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Epistemic Paternalism in Public Health
KTH, School of Architecture and the Built Environment (ABE), Philosophy and History of Technology.
KTH, School of Architecture and the Built Environment (ABE), Philosophy and History of Technology.ORCID iD: 0000-0003-0071-3919
2005 (English)In: Journal of Medical Ethics, ISSN 0306-6800, E-ISSN 1473-4257, Vol. 31, no 11, 648-653 p.Article in journal (Refereed) Published
Abstract [en]

Receiving information about threats to one’s health can contribute to anxiety and depression. In contemporary medical ethics there is considerable consensus that patient autonomy, or the patient’s right to know, in most cases outweighs these negative effects of information. Worry about the detrimental effects of information has, however, been voiced in relation to public health more generally. In particular, information about uncertain threats to public health, from—for example, chemicals—are said to entail social costs that have not been given due consideration. This criticism implies a consequentialist argument for withholding such information from the public in their own best interest. In evaluating the argument for this kind of epistemic paternalism, the consequences of making information available must be compared to the consequences of withholding it. Consequences that should be considered include epistemic effects, psychological effects, effects on private decisions, and effects on political decisions. After giving due consideration to the possible uses of uncertain information and rebutting the claims that uncertainties imply small risks and that they are especially prone to entail misunderstandings and anxiety, it is concluded that there is a strong case against withholding of information about uncertain threats to public health.

Place, publisher, year, edition, pages
BMJ , 2005. Vol. 31, no 11, 648-653 p.
Keyword [en]
epistemic paternalism; public health; withholding of information; uncertain information
National Category
Philosophy
Identifiers
URN: urn:nbn:se:kth:diva-10946DOI: 10.1136/jme.2004.010850ISI: 000233017600008Scopus ID: 2-s2.0-28244441646OAI: oai:DiVA.org:kth-10946DiVA: diva2:232997
Note
QC 20100714Available from: 2009-08-27 Created: 2009-08-27 Last updated: 2017-12-13Bibliographically approved
In thesis
1. Anti-paternalism and Public Health Policy
Open this publication in new window or tab >>Anti-paternalism and Public Health Policy
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This thesis is an attempt to constructively interpret and critically evaluate the liberal doctrine that we may not limit a person’s liberty for her own good, and to discuss its implications and alternatives in some concrete areas of public health policy. The thesis starts theoretical and goes ever more practical. The first paper is devoted to positive interpretation of anti-paternalism with special focus on the reason component – personal good. A novel generic definition of paternalism is proposed, intended to capture, in a generous fashion, the object of traditional liberal resistance to paternalism – the invocation of personal good reasons for limiting of or interfering with a person’s liberty. In the second paper, the normative aspect of this resistance is given a somewhat technical interpretation in terms of invalidation of reasons – the blocking of reasons from influencing the moral status of actions according to their strength. It is then argued that normative anti-paternalism so understood is unreasonable, on three grounds: 1) Since the doctrine only applies to sufficiently voluntary action, voluntariness determines validity of reasons, which is unwarranted and leads to wrong answers to moral questions. 2) Since voluntariness comes in degrees, a threshold must be set where personal good reasons are invalidated, leading to peculiar jumps in the justifiability of actions. 3) Anti-paternalism imposes an untenable and unhelpful distinction between the value of respecting choices that are sufficiently voluntary and choices that are not. The third paper adds to this critique the fourth argument that none of the action types typically proposed to specify the action component of paternalism is such that performing an action of that type out of benevolence is essentially morally problematic. The fourth paper ignores the critique in the second and third papers and proposes, in an anti-paternalistic spirit, a series of rules for the justification of option-restricting policies aimed at groups where some members consent to the policy and some do not. Such policies present the liberal with a dilemma where the value of not restricting people’s options without their consent conflicts with the value of allowing people to shape their lives according to their own wishes. The fifth paper applies the understanding of anti-paternalism developed in the earlier papers to product safety regulation, as an example of a public health policy area. The sixth paper explores in more detail a specific public health policy, namely that of mandatory alcohol interlocks in all cars, proposed by the former Swedish government and supported by the Swedish National Road Administration. The policy is evaluated for cost-effectiveness, for possible diffusion of individual responsibility, and for paternalistic treatment of drivers. The seventh paper argues for a liberal policy in the area of dissemination of information about uncertain threats to public health. The argument against paternalism is based on common sense consequentialist considerations, avoiding any appeal to the normative anti-paternalism rejected earlier in the thesis.

Place, publisher, year, edition, pages
Stockholm: KTH, 2009. viii, 38 p.
Series
Theses in philosophy from the Royal Institute of Technology, ISSN 1650-8831
Keyword
Alcohol Interlocks; Altruism; Anti-paternalism; Epistemic paternalism; Group consent; Harm principle; Interference; Invalidation of reasons; Liberalism; Limiting liberty; Private sphere; Product safety regulation; Public health policy; Reason-actions; Self-regarding; Social responsibility; Uncertain information; Withholding of information.
National Category
Philosophy
Identifiers
urn:nbn:se:kth:diva-10947 (URN)978-91-7415-226-5 (ISBN)
Public defence
2009-09-08, F3, Lindstedtsv. 26, KTH, Stockholm, 10:00 (English)
Opponent
Supervisors
Note
QC 20100714Available from: 2009-08-27 Created: 2009-08-27 Last updated: 2010-07-14Bibliographically approved
2. Anti-paternalism
Open this publication in new window or tab >>Anti-paternalism
2006 (English)Licentiate thesis, comprehensive summary (Other scientific)
Abstract [en]

This is a thesis about anti-paternalism – the liberal doctrine that we may not interfere with a person’s liberty for her own good. Empirical circumstances and moral values may certainly give us reason to avoid benevolent interference. Anti-paternalism as a normative doctrine should, however, be rejected.

Essay I concerns the definitions of paternalism and anti-paternalism. It is argued that only a definition of paternalism in terms of compound reason-actions can accommodate its special moral properties. Definitions in terms of actions, common in the literature, cannot. It is argued, furthermore, that in specifying the reason-actions in further detail, the notion of what is self-regarding, as opposed to other-regarding, is irrelevant, contrary to received opinion.

Essay II starts out with the definition of paternalism defended in essay I and claims that however this very general definition is specified, anti-paternalism is unreasonable and should be rejected. Anti-paternalism is the position that certain reasons – referring one way or the other to the good of a person, give no valid normative support to certain actions – some kind of interferences with the same person. Since the reasons in question are normally quite legitimate and important reasons for action, a convincing argument for anti-paternalism must explain why they are invalid in cases of interference. A closer look at the reasons and actions in question provides no basis for such an explanation.

Essay III considers a concrete case of benevolent interference – the withholding of information concerning uncertain threats to public health in the public’s best interest. Such a policy has been suggested in relation to the European Commission’s proposed new system for the Registration, Evaluation, and Authorisation of Chemicals (REACH). Information about uncertain threats to health from chemicals would allegedly spread anxiety and depression and thus do more harm than good. The avoidance of negative health effects is accepted as a legitimate and good reason for withholding of information, thus respecting the conclusion of essay II, that anti-paternalism should be rejected. Other reasons, however, tip the balance in favour of making the information available. These reasons include the net effects on knowledge, psychological effects, effects on private decisions and effects on political decisions.

Place, publisher, year, edition, pages
Stockholm: Filosofi och teknikhistoria, 2006. vii, 1-8 sammanfattning, s.9-79: 3 uppsatser p.
Series
Theses in philosophy from the Royal Institute of Technology, ISSN 1654-627X
Keyword
paternalism, anti-paternalism, private sphere, self-regarding, harm principle, interference, reasons, actions, reason-actions, epistemic paternalism, public health, withholding of information, uncertain information, MCS (multiple chemical sensitivity).
National Category
Philosophy
Identifiers
urn:nbn:se:kth:diva-4065 (URN)91-7178-404-7 (ISBN)
Presentation
2006-06-14, Seminarierum 231, KTH, Teknikringen 78B, Stockholm, 10:15
Opponent
Supervisors
Note
QC 20101115Available from: 2006-06-28 Created: 2006-06-28 Last updated: 2010-11-15Bibliographically approved

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