Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Anti-paternalism and Public Health Policy
KTH, School of Architecture and the Built Environment (ABE), Philosophy and History of Technology.
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 [en]
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: urn:nbn:se:kth:diva-10947ISBN: 978-91-7415-226-5 (print)OAI: oai:DiVA.org:kth-10947DiVA: diva2:233000
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
List of papers
1. The Normative Core of Paternalism
Open this publication in new window or tab >>The Normative Core of Paternalism
2007 (English)In: Res Publica, ISSN 1356-4765, E-ISSN 1572-8692, Vol. 13, no 4, 441-458 p.Article in journal (Refereed) Published
Abstract [en]

The philosophical debate on paternalism is conducted as if the property of being paternalistic should be attributed to actions. Actions are typically deemed to be paternalistic if they amount to some kind of interference with a person and if the rationale for the action is the good of the person interfered with. This focus on actions obscures the normative issues involved. In particular, it makes it hard to provide an analysis of the traditional liberal resistance to paternalism. Given the fact that actions most often have mixed rationales, it is not clear how we should categorize and evaluate interfering actions for which only part of the rationale is the good of the person. The preferable solution is to attribute the property of being paternalistic not to actions, but to compounds of reasons and actions. The framework of action–reasons provides the tools for distinguishing where exactly paternalism lies in the complex web of reasons and actions.

Place, publisher, year, edition, pages
Springer, 2007
Keyword
actions - action-reasons - anti-paternalism - harm to others - interference - paternalism - reasons
National Category
Philosophy
Identifiers
urn:nbn:se:kth:diva-10940 (URN)10.1007/s11158-007-9036-9 (DOI)2-s2.0-36648998969 (Scopus ID)
Note
QC 20100714Available from: 2009-08-27 Created: 2009-08-27 Last updated: 2017-12-13Bibliographically approved
2. Anti-paternalism and Invalidation of Reasons
Open this publication in new window or tab >>Anti-paternalism and Invalidation of Reasons
(English)Manuscript (preprint) (Other (popular science, discussion, etc.))
Abstract [en]

Anti-paternalism can fruitfully be interpreted as a principle of invalidation of reasons. That a reason for an action is invalid means that the reason is blocked from influencing the moral status of the action. More specifically, anti-paternalism blocks personal good reasons from influencing the moral status of certain interfering actions. Actions are only interfering in this sense if they target choice or action that is sufficiently voluntary. Antipaternalism so interpreted is unreasonable on three grounds. First, it essentially entails that the degree to which a person acts voluntarily determines whether or not her good provides reasons for action. This leads to wrong answers to moral questions. Second, anti-paternalism entails peculiar jumps in justifiability at the threshold of voluntary enough. Third, anti-paternalism imposes a distinction in kind between the value of respecting choices that are sufficiently voluntary and choices that are not. This distinction is untenable and diverts our attention away from the relative strength of reasons. Invalidation in general is unreasonable on the same grounds.

National Category
History of Technology Philosophy
Identifiers
urn:nbn:se:kth:diva-10941 (URN)
Note
QC 20100714Available from: 2009-08-27 Created: 2009-08-27 Last updated: 2010-07-14Bibliographically approved
3. Paternalistic Interference
Open this publication in new window or tab >>Paternalistic Interference
(English)Manuscript (preprint) (Other academic)
Abstract [en]

In order that paternalism, understood as benevolent interference, should be a morally relevant category, there would have to be something morally significant about the combination of benevolence and interference that goes beyond that of interference as such. In the context of paternalism, interference is almost universally defined in terms of either liberal values such as liberty, autonomy or sovereignty, or a self-regarding sphere of life, or operationalizations of the liberal values in terms of choice, decision or agency, or coercion, or wronging. A survey of these five accounts shows that none provide a definition on which paternalism is morally relevant. We should therefore understand paternalism as a conflict between typical liberal values and other values for a person, which but must be resolved in different ways in different contexts.

National Category
Philosophy
Identifiers
urn:nbn:se:kth:diva-10942 (URN)
Note
QC 20110214Available from: 2009-08-27 Created: 2009-08-27 Last updated: 2011-02-14Bibliographically approved
4. Liberalism, Altruism and Group Consent
Open this publication in new window or tab >>Liberalism, Altruism and Group Consent
2009 (English)In: Public Health Ethics, ISSN 1754-9973, E-ISSN 1754-9981, Vol. 2, no 2, 146-157 p.Article in journal (Refereed) Published
Abstract [en]

This article first describes a dilemma for liberalism: On the one hand restricting their own options is an important means for groups of people to shape their lives. On the other hand, group members are typically divided over whether or not to accept option-restricting solutions or policies. Should we restrict the options of all members of a group even though some consent and some do not? This dilemma is particularly relevant to public health policy, which typically target groups of people with no possibility for individuals to opt out. The article then goes on to propose and discuss a series of aggregation rules for individual into group consent. Consideration of a number of scenarios shows that such rules cannot be formulated only in terms of fractions of consenters and non-consenters, but must incorporate their motives and how much they stand to win or lose. This raises further questions, including what is the appropriate impact of altruistic consenters and non-consenters, what should be the impact of costs and benefits and whether these should be understood as gross or net. All these issues are dealt with in a liberal, anti-paternalistic spirit, in order to explore whether group consent can contribute to the justification of option-restricting public health policy.

Place, publisher, year, edition, pages
Oxford: Oxford Journals, 2009
Keyword
altruism; article; cost benefit analysis; freedom; health care policy; human; priority journal; public health
National Category
Philosophy
Identifiers
urn:nbn:se:kth:diva-10943 (URN)10.1093/phe/php014 (DOI)000208221600004 ()2-s2.0-77949337925 (Scopus ID)
Note

QC 20100714

Available from: 2009-08-27 Created: 2009-08-27 Last updated: 2017-12-13Bibliographically approved
5. Anti-paternalism and Public Health Policy: The Case of Product Safety Legislation
Open this publication in new window or tab >>Anti-paternalism and Public Health Policy: The Case of Product Safety Legislation
2009 (English)In: Annual Conference of the Society-for-Applied-Philosophy, Farnham: Ashgate , 2009, 101-110 p.Conference paper, Published paper (Other academic)
Place, publisher, year, edition, pages
Farnham: Ashgate, 2009
National Category
Philosophy
Identifiers
urn:nbn:se:kth:diva-10944 (URN)000335909900009 ()978 0 7546 6043 9 (ISBN)
Conference
Annual Conference of the Society-for-Applied-Philosophy, Manchester, ENGLAND 2006
Note

QC 20100714

Available from: 2009-08-27 Created: 2009-08-27 Last updated: 2014-10-08Bibliographically approved
6. Responsibility, Paternalism and Alcohol Interlocks
Open this publication in new window or tab >>Responsibility, Paternalism and Alcohol Interlocks
(English)In: Ethics of Health Promotion, SpringerChapter in book (Other academic)
Abstract [en]

Drink driving causes great suffering and material destruction. The alcohol interlock promises to eradicate this problem by technological design. Traditional counter-measures to drink driving such as policing and punishment and information campaigns have proven insufficient. Extensive policing is expensive and arguably intrusive. Severe punishment may be disproportionate to the risks created in most single cases. If the interlock becomes inexpensive and convenient enough, and if there are no convincing moral objections to the device, it may prove the only feasible as well as the only justifiable solution to the problem of drink driving. Taking this to heart, the former Swedish government, supported by the National Road Administration and a 2006 final report of the Alcohol Interlock Commission, proposed that interlocks should be required as standard equipment in all cars. This article assesses two possible moral objections to a policy of mandatory interlocks: 1) That it displaces the responsibility of individual drivers, and 2) that it constitutes a paternalistic interference with drivers. The first objection is found unconvincing, while the second has only limited bite and may be neutralized if paternalism is accepted for the sake of greater net liberty. If technological development can make mandatory interlocks cost-efficient, the proposed policy seems a commendable public health measure.

Place, publisher, year, edition, pages
Springer
National Category
Philosophy
Identifiers
urn:nbn:se:kth:diva-10945 (URN)
Note
QC 20100714Available from: 2009-08-27 Created: 2009-08-27 Last updated: 2010-08-31Bibliographically approved
7. Epistemic Paternalism in Public Health
Open this publication in new window or tab >>Epistemic Paternalism in Public Health
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
Keyword
epistemic paternalism; public health; withholding of information; uncertain information
National Category
Philosophy
Identifiers
urn:nbn:se:kth:diva-10946 (URN)10.1136/jme.2004.010850 (DOI)000233017600008 ()2-s2.0-28244441646 (Scopus ID)
Note
QC 20100714Available from: 2009-08-27 Created: 2009-08-27 Last updated: 2017-12-13Bibliographically approved

Open Access in DiVA

spikblad(102 kB)17 downloads
File information
File name SPIKBLAD01.pdfFile size 102 kBChecksum SHA-512
3bf4039d0b069a72758c6f7ca685788dec98df58cdaa425fbc35c1e329197056c86449669c5d5feb446fbb80a15aa0a2e7fd9dcc9a7671f5e89b222c853d7987
Type spikbladMimetype application/pdf
fulltext(373 kB)1051 downloads
File information
File name FULLTEXT01.pdfFile size 373 kBChecksum SHA-512
1767810aacf1e3b4dc5faf9687e30c1670576f47cf47408f4bdbdae55e4a5c5fb54ed7ea3bce8895e87093145a84e09f97497474196c8b3c061e4b4b91031038
Type fulltextMimetype application/pdf

Search in DiVA

By author/editor
Grill, Kalle
By organisation
Philosophy and History of Technology
Philosophy

Search outside of DiVA

GoogleGoogle Scholar
Total: 1051 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

isbn
urn-nbn

Altmetric score

isbn
urn-nbn
Total: 655 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf