In this chapter, I consider the idea that physician-assisted death might come into question in the cases of psychiatric patients who are incapable of making autonomous choices about ending their lives. I maintain that the main arguments for physician-assisted death found in recent medical ethical literature support physician-assisted death in some of those cases. After assessing several possible criticisms of what I have argued, I conclude that the idea that physicianassisted death can be acceptable in some cases of psychiatric patients (...) who lack autonomy ought to be taken into account in assessing the moral and legal acceptability of physician-assisted death. (shrink)

Progressive family policy regimes typically aim to promote and protect women’s opportunities to participate in the workforce. These policies offer significant benefits to affluent, two-parent households. A disproportionate number of low-income and impoverished families, however, are headed by single mothers. How responsive are such policies to the objectives of these mothers and the needs of their children? This chapter argues that one-size-fits-all family policy regimes often fail the most vulnerable household and contribute to intergenerational poverty in two ways: by denying (...) at-risk children adequate parenting, and by undermining their mothers’ legitimate interest in nurturing and caring for their own children. The capabilities of these mothers and the well-being of their children are better served by policies which recognise maternal caregiving as a productive and valuable occupation meriting equal respect and social support. (shrink)

A governing principle in medical ethics is respect for patient autonomy. This principle is commonly drawn upon in order to argue for the permissibility of assisted dying. In this paper I explore the proper role that respect for patient autonomy should play in this context. I argue that the role of autonomy is not to identify a patient’s best interests, but instead to act as a side-constraint on action. The surprising conclusion of the paper is that whether or not it (...) is in the best interests for the patient to die is a morally objective matter. This allows for the possibility that it can be in the best interests of the patient to die even if she autonomously considers it to be in her best interest to continue living. I argue that concerns about ‘mandatory’ euthanasia can be met when patient autonomy is respected as a side-constraint on action. Ultimately, this means that assisted dying is permissible, not because the autonomous patient views her suffering to be unbearable, but because it is in her objective best interests and she permitted it via her consent. (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)

Philosophers have talked to each other about moral issues concerning technology, but few of them have talked about issues of technology and the good life, and even fewer have talked about technology and the good life with the public in the form of recommendation. In effect, recommendations for various technologies are often left to technologists and gurus. Given the potential benefits of informing the public on their impacts on the good life, however, this is a curious state of affairs. In (...) the present paper, I will examine why philosophers are seemingly reluctant to offer recommendations to the public. While there are many reasons for philosophers to refrain from offering recommendations, I shall focus on a specific normative reason. More specifically, it appears that, according to a particular definition, offering recommendations can be viewed as paternalistic, and therefore is prima facie wrong to do so. I will provide an argument to show that the worry about paternalism is unfounded, because a form of paternalism engendered by technology is inevitable. Given the inevitability of paternalism, I note that philosophers should accept the duty to offer recommendations to the public. I will then briefly turn to design ethics, which has reconceptualised the role of philosophers and, in my mind, fitted well with the inevitability of paternalism. Finally, I shall argue that design ethics has to be supplemented by the practice of recommendation if it is to sustain its objective. (shrink)

According to the influential disrespect account of what paternalism is, and why it is wrong, paternalism involves an anti-egalitarian, disrespectful attitude on the part of the paternalist: X (the paternalist) assumes an attitude of superiority when interfering in Y's matters for Y's good. Pace this account, the article argues that an important, although somewhat overlooked, form of paternalism is not, all things considered, insulting. This form of paternalism focusses on people's occasional lack of appropriate self-respect or their failure to see (...) themselves as equals or to stand vis-à-vis others as such. (shrink)

Governments often aim to improve children’s wellbeing by targeting the decision-making of their parents. In this paper, I explore this phenomenon, providing an ethical evaluation of the ways in which governments target parental decision-making in the context of anti-poverty policies. I first introduce and motivate the concept of parent-targeted paternalism to categorize such policies. I then investigate whether parent-targeted paternalism is ever pro tanto wrong, arguing that it is when directed at parents who meet a threshold of parental competency. I (...) next explore the factors that affect the degree of pro tanto wrongness of paternalistic anti-poverty policies targeting parents, and provide an account of the conditions under which such policies are on balance permissible, and when they are not. Finally, I illustrate the plausibility and usefulness of my framework by considering a case. (shrink)

Soda taxes are controversial. While proponents point to their potential health benefits and the public projects that could be funded with their revenue, critics argue that they are paternalistic and regressive. In this paper, we explore the prospects for designing a just soda tax, one that appropriately balances the often-competing ethical considerations of promoting social welfare, respecting people’s autonomy, and ensuring distributive fairness. We argue that policymakers have several paths forward for designing a just soda tax, but that the considerations (...) relevant to ethical policy design are more complicated than is sometimes acknowledged. (shrink)

Baselines are commonly used to enable harm identification. The temporal, the counterfactual and the duty-based normative baselines are the most prominent. Each of these captures an aspect of common conceptions of what it is to harm and be harmed. However, each baseline also fails to deliver workable identifications of harm when presented with certain types of case. Problematic cases are found readily in childhood, a venue in which harm identification is often called for. Without a reliable means of identifying harm (...) in childhood, harm cannot properly play a central role in normative assessments of parental practices and state intervention. This paper presents childhood cases in which the prominent baselines fail and offers an alternative: the interest-based normative baseline. Should the interest-based normative baseline replace its rivals and reign supreme? I argue not, presenting a case for maintaining a suite of baselines for use in varying contexts. (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)

The traditional liberal view on conflicts between care for wellbeing and respect for choice and desire is that we should look to degrees of competence and voluntariness to determine which moral imperative should take priority. This view has likely influenced the common view that children’s choices should be considered only to the extent that this promotes their future autonomy and helps us determine their best interests. I reject both the general traditional liberal view and its application to children. Competence and (...) voluntariness, as well as maturity, are at best proxies for what really matters, which is wellbeing, choice and desire. We typically have reason to respect children’s choices, irrespective of any further positive consequences. If we should more often make children do what they do not want to do, this is mainly because, though we should care about respecting their choices, we should care even more about their wellbeing and future autonomy. (shrink)

People in our liberal pluralistic society have conflicting intuitions about the legitimacy of coercive hard paternalism, though respect for agency provides a common source of objection to it. The hard paternalist must give adequate reasons for her coercion which are acceptable to a free and equal agent. Coercion that fails to meet with an agent’s reasonable evaluative commitments is at least problematic and risks being authoritarian. Even if the coercer claims no normative authority over the coercee, the former still uses (...) coercion to replace the latter’s reasons or will with his own reasons or will. But does every hard paternalistic view have to invite such objection? Throughout I will assume that defenders of what I will call “Neutral Paternalism” (NP) and “Commonsense Paternalism” (CP) aim to offer reasons for coercion all can reasonably endorse despite evaluative diversity, in opposition to more objectionable forms of coercive paternalism, such as those which defend it on religious or perfectionist grounds. I will argue, nonetheless, that Gerald Dworkin’s defense of NP and Danny Scoccia’s defense of CP succumb to the same problems of objectionable imposition that saddle other forms of coercive paternalism. The shortcomings in their views suggest that even modest hard paternalism is nonetheless problematic for liberals. (shrink)

The current debate on recreational drug policy is roughly a contest between prohibition advocates and legalization advocates. This paper offers a third alternative that is a compromise between those two. The centralized-use compromise can secure the autonomy interests that are important to defenders of legalization, and it can prevent harms to others that are the focus of prohibition arguments. The centralized-use compromise also offers a possible way to reduce the black market while also reducing the rate of addiction and the (...) associated debasing harms to self. (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)

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)

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)

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)

In this paper, I argue against the commonly held view that paternalism is all things considered wrong when it interferes with a person’s autonomy. I begin by noting that the plausibility of this view rests on the assumption that there is a morally relevant difference in the normative reasons concerning an intervention in a person’s self-regarding actions and an intervention in his other-regarding actions. I demonstrate that this assumption cannot be grounded by wellbeing reasons, and that autonomy-based reasons of non-interference (...) also cannot adequately explain the difference. Following this, I propose that the difference in the reasons related to an intervention in a person’s self-regarding actions and an intervention in his other-regarding actions can be explained by the value of holding a person responsible for his choices. Nonetheless, this does not result in paternalistic behavior that interferes with autonomy being all things considered wrong. Instead, I show that the reason to hold a person responsible for a diminution of his wellbeing does not necessarily defeat the wellbeing reasons that count in favor of paternalistic behavior. (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)

: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)

The use of tanning beds has been identified as being among the most significant causes of melanoma and non-melanoma skin cancer. Accordingly, the activity is properly seen as one that involves profound harm to self. The article examines paternalistic reasons for restricting sunbed usage. We argue that both so-called soft and hard paternalistic arguments support prohibiting the use of sunbeds. We make the following three arguments: an argument from oppressive patterns of socialization suggesting that the autonomous nature of the conduct (...) in question is questionable; an argument from so-called evaluative delusions in which individuals attach incorrect weights to some of their values; a strictly hard paternalistic argument appealing to the harm in itself pertaining to the use of sunbeds. (shrink)

In this paper, I address two related challenges the phenomenon of depression raises for conceptions according to which autonomy is an agency concept and an independent source of justification. The first challenge is directed at the claim that autonomous agency involves intending under the guise of the good: the robust though not always direct link between evaluation and motivation implied here seems to be severed in some instances of depression; yet, this does not seem to affect the possibility of autonomous (...) action. The second challenge targets the feasibility of a reliable distinction between autonomous and non-autonomous choices in the context of depression: value-neutral and value-laden ways of drawing the distinction seem both open to decisive objections. I develop an account of paradoxical identification which supports a revised value-neutral distinction between autonomous and non-autonomous choices in the context of depression (my response to challenge 2), and shows that depression is inconsistent with autonomy to the extent that it involves an agent’s (paradoxical) identification with projects she implicitly loathes, that is, to the extent that depression thwarts intending under the guise of the good (my response to challenge 1). (shrink)

I first provide an analysis of Joel Feinberg’s anti-paternalism in terms of invalidation of reasons. Invalidation is the blocking of reasons from influencing the moral status of actions, in this case the blocking of personal good reasons from supporting liberty-limiting actions. Invalidation is shown to be distinct from moral side constraints and lexical ordering of values and reasons. I then go on to argue that anti-paternalism as invalidation is morally unreasonable on at least four grounds, none of which presuppose that (...) people can be mistaken about their own good: First, the doctrine entails that we should sometimes allow people to unintentionally severely harm or kill themselves though we could easily stop them. Second, it entails that we should sometimes allow perfectly informed and rational people to risk the lives of themselves and others, though they are in perfect agreement with us on what reasons we have to stop them for their own good. Third, the doctrine leaves unexplained why we may benevolently coerce less competent but substantially autonomous people, such as young teens, but not adults. Last, it entails that there are peculiar jumps in justifiability between very similar actions. I conclude that as liberals we should reject anti-paternalism and focus our efforts on explicating important liberal values, thereby showing why liberty reasons sometimes override strong personal good reasons, though never by making them invalid. (shrink)

In this Introduction, I situate the underlying project “Autonomy and Mental Disorder” with reference to current debates on autonomy in moral and political philosophy, and the philosophy of action. I then offer an overview of the individual contributions. More specifically, I begin by identifying three points of convergence in the debates at issue, stating that autonomy is: 1) a fundamentally liberal concept; 2) an agency concept and; 3) incompatible with (severe) mental disorder. Next, I explore, in the context of decisional (...) capacity assessments, the difficulties to reconcile 1) and 2) with 3) which they at the same time seem to imply. Having clarified the centrality of a cogent notion of mental disorder for addressing these difficulties, I comment on three promising lines of inquiry about the nature and scope of autonomy that emerge from the following chapters. (shrink)

In this chapter, I articulate the structure of a general concept of autonomy and then reply to possible objections with reference to Ulysses arrangements in psychiatry. The line of argument is as follows. Firstly, I examine three alternative conceptions of autonomy: value-neutral, value-laden, and relational. Secondly, I identify two paradigm cases of autonomy and offer a sketch of its concept as opposed to the closely related freedom of action and intentional agency. Finally, I explain away the autonomy paradox, to which (...) the previously identified pair of paradigm cases seems to give rise in the context of mental disorder. By addressing this paradox, we learn two valuable lessons. The first is about the relationships between the three conceptions of autonomy above. The second is about the relationship between autonomy and mental disorder. (shrink)

According to the doctrine of informed consent medical procedures are morally permissible when a patient has consented to the treatment. Problematically it is possible for a patient to consent to or refuse treatment which consequently leads to a decline in her best interests. Standardly, such conflicts are resolved by prioritising the doctrine of informed consent above the requirement that the medical practitioner acts in accordance with the duty of care. This means that patient free choice is respected regardless as to (...) whether her choice leads to a decline in her best interests, since to disrespect patient choice would be an instance of ‘unwarranted’ paternalism. This thesis defends the claim that in cases where patient consent comes into conflict with her best interests, paternalistic interference is in fact justified. The ambition of the thesis is thus twofold: in the first place I argue that the doctrine of informed consent cannot be used as an ethical guarantor for medical decision making. Secondly I will conclude that hard paternalism is justified in medical practice, thereby calling for a reversal of the prioritisation of informed consent procedures over the medical practitioner’s duty of care. (shrink)

Digital media has become an integral part of people’s lives, and its ubiquity and pervasiveness in our everyday lives raise new ethical, social, cultural, political, economic and legal issues. Many of these issues have primarily been dealt with in terms of what is ‘right’ or ‘just’ with digital media and digitally-mediated practices, and questions about the relations between digital media and the good life are often left in the background. In short, what is often missing is an explicit discussion of (...) the relations between digital media and the good life. Under the label of ‘Net recommendation’, the present study aims to offer a balanced and constructive normative analysis of digital media, focusing on the relations between digital media and the good life. The project of Net recommendation aims to (re)assert the importance of actual discourses in our normative analysis of the relations between digital media and the good life. I pursue this project with a Walzerian approach to digital media and the good life that takes seriously (and, ideally, also interacts with) actual discourses. This approach allows us to have a better understanding of our normative judgements on the impacts of digital media has (or will have) on the good life and, at the same time, allows us to answer the question of ‘how should we live with digital media?’ more adequately. Moreover, the Walzerian approach is useful in both an intra-cultural and an inter¬cultural context. Using China’s Internet as a case study, I show that the relations between digital media and the good life in each culture should be examined in its own right. Together, I hope, this study provides an adequate illustration and defence of the project of Net recommendation that does not start with the assumption of digital media being a source of moral problem and strives to recommending specific ways to reform and/or transform digital media and digitally-mediated practices that allow us to have better relations with digital media and enable us to live better lives with them. (shrink)