Respect for Autonomy: Deciding What Is Good for Oneself

University of Utah psychiatrist Brent M. Kious has a new article in the Journal of Medical u0763085Ethics: “Respect for Autonomy: Deciding What Is Good for Oneself.”

“Paternalistic interference in autonomous decisions is typically impermissible. This has several explanations, among which is a view I call the agent-constitution of the good: that the autonomous agent not only knows what is best for herself, but determines what is best for herself through her desires, goals and so on (her aims). For instance, it might seem that if an autonomous person does choose not to take insulin for her diabetes, then not only is it inappropriate to force treatment upon her, it is also not in her best interest to take insulin.”

“Here I argue that agent-constitution, though appealing, is false. In fact, autonomous agents can be mistaken about their good, even when it seems to depend only upon their aims. Agent-constitution appears true only because we typically fail to notice constraints on a person’s good in private, self-regarding decisions where paternalism might be considered.”

Respect for Autonomy: Deciding What Is Good for Oneself

Stay Out of the Sunbed! Paternalistic Reasons for Restricting the Use of Sunbeds

Two Danish political science professors have just published “Stay Out of the Sunbed! zzzPaternalistic Reasons for Restricting the Use of Sunbeds” in Public Health Ethics.  Here is their abstract:

“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: (i) an argument from oppressive patterns of socialization suggesting that the autonomous nature of the conduct in question is questionable; (ii) an argument from so-called evaluative delusions in which individuals attach incorrect weights to some of their values; (iii) a strictly hard paternalistic argument appealing to the harm in itself (as opposed to failures of rationality or agency) pertaining to the use of sunbeds.”

It is a refreshing surprise to see authors make a hard paternalistic justification for limiting liberty.

Stay Out of the Sunbed! Paternalistic Reasons for Restricting the Use of Sunbeds

Public Health Ethics: Individualism, Republicanism, Paternalism

A new special issue of Public Health Ethics is organized around a key question: should republicans care about health?  Republicanism is the political doctrine 2.coverthat holds that society should be ordered on the basis of principles that prioritize the value of individual freedom. Republicans’ focus on individual freedom is shared with many variants of Liberalism, but they contrast with the latter by virtue of adopting a distinctive conception of freedom as non-domination.  For republicans, you are free insofar as you are robustly protected from even the mere possibility of someone arbitrarily interfering with your choices.

Republicanism Special Symposium
Jurgen De Wispelaere and John Coggon
Introduction: Towards a Republic of Health?

Daniel Weinstock
Can Republicanism Tame Public Health?

Paul Scott
Democracy, Law and Relationships of Domination—A Response to ‘Can Republicanism Tame Public Health?’

A. M. Viens
Public Health and Political Theory: The Importance of Taming Individualism

Stephen R. Latham
Political Theory, Values and Public Health

Leticia Morales
Republicanism and the Paradox of Public Health Preconditions Comments on Steve Latham

Karen Yeung
Public Health Interventions as Regulatory Governance: The Place of Political Theory

Morten Ebbe Juul Nielsen and Xavier Landes
Fighting Status Inequalities: Non-domination vs Non-interference

Stephen John
The Moral Physiology of Inequality: Response to ‘Fighting Status Inequalities: Non-domination vs Non-interference’

Cillian McBride
Commentary on Nielsen and Landes, ‘Fighting Status Inequalities: Non-domination and Non-interference’

Bruce Jennings
Right Relation and Right Recognition in Public Health Ethics: Thinking Through the Republic of Health

David Owen
Right, Well-being and the Republic of Health: A Response to Jennings

Keith Syrett
Comment on Jennings, ‘Right Relation and Right Recognition in Public Health Ethics: Thinking through the Republic of Health’

Public Health Ethics: Individualism, Republicanism, Paternalism

Public Health and Political Theory: The Importance of Taming Individualism

The Oxford journal Public Health Ethics continues to be a great source of scholarship on the conflict between public health and individual liberty.  One of the newest is Adrian Viens (Southhampton Law), “Public Health and Political Theory: The Importance of Taming Individualism.”

“Daniel Weinstock (2016) notes two significant problems with applying liberalism to public health: (i) liberals tend to be individualists, while public health is predominantly focused on populations and (ii) many public health measures involve interventions that can be seen as being in tension with liberal values such as autonomy, liberty and privacy. He examines whether civic republicanism can provide a more promising means of reconciling these concerns.”

“Despite Weinstock’s proposed solution to the problem of potential domination with its institutional and ethical solutions, I suggest the individualism at the core of liberalism and civic republicanism means both political theories will continue to have conceptual and normative problems with public health’s population-level perspective.”

Public Health and Political Theory: The Importance of Taming Individualism

Mini-Symposium: Regulating smoking

The May 2016 issue of the Journal of Medical Ethics includes a mini-symposiumF1.medium on “Regulating Smoking.”

Paper: Ethics of tobacco harm reduction from a liberal perspective
Yvette van der Eijk

The ethics of a smoking licence
Daniel Halliday

Commentary: Daniel Halliday, ‘The Ethics of a Smoking License’
David Shein

Commentary: What’s the point of tobacco control? Comment on Dan Halliday, ‘The ethics of a smoking licence’
Kristin Voigt

Commentary: Halliday’s ‘The ethics of a smoking licence’
Simon Chapman

Commentary: Replies to Shein, Voigt and Chapman
Daniel Halliday

Commentary: The case for banning cigarettes
Sarah Conly

The case for banning cigarettes
Kalle Grill, Kristin Voigt

Commentary: Tobacco bans and smokers’ autonomy
Daniel Halliday

Commentary: Double standards and arguments for tobacco regulation
Jessica Flanigan

Mini-Symposium: Regulating smoking

Considering Consequences: Autonomy’s Missing Half

Catherine Hardee at California Western has published a new article in the Pepperdine Law Review titled “Considering Consequences: Autonomy’s Missing Half.”  Here is her abstract:catherine_hardee

In a subtle but discernible trend, courts, commentators, and policymakers increasingly use autonomy-based justifications to support expanding economic rights. Their use of autonomy, however, is inconsistent with the concept of traditional liberal autonomy that proponents of economic rights embrace. This is because many, if not most, economic choices have some measure of consequences ameliorated by state action.

This Article exposes the conceptual incoherence of this approach and argues that these autonomy-based arguments are invalid when they fail to acknowledge the vital role consequences play in constituting liberal autonomy. It also demonstrates that the failure to account for consequences in determining the value of a choice creates conceptual and practical problems that can unnecessarily hamper effective regulations while simultaneously undervaluing true autonomy. 

To do so, this Article uses the Supreme Court’s landmark NFIB v. Sebelius decision and the debate over privatizing Social Security as case studies to critique autonomy-based arguments used to justify economic rights in circumstances where consequences are artificially constrained. This Article then provides an alternative consequence-focused framework for evaluating the regulation of such choices. Finally, this Article applies that framework to demonstrate that considering consequences helps ensure a more robust protection of true autonomy while still providing policymakers flexibility to address social issues.

Considering Consequences: Autonomy’s Missing Half

Drawing the Line between Paternalism and Patient-Centered Care

Where do we draw the line between improving people’s health behavior in the direction downloadthat we want, versus leaving them happy with what they have?   That was the question tackled by NEJM Catalyst, from the February 25th “Patient Engagement: Behavioral Strategies for Better Health” at the University of Pennsylvania.

Kevin Volpp, Director of the Center for Health Incentives and Behavioral Economics at the University of Pennsylvania, David Kirchhoff, CEO of Snap Kitchen and former CEO of Weight Watchers, and Wendy Wood, Provost Professor of Psychology and Business at the University of Southern California, discuss how much providers should let patients drive what happens (patient-centered care), and when it might make sense to be more paternalistic.

If a patient makes a well-reasoned, well-informed decision not to change an unhealthy behavior, maybe we shouldn’t push that person, suggests Volpp. On the other hand, for patients who are dangerously at risk, Kirchhoff argues that clinicians can’t shy away from a serious discussion. “You cannot say it’s OK, to just blow it off,” says Kirchhoff. “I don’t know how as a doctor you’re doing your job if you step away from that responsibility.” Wood points to the amount of data on lifestyle behaviors and what diseases are linked to them. We need tax and social policies that are more closely aligned to these data, she says, and the conversation with health care providers should reflect that.

Drawing the Line between Paternalism and Patient-Centered Care