Abstract
The charge of paternalism is a common objection to the actions of political and other authorities. Sometimes the charge is only that the authority has undervalued typical liberal values like freedom and autonomy relative to other values, such as physical, mental or financial wellbeing. Making this objection is consistent with accepting that in some cases, wellbeing outweighs freedom and autonomy and should be furthered at their expense. Other times, however, the charge of paternalism is more principled. The objection is not that wellbeing considerations are overstated, but that they are allowed to weigh in on the matter at all. This is the sort of antipaternalism that I will analyze in this article. My discussion and my proposals are meant to be helpful to the antipaternalist, and to anyone who wants to understand her. However, I should state at the outset that the antipaternalist position I describe and develop is not one I endorse.
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Notes
- 1.
Feinberg claims, for example, that “personal autonomy […] is a moral trump card, not to be merely balanced with considerations of harm diminution in cases of conflict, but always and necessarily taking moral precedence over those considerations.” (1986, p. 26) For a more recent example, Daniel Groll proposes that when it comes to benefitting a person, her will should be treated as “structurally decisive in determining what to do – it is meant to supplant the reason-giving force of other considerations not because it outweighs those other considerations but because it is meant to silence, or exclude, those other considerations from the practical deliberations of the subject of the demand” (2012, p. 701).
I should perhaps recognize that John Rawls is well known for his argument for the priority of liberty within the special context of distributive justice. Rawls, however, says very little about paternalism. He accepts paternalism since people’s “capacity to act rationally for their good may fail, or be lacking altogether.” (1999, p. 219) He does not discuss other, more problematic cases.
- 2.
Other authors with a similar take on paternalism are no clearer than Shiffrin in this regard. For example, Jonathan Quong argues that the essence of paternalism is that action is “motivated by a negative judgment about the ability of others to run their own lives.” (2010, p. 74). Paternalism is wrong, Quong claims, “because of the way it denies someone’s moral status as a free and equal citizen.” (Ibid.) It is not clear whether Quong thinks that being motivated by a negative judgment is a mental state distinct from simply judging oneself to have superior knowledge or ability in the particular case, or whether this (possibly true) judgment of superiority, regardless of other mental states, embodies a “negative judgment” that denies others’ their moral status. Only the first understanding could be the basis of an independent objection.
- 3.
The formula cannot be applied directly. Strictly speaking, it is not correct to say that the filter prevents the fact that the limitation of several persons’ liberty causes the promotion or protection of their good from playing the role of a reason for such limitation. This is because an action that limits the liberty of several people may promote the good of each one only or partly by limiting the liberty of the others. Antipaternalism does not apply to such liberty-limitation. For a thorough treatment of many-people cases, see Grill (2007, pp. 453–455).
- 4.
To the extent that a filter account prevents the consideration of certain facts, it is in a sense focused on action, namely on the mental action of considering facts. This does not, however, amount to an overlap with the action-focused approach, which is concerned with physical actions (and omissions), policies, laws etc.
- 5.
For Feinberg, the harm principle is the principle that preventing harm to other persons than the actor is always a good reason for prohibition given that there are no better ways of preventing this harm.
- 6.
Towards the end of the four volumes, Feinberg retracts this claim and in fact states to the contrary that these considerations are “always relevant” (1990, p. 322). This could be understood as a complete abandonment of principled antipaternalism, along with principled antimoralism. However, Feinberg insists that the retraction is not that consequential. He still thinks that the considerations are “hardly ever” good reasons and “perhaps never” decisive (p. 323). Especially in the case of paternalism, Feinberg reaffirms his earlier stance that liberty, in the form of personal sovereignty, is a “trump” that “cannot be put on the interest-balancing scales at all” (p. 322). Tenable or not, his position, even here, is that there is a principled difference between different kinds of reasons, though perhaps a principle with some exceptions.
- 7.
Husak refers to Waldron’s “Legislation and moral neutrality” (1989), where Waldron proposes a very similar interpretation of neutralism in politics. The debate on neutrality is in general more explicit and more consistent regarding the role of reasons than is the paternalism debate. Still, the filter approach may be useful for interpreting neutrality too. Rawls’ idea of public reason, restricted in content, is a sort of filtering device (e.g. 1997, p. 776). Authors on neutrality such as Larmore (1987), De Marneffe (2010) and most explicitly Wall (1998) talk of neutrality as a constraint or restraint on some sort of reasons.
- 8.
One earlier example is C.L. Ten (1980), e.g. p. 40: ‘There are certain reasons for intervention in the conduct of individuals which must always be ruled out as irrelevant’.
- 9.
Husak recapitulates these points in a more recent contribution on penal paternalism (2013, p. 40–41).
- 10.
Important adherents to the action-focused approach include (Dworkin 1972; Gert and Culver 1976; Arneson 1980; Kleinig 1983; VanDeVeer 1986; Archard 1990; Shiffrin 2000; De Marneffe 2006; Dworkin 2010). All of these authors focus their conceptual concern on paternalism rather than on antipaternalism, but their contributions are motivated by the observation that paternalism is, or is allegedly, morally wrong.
- 11.
Like most other moral doctrines, antipaternalism, on the filter approach, has no obvious implications for how transgressions should be evaluated. It may be tempting to call “paternalism” failures to abide by antipaternalism directed at deliberation. However, such failures can be trivial in the sense that they do not affect the outcome of deliberation. It is not clear to me whether such trivial failures should be called “paternalism” or what would be gained by doing so.
It may seem extreme to hold that furthering people’s good should not even be an operative reason to limit their liberty, in public policy and perhaps especially in the context of medical care. However, it should be noted that the preferences of citizens, residents or patients can still provide operative reasons. The principally antipaternalist physician would presumably treat patients in accordance with their preferences and not in accordance with their best interest (and if these are identical, her operative reasons would still be based on patient preference as preference, not as constituent of the good).
- 12.
Amartya Sen attempts to deal with this problem by emphasizing our imperfect duty to aid (e.g. Sen 2012, p. 96, but also in 2009, chapter 17). As noted by Frances Kamm, however, Sen’s duty to aid “seems merely to ask us to think and act appropriately about important matters” (2011, p. 94). This is not very helpful.
- 13.
Some examples: VanDeVeer (1986, p. 22) says that behavior towards a person S is paternalistic only if it has “the primary or sole aim of promoting a benefit for S”, Archard (1990, p. 36) says that behavior by P towards Q is paternalistic only if “P’s belief that this behaviour promotes Q’s good is the main reason for P’s behaviour”, De Marneffe (2006, pp. 73–74) says that a policy is paternalistic towards A only if “the government has this policy only because those in the relevant political process believe or once believed that this policy will benefit A in some way”, and Dworkin (2010) says that X acts paternalistically towards Y by doing Z only if “X does so just because Z will improve the welfare of Y”.
- 14.
Feinberg clearly identifies both of these problems (1986, pp. 16–23). So does Husak, see esp. pp. 390–391. Feinberg uses “multiple” and “mixed” interchangeably. I will for the most part stick with “multiple”. It should not be assumed that multiple rationales are a set of rationales that are individually sufficient (to motivate, to justify, etc.) – rationales may be of any strength or weight.
- 15.
- 16.
The problem cannot be avoided by simply tweaking de Marneffe’s definition so that the relevant question is whether the policy can be expected to benefit each member of some group to which A belongs, as this would imply, implausibly, that a policy is not paternalistic toward A even if it limits her choices, she does not want it, and its benefit to her is a necessary part motive and part justification, as long as the policy also affects some other member, who is not (expected to be) benefitted.
- 17.
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Grill, K. (2015). Antipaternalism as a Filter on Reasons. In: Schramme, T. (eds) New Perspectives on Paternalism and Health Care. Library of Ethics and Applied Philosophy, vol 35. Springer, Cham. https://doi.org/10.1007/978-3-319-17960-5_4
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