmukler for their thoughtful commentaries; I am particularly glad to see these scholars' valuable expertise directed toward what raises pressing issues not only for psychiatry but for contemporary society.Prof. Hawkins reasons that the use of forced feeding with some anorexia is justified, while emphasizing that this will occur rarely. She and I are in agreement that a mere handful of cases may be affected by our debate, since anecdotal evidence from clinical settings as well (...) as the studies Hawkins cites suggest that forced feeding will often be contraindicated. Still, the matter can equally well be cast hypothetically, as I implied in my earlier discussion. If forced feeding... (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)

Cases of paternalism usually involve disagreement between the paternalist and the paternalized subject. But not all the disagreements that give rise to paternalism are of the same kind and, as a result, not all instances of paternalism are morally on a par. There is, in other words, a moral difference between different kinds of paternalism, which can be explained in terms of the nature of the disagreements that give rise to the paternalism in the first (...) place. This paper offers a novel account of how to characterize the nature of these disagreements such that we can explain this moral difference. (shrink)

BackgroundPatient autonomy is a fundamental, yet challenging, principle of professional medical ethics. The idea that individual patients should have the freedom to make choices about their lives, including medical matters, has become increasingly prominent in current literature. However, this has not always been the case, especially in communist countries where paternalistic attitudes have been interwoven into all relationships including medical ones. Patients’ expectations and the role of the doctor in the patient-physician relationship are changing. Croatia, as a transitional country, is (...) currently undergoing this particular process.MethodsQualitative research was conducted by means of six focus group discussions held in the years 2012 and 2013 in Croatia. Focus groups were held separately with each of the following: first year and final year medical students, physicians engaged in medical ethics education, physicians practicing in a clinical hospital, family medicine residents and individuals representing patients with chronic disease. This research specifically addresses issues related to patient autonomy, in particular, the principles of truth telling, confidentiality, and informed consent. All focus group discussions were audio taped and then transcribed verbatim and systematized according to acknowledged qualitative analysis methods.Results and discussionPatient autonomy is much more than a simple notion defined as the patient’s right to make treatment decisions independently. It has to be understood in context of the broader socio-cultural setting. At present, both patients and medical doctors in Croatia are increasingly appreciating the importance of promoting the principle of autonomy in medical decision-making. However, the current views of medical students, physicians and patients reveal inconsistencies.Conclusions Knowing how to respect the various facets of patients’ autonomy should be part of physician’s professional duties, and also be reflected in his or her core clinical competencies. For this reason greater importance should be dedicated to patient autonomy issues in medical education in Croatia. (shrink)

I argue that libertarian paternalism is in fact paternalism, or hard paternalism, rather than a form of soft paternalism. I do so on the basis of an analysis of the paternalist act according to which the paternalist act needn’t violate the will of the agent who is the target of that act and the paternalist actor need only suspect that her action may improve the welfare of that target. The paper considers and rejects interpretations of (...) libertarian paternalism as soft paternalism. I then provide an outline as to how libertarian paternalism may be reformed in light of the finding that current libertarian paternalism is hard paternalism. The proposal is to require that the enactment of libertarian paternalist policies be conditional on opinion polling indicating support for those policies from the agents they target. (shrink)

In this book the authors introduced the notions of soft neutrosophic algebraic structures. These soft neutrosophic algebraic structures are basically defined over the neutrosophic algebraic structures which means a parameterized collection of subsets of the neutrosophic algebraic structure. For instance, the existence of a soft neutrosophic group over a neutrosophic group or a soft neutrosophic semigroup over a neutrosophic semigroup, or a soft neutrosophic field over a neutrosophic field, or a soft neutrosophic (...) LA-semigroup over a neutrosophic LAsemigroup, or a soft neutosophic loop over a neutrosophic loop. It is interesting to note that these notions are defined over finite and infinite neutrosophic algebraic structures. These structures are even bigger than the classical algebraic structures. This book contains five chapters. Chapter one is about the introductory concepts. In chapter two the notions of soft neutrosophic group, soft neutrosophic bigroup and soft neutrosophic N-group are introduced and many fantastic properties are given with illustrative examples. (shrink)

In this article we propose a philosophical critique of two general, but not exhaustive, approaches to gender studies in sport, namely gynocentric feminism and humanist feminism. We argue that both approaches are problematic because they fail clearly to distinguish or articulate their epistemological and ideological commitments. In particular, humanist feminists articulate the human condition using the sex/gender dichotomy, which fails to account adequately for gendered subjectivity. For them gender difference is a contingent feature of humanity developed through socialisation. As a (...) result, it seems that what humanist feminists regard as women in their natural ?state? is in itself ideological. The generic ?human? condition is by no means a neutral condition but rather an idea tarnished by gender history characterised by the masculine. Consequently, humanist feminists uncritically argue for inclusion in sport, with access to an equal share of the human goods available, without carefully problematising the ideological nature of the practice. Gynocentric feminists also subscribe to the sex/gender dichotomy, suggesting however, that gender subjectivity is the result of a biological imperative. For gynocentric feminists, sexual difference provides authority for adjudicating between a separate and different male and female epistemology. Accordingly, gynocentric feminists commit the genetic fallacy by condemning sport to a masculine activity and therefore incompatible with feminine value in light of its male ancestry. ?Soft? gynocentrism does not fully sanction a conception of sport which allows only traditionally female values to flourish, or at least the reason for celebrating such sports would focus upon the goods and values therein. In other words, the value of the practice for either men or women is to be found, following MacIntyre (1985), in the internal goods that characterise the particular practice. Such internal goods are, as MacIntyre argues, goods of the practice and do not belong to any particular gender or group. (shrink)

The purpose of this article is to discuss the importance of soft skills in the context of higher education and in the context of the foreign language learning classroom. The article aims to define the notion of soft skills and to offer possible ways of grouping soft skills. It also provides ways of including soft skills instruction in the context of higher education. In addition, the article aims to propose models of implementing soft skills in (...) foreign language learning and teaching situations and to suggest teaching procedures and activities which will facilitate the introduction of soft skills in the EFL classroom at South East European University. The article also aims to discuss the need of including soft skills in undergraduate studies curricula and to provide arguments in favour of including soft skills. The article will also present participants’ views and perceptions, collected via survey, of the importance and necessity of soft skills for their future careers and workplaces. The conclusion will offer some practical suggestions regarding soft skill inclusion in the EFL classroom. (shrink)

Sarah Conly defends paternalistic public health policies, such as New York City’s soft drink ban, on the grounds that they promote values that people accept but have difficulty realizing, owing to their cognitive biases. In this commentary, I criticize Conly’s defense of the soft drink ban and offer my own view of the justification for paternalistic food and beverage policies. I propose that paternalistic government restrictions on food and beverage choices should address a significant health problem pertaining to (...) a specific type or class of food or beverage. There should also be substantial evidence that the restrictions are likely to be effective at dealing with the problem and that alternative ways of dealing with it, which do not involve coercion, are likely to be ineffective. (shrink)

In this book we define some new notions of soft neutrosophic algebraic structures over neutrosophic algebraic structures. We define some different soft neutrosophic algebraic structures but the main motivation is two-fold. Firstly the classes of soft neutrosophic group ring and soft neutrosophic semigroup ring defined in this book is basically the generalization of two classes of rings: neutrosophic group rings and neutrosophic semigroup rings. These soft neutrosophic group rings and soft neutrosophic (...) semigroup rings are defined over neutrosophic group rings and neutrosophic semigroup rings respectively. This is basically the collection of parameterized subneutrosophic group ring and subneutrosophic semigroup ring of a neutrosophic group ring and neutrosophic semigroup ring respectively. These soft neutrosophic algebraic structures are even bigger than the corresponding classical algebraic structures. It is interesting to see that it wider the area of research for the researcher of algebraic structures. (shrink)

In 1989, the Cold War abruptly ended and it seemed as if the world was at last safe for democracy. But a spirit of uneasiness, discontent, and world-weariness soon arose and has persisted in Europe, in America, and elsewhere for two decades. To discern the meaning of this malaise we must investigate the nature of liberal democracy, says the author of this provocative book, and he undertakes to do so through a detailed investigation of the thinking of Montesquieu, Rousseau, and (...) Tocqueville. Paul A. Rahe argues that these political thinkers anticipated the modern liberal republic's propensity to drift in the direction of “soft despotism”—a condition that arises within a democracy when paternalistic state power expands and gradually undermines the spirit of self-government. Such an eventuality, feared by Tocqueville in the nineteenth century, has now become a reality throughout the European Union, Canada, Australia, New Zealand, and the United States. So Rahe asserts, and he explains what must be done to reverse this unfortunate trend. (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)

Some disability rights (DR) advocates oppose physician-assisted suicide (PAS) laws like Oregon’s on the grounds that they reflect ableist prejudice: how else can their limit on PAS eligibility to the terminally ill be explained? The paper answers this DR objection. It concedes that the limit in question cannot be defended on soft paternalist grounds, and offers a hard paternalist defense of it. The DR objection makes two mistakes: it overlooks the possibility of a hard paternalist defense of the limit, (...) and it confuses terminal illness, which is at best one type of disability, with disability itself. (shrink)

This thesis is an attempt to constructively interpret and critically evaluate the liberal doctrine that we may not limit a person’s liberty for her own good, and to discuss its implications and alternatives in some concrete areas of public health policy. The thesis starts theoretical and goes ever more practical. The first paper is devoted to positive interpretation of anti-paternalism with special focus on the reason component – personal good. A novel generic definition of paternalism is proposed, intended (...) to capture, in a generous fashion, the object of traditional liberal resistance to paternalism – the invocation of personal good reasons for limiting of or interfering with a person’s liberty. In the second paper, the normative aspect of this resistance is given a somewhat technical interpretation in terms of invalidation of reasons – the blocking of reasons from influencing the moral status of actions according to their strength. It is then argued that normative anti-paternalism so understood is unreasonable, on three grounds: 1) Since the doctrine only applies to sufficiently voluntary action, voluntariness determines validity of reasons, which is unwarranted and leads to wrong answers to moral questions. 2) Since voluntariness comes in degrees, a threshold must be set where personal good reasons are invalidated, leading to peculiar jumps in the justifiability of actions. 3) Anti-paternalism imposes an untenable and unhelpful distinction between the value of respecting choices that are sufficiently voluntary and choices that are not. The third paper adds to this critique the fourth argument that none of the action types typically proposed to specify the action component of paternalism is such that performing an action of that type out of benevolence is essentially morally problematic. The fourth paper ignores the critique in the second and third papers and proposes, in an anti-paternalistic spirit, a series of rules for the justification of option-restricting policies aimed at groups where some members consent to the policy and some do not. Such policies present the liberal with a dilemma where the value of not restricting people’s options without their consent conflicts with the value of allowing people to shape their lives according to their own wishes. The fifth paper applies the understanding of anti-paternalism developed in the earlier papers to product safety regulation, as an example of a public health policy area. The sixth paper explores in more detail a specific public health policy, namely that of mandatory alcohol interlocks in all cars, proposed by the former Swedish government and supported by the Swedish National Road Administration. The policy is evaluated for cost-effectiveness, for possible diffusion of individual responsibility, and for paternalistic treatment of drivers. The seventh paper argues for a liberal policy in the area of dissemination of information about uncertain threats to public health. The argument against paternalism is based on common sense consequentialist considerations, avoiding any appeal to the normative anti-paternalism rejected earlier in the thesis. (shrink)

In a Swedish setting physicians are unlikely to give explicitly paternalistic reasons when asked about their attitudes towards patients’ involvement in decision-making. There is considerable risk that they will disguise their paternalism by giving ‘socially correct answers’. We suggest that disguised paternalism can be revealed with the help of indexes based on certain responses in postal questionnaires. The indexes were developed using material from a study examining attitudes of Swedish physicians to physician-assisted suicide (PAS). Apart from being asked (...) about their attitudes, they were asked to prioritise between different arguments for and against PAS. One argument for PAS was: “PAS should be permitted out of respect for patients’ autonomy”. One argument against PAS was: “PAS should not be permitted since the non-maleficence principle in this case takes precedence over respecting patients’ autonomy”. Responses to the latter argument formed the cornerstone of a disguised-paternalism index, while an autonomy index was based on answers to the former argument. Applying our indexes to data from the PAS survey, we found that female GPs, surgeons, and older male physicians were least paternalistic. Among female physicians one finds both the most autonomy-respecting groups (female surgeons and GPs) and the least autonomy-respecting groups (female oncologists and psychiatrists); together with older male physicians in general, female GPs are the group displaying least disguised paternalism. We suggest that questionnaires exploring paternalism might be improved by including case-specific questions or statements by which to explore disguised paternalism. Here our indexes might be useful tools. (shrink)

In this article we examine Classical Confucian political thinking through the lens of paternalism. We situate Confucianism amid contemporary models of paternalism to show that Confucianism can be understood as a soft form of paternalism regarding its method. Confucianism stresses cultivation of the people by moral exemplars to guide the people to act in ways that are in their own best interests. This is in contrast to use of law and punishment as a deterrent of unwanted (...) behaviours of the people. We demonstrate that Confucian paternalism does not advocate for a static top-down structure of governance that is incapable of reform, underscoring its non-authoritarian ideal. We do this by stressing the vital upward momentum constituted in general cultivation of the wider population utilizing li. The picture that emerges from an examination of Confucian political thought through the lens of paternalism is what we name “exemplary paternalism.”. (shrink)

Soft regulation has increased its importance in science and technology governance. Despite such indisputable significance, the literature on technology policy and regulation so far seems to have dedicated only a limited attention to a systematic understanding of the factors affecting compliance with these soft rules. This article addresses this limitation. By way of a literature scoping exercise, we propose a taxonomy of the mechanisms affecting compliance with soft regulation. We subsequently apply the taxonomy as a guide to (...) examine the opinions of a small group of scientists and company managers in the Italian nanotechnology sector. The case study does not assess compliance in a direct way, i.e., observing how organizations comply with regulation, but it explores the opinions on what the factors affecting compliance are. (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)

In this article, I will elucidate the Indian government’s two primary discourses concerning yoga since 2014 as right-wing Hindu Nationalist Prime Minister Narendra Modi and his Hindu Nationalist political party, the Bharatiya Janata Party, have interacted with both international and domestic audiences. These discourses can be broadly grouped into two categories, or what I refer to as Modi and the BJP’s “double discourse”: Yoga as a global soft power solution to counter the Global North’s climate change privilege on the (...) international stage and Yoga as biopower for the advancement of India’s depressed economy on the domestic front. Relying on yoga’s polyvalent character, Modi and the BJP are able to frame yoga in these two particular ways—which together signal their commitment to neoliberal economic ideology—by drawing from historical and contemporaneous precedents which I also outline in the article. I conclude with a brief visit to the preparations for the BJP’s 2019 International Day of Yoga, where this double discourse becomes most evident in the two divergent themes announced for the event. (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)

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)

Members of oppressed groups are often silenced. One form of silencing is what Kristie Dotson calls “testimonial smothering”. Testimonial smothering occurs when a speaker limits her testimony in virtue of the reasonable risk of it being misunderstood or misapplied by the audience. Testimonial smothering is thus a form of epistemic paternalism since the speaker is interfering with the audience’s inquiry for their benefit without first consulting them. In this paper, we explore the connections between epistemic injustice and epistemic (...) class='Hi'>paternalism through the phenomenon of silencing. We argue that when you silence your testimony as a result of epistemic injustice it is an act of epistemic paternalism and that it is epistemically permissible. In fact, self-silencing resulting from epistemic injustice is a particularly clear example of permissible epistemic paternalism. (shrink)

ABSTRACT This paper attempts to provide some new insights into the problem of justifying paternalism. To begin with, there is a general analysis of the concept of paternalism which examines the conditions that must be present for it to occur. A distinction is then drawn between two contexts in which paternalism exists—first, where it applies to individuals or clearly specifiable groups and second, where it applies to society in general. Different approaches to justification are required in each (...) case. It is argued that paternalism of the former type has to meet two necessary and sufficient conditions for it to be acceptable and a good deal of the paper is devoted to a discussion of these two conditions and the ways of determining when they are satisfied. Paternalism of the latter type which applies to the whole society is more difficult to justify, mainly because it applies indiscriminately to everyone regardless of their particular capacities, interests etc., but some suggestions are made as to when such paternalism may nevertheless be justified. (shrink)

This article first describes a dilemma for liberalism: On the one hand restricting their own options is an important means for groups of people to shape their lives. On the other hand, group members are typically divided over whether or not to accept option-restricting solutions or policies. Should we restrict the options of all members of a group even though some consent and some do not? This dilemma is particularly relevant to public health policy, which typically target groups (...) of people with no possibility for individuals to opt out. The article then goes on to propose and discuss a series of aggregation rules for individual into group consent. Consideration of a number of scenarios shows that such rules cannot be formulated only in terms of fractions of consenters and non-consenters, but must incorporate their motives and how much they stand to win or lose. This raises further questions, including what is the appropriate impact of altruistic consenters and non-consenters, what should be the impact of costs and benefits and whether these should be understood as gross or net. All these issues are dealt with in a liberal, anti-paternalistic spirit, in order to explore whether group consent can contribute to the justification of option-restricting public health policy. (shrink)

BackgroundAn ethics reflection group is one of a number of ethics support services developed to better handle ethical challenges in healthcare. The aim of this article is to evaluate the significance of ERGs in psychiatric and general hospital departments in Denmark.MethodsThis is a qualitative action research study, including systematic text condensation of 28 individual interviews and 4 focus groups with clinicians, ethics facilitators and ward managers. Short written descriptions of the ethical challenges presented in the ERGs also informed the (...) analysis of significance.ResultsA recurring ethical challenge for clinicians, in a total of 63 cases described and assessed in 3 ethical reflection groups, is to strike a balance between respect for patient autonomy, paternalistic responsibility, professional responsibilities and institutional values. Both in psychiatric and general hospital departments, the study participants report a positive impact of ERG, which can be divided into three categories: 1) Significance for patients, 2) Significance for clinicians, and 3) Significance for ward managers. In wards characterized by short-time patient admissions, the cases assessed were retrospective and the beneficiaries of improved dialogue mainly future patients rather than the patients discussed in the specific ethical challenge presented. In wards with longer admissions, the patients concerned also benefitted from the dialogue in the ERG.ConclusionThis study indicates a positive significance and impact of ERGs; constituting an interdisciplinary learning resource for clinicians, creating significance for themselves, the ward managers and the organization. By introducing specific examples, this study indicates that ERGs have significance for the patients discussed in the specific ethical challenge, but mostly indirectly through learning among clinicians and development of clinical practice. More research is needed to further investigate the impact of ERGs seen from the perspectives of patients and relatives. (shrink)

A fundamental problem in game theory is the possibility of reaching equilibrium outcomes with undesirable properties, e.g., inefficiency. The economics literature abounds with models that attempt to modify games in order to avoid such undesirable properties, for example through the use of subsidies and taxation, or by allowing players to undergo a bargaining phase before their decision. In this paper, we consider the effect of such transformations in Boolean games with costs, where players control propositional variables that they can set (...) to true or false, and are primarily motivated to seek the satisfaction of some goal formula, while secondarily motivated to minimise the costs of their actions. We adopt preparation sets as our basic solution concept. A preparation set is a set of outcomes that contains for every player at least one best response to every outcome in the set. Prep sets are well-suited to the analysis of Boolean games, because we can naturally represent prep sets as propositional formulas, which in turn allows us to refer to prep formulas. The preference structure of Boolean games with costs makes it possible to distinguish between hard and soft prep sets. The hard prep sets of a game are sets of valuations that would be prep sets in that game no matter what the cost function of the game was. The properties defined by hard prep sets typically relate to goal-seeking behaviour, and as such these properties cannot be eliminated from games by, for example, taxation or subsidies. In contrast, soft prep sets can be eliminated by an appropriate system of incentives. Besides considering what can happen in a game by unrestricted manipulation of players’ cost function, we also investigate several mechanisms that allow groups of players to form coalitions and eliminate undesirable outcomes from the game, even when taxes or subsidies are not a possibility. (shrink)

ABSTRACT Isobel Ross rightly points out that providing information is not enough to guarantee that patients will choose the best course of action. She argues that to adequately protect patients’interests, we need practice guidelines to‘ensure that dangerous and unnecessarily risky procedures are excluded from practice’. What constitutes an‘unnecessarily risky procedure’is to be determined by a group of reasonable doctors. At one point, Ross suggests that such guidelines are‘presumptive’rather than ‘absolute’. But this is really a concession to patient variability. She (...) intends that certain procedures are ruled out on paternalistic grounds. I will argue that practice guidelines are desirable but should not determine practice. We should not rule out procedures on paternalistic grounds. (shrink)

MacDougall has argued that Rawls’s liberal social theory suggests that parents who hold certain religious convictions can legitimately refuse blood transfusion on their children’s behalf. This paper argues that this is wrong for at least five reasons. First, MacDougall neglects the possibility that true freedom of conscience entails the right to choose one’s own religion rather than have it dictated by one’s parents. Second, he conveniently ignores the fact that children in such situations are much more likely to die than (...) to survive without blood. Third, he relies on an ambiguous understanding of what is "rational" and treats children as mere extensions of their parents. Fourth, he neglects the fact that those in the original position would seek to protect themselves from persecution and enslavement and thus would not allow groups of children to be killed because of their parents’ beliefs. Finally, Rawls makes it clear that we should choose for children as we would choose for ourselves in the original position, with no particular conception of the good (such as that held by Jehovah’s Witnesses). (shrink)