It is sometimes suggested that the physician should offer the patient “just the facts,” preferably in a “value-free manner,” explain the different options, and then leave it to the patient to make the choice. This paper explores the extent to which this adviser model is realistic. The clinical decision process and the various components of clinical reasoning are discussed, and a distinction is made between the biological, empirical, empathic/hermeneutic and ethical components. The discussion is based on the ethical norms of (...) the public health services in the Nordic countries, and the problems are illustrated by a clinical example. It is concluded that the adviser model is unrealistic. Patient information is important, but the complexity of clinical reasoning makes it impossible to separate facts and value judgments. It is claimed that there is an inherent element of paternalism in clinical decision-making and that clinical practice presupposes a mutual trust between physician and patient. (shrink)

Ronald Dworkin argues on the basis of a theory of well-being that critical paternalism is self-defeating. People must endorse their lives if they are to benefit. This is the endorsement constraint and this paper rejects it. For certain kinds of important mistakes that people can make in their lives, the endorsement constraint is either incredible or too narrow to rule out as much paternalism as Dworkin wants. The endorsement constraint cannot be interpreted to give sensible judgements when people change their (...) minds about the value of their lives. And the main argument for the endorsement constraint, which is based on the value of integrity, does not support Dworkin's anti-paternalism. (shrink)

Let us take, as a starting assumption, the Benthamic understanding of the point of law: We should make laws that will increase the overall happiness of the people whose lives are affected by them. But how should we go about doing that? And more particularly, what role, if any, should our held desires play in the task of ascertaining the content of our happiness? And when, if ever, should we defer to the desires of the affected masses, and when should (...) we not, in determining what will or will not promote happiness? The classical, or “hedonic,” utilitarians of the eighteenth and nineteenth centuries suggested a number of answers to these related questions, of which I will mention two. (shrink)

The question concerning an individual''s rightto remain in ignorance regarding her owngenetic makeup is central to debates aboutgenetic information. Whatever is decided onthis matter has a weighty bearing on all of therelated third-party issues, such as whetherfamily members or employers should be toldabout an individual''s genetic makeup. Thosearguing that no right to genetic ignoranceexists tend to argue from a viewpoint I havecalled in this paper reasonablepaternalism. It is an appealing position whichrests on widely shared intuitions on reasonablechoices, but which, in (...) the end, smugglespaternalism back to medical practice. (shrink)

A principle of paternalism must be able to answer three questions. Who are the persons who are the proper object of paternalism? Which actions should we prevent persons from doing or induce them to perform? What should our goals be when acting paternalistically toward these persons? A satisfactory principle will also be reasonably precise in distinguishing appropriate from inappropriate instances of paternalism, and it will be comprehensive, speaking to most potential cases, including suicide. My purpose is not to reach a (...) conclusion about the acceptability of paternalistic restrictions on suicide. Rather, because such a conclusion will follow from the way in which a principle of paternalism is formulated, I want to examine several liberal attempts at formulation and the theoretical background underlying these attempts. (shrink)

This essay argues that Dworkin, Feinberg and others who claim exceptions against the principle of paternalism for the sake of preventing seroius physical harm are forced to treat mature adults as mental incompetents and that they are forced to do so by the prevailing concept of paternalism itself. The essay then shows how we can get around this dilemma by re-thinking paternalism as part of distinctly paternal relationships of domination and inequality.

A critical survey of arguments for and against the morality and the legality of recreational drug use, deploying Feinberg's analysis of liberty-limiting principles.

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)

Over the last ten years or so, John Stuart Mill’s position on paternalism has been thoroughly re-examined by philosophers. The majority view now seems to be that it is unreasonable to rule out paternalism altogether. The argument is often couched in vaguely utilitarian terms: the benefit of a particular paternalistic measure may so clearly outweigh the disadvantage, if there is any, that it is utterly unreasonable to object to it. For instance, it is unreasonable to object to a law enforcing (...) the wearing of seat belts when driving, given the enormous benefits and the minor irritation of having to conform. (shrink)

The contention that paternalism can be modernised in such a way as to avoid the usual criticisms is examined and dismissed. The alleged 'modernisation' consists simply in going through the motions of achieving the patient's free consent, while leaving the ultimate decision to the physician. Paternalism in this form is no better than the more old-fashioned variety, since it still takes away from patients the fundamental human right to make decisions about their own fate.

Liberalism, or at least twentieth century liberalism, is today out of fashion amongst the electorate of the United States and Britain. Even within the academy—often, contrary to liberalism itself, one of the last institutions to reflect major shifts in ideology—it appears to be losing its grip. The rise of neo-contractarianism in social and political philosophy and neo-conservatism in economics are only two pieces of evidence of its demise. Nevertheless, reports of its death have been greatly exaggerated in some quarters of (...) social philosophy; in particular, it still thrives as the received opinion whenever the issue of paternalism is raised. And, of course, the single most important liberal standard-bearer here is John Stuart Mill. (shrink)

All illness represents a state of diminished autonomy and therefore the doctor-patient relationship necessarily and justifiably involves a degree of medical paternalism argues the author, an American medical student. In a broad-ranging paper he discusses the concepts of autonomy and paternalism in the context of the doctor-patient relationship. Given the necessary diminution of autonomy which illness inflicts, a limited form of medical paternalism, aimed at restoring or maximising the patient's autonomy is entirely acceptable, and indeed fundamental to the relationship he (...) argues. However, the exercise of this paternalism should be flexible and related to the current 'level of autonomy' of the patient himself. An editorial in this issue comments briefly on this paper. (shrink)

Due to the rise of functional foods,the distinction between foods and medicines hasbecome increasingly blurred. A new EUregulation covering health claims and otherclaims on food and drink products is on thedocks. A basic motive of legal regulation oflabeling and advertising is to inform andprotect the consumer. Promotion of informedchoice and consumer protection may, however, beconflicting objectives. A further problemsprings from the fact that choice, likeconsent, is a propositional attitude andtherefore opaque. Thus it is extremelydifficult for regulators to fasten onparticular formulations (...) of claims. Despite theprofessed respect for the autonomy of theconsumer, paternalism is never far away andeasily enters in various guises. (shrink)

: It is argued that in many cases surrogate mothers are exploited when they participate in altruistic surrogacy arrangements, since their altruistic personality structure is not in the relevant sense "their own." The question of whether paternalistic interference is justified in these cases is discussed. Such interference seems to be acceptable on condition that the person interfering is someone belonging to the woman's intimate sphere.

I examine how deferred-prosecution agreements employed against suspected corporate criminality amount to a form of social engineering that infringes the presumption. I begin with a broad understanding of the presumption itself. Then I offer a brief description of how these agreements function. Finally I address some of the normative issues that must be confronted if legal philosophers who hold retributivist views on punishment and sentencing hope to assess this device. My judgment tends to be favorable. More importantly, I caution against (...) the facile assumption that any means to infringe the presumption is necessarily an illegitimate part of penal practice. (shrink)

The Israeli Patient Rights Act attempts to accommodate personal autonomy within an avowedly paternalist communitarian state. Although Israel is still groping toward a solution, the legislation begins to show the different form a communitarian version of autonomy must take.

In 'Meeting Needs', Braybrooke argues that a new and improved version of utilitarianism can be constructed around making a priority of satisfying needs. In this paper I concentrate on Braybrooke's suggestion about the method for determining needs, and more generally, the method of settling issues concerning matters of need. (This emphasis is chosen since these problems are most devastating to his project as currently formulated.) I argue that Braybrooke's method is seriously flawed. Braybrooke believes that the process for settling issues (...) concerning needs guarantees consensus and fairness. I refute this claim by showing that a number of assumptions crucial to Braybrooke's method are unwarranted. In addition, I show that these and other structural defects in the method are such that Braybrooke's account is guilty of paternalism and "fraud", despite his attempts to avoid these charges. I also indicate why similar methods are unlikely to meet with success. -/- . (shrink)

Critics have charged that John Stuart Mill''s discussion as of paternalism in On Liberty is internally inconsistent, noting, for example, the numerous instances in which Mill explicitly endorses examples of paternalistic coercion. Similarly, commentators have noted an apparent contradiction between Mill''s political liberalism – according to which the state should be neutral among competing conceptions of the good – and Mill''s condemnation of non-autonomous ways of life, such as that of a servile wife. More generally, critics have argued that while (...) Mill professes an allegiance to utilitarianism, he actually abandons it in favor of a view that values personal autonomy as the greatest intrinsic good. This paper presents an interpretation of Mill that provides a viable and consistent treatment of paternalism, thereby refuting each of the aforementioned critiques. Mill''s views, it argues, are consistently utilitarian. Moreover, the interpretation accounts for all of Mill''s departures from his otherwise blanket prohibition of paternalistic legislation. In particular, it explains his most notorious example, the condemnation of voluntary contracts for slavery. The interpretation emphasizes Mill''s conceptual linkage between autonomy and utility, noting his implicit use of at least three different senses of the notion of autonomy. (shrink)

(1984). Performance-Enhancing Drugs in Sport: The Ethical Issue. Journal of the Philosophy of Sport: Vol. 11, No. 1, pp. 23-28. doi: 10.1080/00948705.1984.9714410.

Though much has been written about when paternalistic intervention is justified, and about how it is justified, much less has been written about who may do the intervening. This is a substantial lacuna in our understanding of the nature of justified paternalism. By examining the question of who it is that may most appropriately interfere with the course of our decision-making, we can learn something useful both about paternalism and about the nature of friendship.In this essay I will argue that (...) friendship and paternalistic intervention are linked. Friendship of the close, intimate variety that I will be discussing is in part constituted by the fact that one friend is morally justified in interfering with the other’s decisions. Intimate friendship involves a partial meshing of identities. This meshing of identities manifests itself in part by the liberties that one friend takes in guiding the life of the other. Paternalistic intervention between friends can thus be justified because it expresses the union of the friends, and because it preserves that union. (shrink)

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

324 "we should impose a single legal restriction that would effectively eliminate boxing's main medical risk: a complete ban on blows to the head" against Mill's harm principle, is not possible to justify paternalism requires other paternalistic arguments 325 "the entire paternalism v. respect for autonomy debate as it applied to boxing is cast in nonconsequentialist terms" do we have any reason to suppose that boxers' decisions to enter the profession are lacking in autonomy? many fail the first hurdle: "having (...) adequate information" - unlikely to know the medical facts 326 liberal view would state we need better education, not paternalism stronger paternalism = "an autonomous decision must flow from the agent's own values, without undue pressure from other people or external circumstances." otherwise is coercive and precludes autonomous action "since boxers often come from severely disadvantaged backgrounds and may see boxing as their only means of escaping from dangerous, povery-stricken neighborhoods, their decision to become boxers may reflect their desperation, rather than an authentic desire that flows from their own considered values". (shrink)