Kind Of Paternalism Research Articles

Book review: The philosophy of person‐centred healthcare, By DerekMitchell, MichaelLoughlin, Cambridge: Cambridge Scholars Publishing. 2023. 201 pp. £64.99. ISBN (10): 1‐5275‐9058‐5, ISBN (13): 978‐1‐5275‐9058‐8

Book review: The philosophy of person‐centred healthcare, By DerekMitchell, MichaelLoughlin, Cambridge: Cambridge Scholars Publishing. 2023. 201 pp. £64.99. ISBN (10): 1‐5275‐9058‐5, ISBN (13): 978‐1‐5275‐9058‐8

A new kind of paternalism in surrogate decision-making? The case of Barnsley Hospitals NHS Foundation Trust v MSP

The modern legal and ethical movement against traditional welfare paternalism in medical decision-making extends to how decisions are made for patients lacking decisional capacity, prioritising surrogates’ judgment about what patients...

PATERNALISM, DISAGREEMENTS, AND THE MORAL DIFFERENCE

Abstract 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.

Children and the Limits of Paternalism

Philosophers disagree about what precisely makes an act paternalistic, and about whether, when, and why paternalistic acts are morally objectionable. Despite these disagreements, it might seem uncontroversial to think that it is permissible to paternalize children. When paternalism seems morally objectionable, that is usually because an adult has been treated in a way that seems appropriate only for children. But, we might think, there can be nothing morally objectionable about treating children as children. In this paper, however, I argue that there are limits to how we may permissibly paternalize children. I begin in Section 1 by describing and endorsing Jonathan Quong’s account of paternalism, which defines paternalistic acts as those that involve particular kinds of judgments that the paternalizer makes about the capacities of the paternalizee. In Section 2, I identify a distinction between two kinds of paternalism: ‘compensatory’ paternalism, and ‘non-compensatory’ paternalism. In Section 3, I argue that compensatory paternalism is usually permissible in the case of children. In section 4, I argue that non-compensatory paternalism is much harder to justify than compensatory paternalism, and because of this, it is sometimes impermissible even when directed at children.

Autonomy and Settling: Rehabilitating the Relationship between Autonomy and Paternalism

In this article I show the shortcomings of autonomy-based justifications for exemptions from paternalism and appeal to the value of settling to defend an alternative well-being-based justification. My well-being-based justification, unlike autonomy-based justifications, can (1) explain why adults but not children are exempt from paternalism; (2) show which kinds of paternalism are justified for children; (3) explain the value of the capacity of autonomy; (4) offer a plausible relationship between autonomy and exemption from paternalism; and (5) give political philosophers a justification for exempting persons from paternalism even if broad scepticism about the capacity for autonomy is justified.

PATERNALISM AND GLOBAL GOVERNANCE

Abstract: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 (force versus information); the scope of the interference (wide versus narrow); the purpose of the intervention (prevention of harm versus emancipation); the source of the paternalizer’s confidence (faith versus evidence); and the mechanisms of accountability (internal versus external). 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.

Old wine in new casks: libertarian paternalism still violates liberal principles

Libertarian Paternalism (LP) purports to be a kind of paternalism that is “liberty-preserving” and hence compatible with liberal principles. In this paper, I argue against this compatibility claim. I show that LP violates core liberal principles, first because it limits freedom, and secondly because it fails to justify these limitations in ways acceptable to liberal positions. In particular, Libertarian Paternalists argue that sometimes it is legitimate to limit people’s liberties if it improves their welfare. A closer look at the welfare notions used, however, reveals that they respect neither the subjectivity nor the plurality of people’s values. Thus its justification of the liberty-welfare trade-off is not compatible with liberal principles. I conclude that to justify LP policies, one must appeal to traditional paternalistic principles—and thus, there is no categorical difference between “libertarian” and other forms of paternalism.

How Relevant is Jury Rationality?

This essay reviews Punitive Damages: How Juries Decide by Cass Sunstein, et al. The book provides a good example of a recent trend: the use of behavioralist research to justify surprisingly paternalistic legal reforms. While critics of behavioralism often contend that its theoretical foundations are weak, this approach is unlikely to prove an effective rejoinder in the new debate about what kinds of paternalism are made permissible by human irrationality. A better approach: (1) notes the lack of a nexus between behavioralism and the supposed emergent necessity of paternalist reforms; and (2) suggests that juror unwillingness to apply cost-benefit formula provides the true motivating force for the new paternalism in law and economics. Rather than asking if jurors act rationally (and punishing them if they will not), we should instead question what law and economists mean when they use the word rational as an initial matter.

Commentary: Respecting Autonomy But Avoiding Benevolent Paternalism

The patient’s wife supported this view, as he had told her his life was complete and it was time for it to be over. She felt his way of dealing with this situation, as well as his behavior, was not different from before he stopped eating. She would admit to ambivalent thoughts about this course of action and had said to her husband earlier that she felt that this was suicide. However, she bowed to his wishes, as she did not wish to force him and cause him any further suffering. Palliative care was consulted to see if there were any additional elements of care that could be added. We ordered nebulized morphine for dyspnea, which he tried once and then refused. He refused all other medications and suggestions for mouth care. The staff found it very hard to care for him as he refused all their approaches. He continued to refuse all care and died 5 days later.