Abstract
Paternalistic interventions restrict individuals’ liberty or autonomy so as to guide their decisions towards options that are more beneficial for them than the ones they would choose in the absence of such interventions. Although some philosophers have emphasised that there is a case for justifiable paternalism in certain circumstances, much of contemporary moral and political philosophy works from a strong presumption against paternalistic interventions. However, Richard Arneson has argued that there are egalitarian reasons that support the case for paternalism: paternalistic interventions can protect poor decision-makers from making ‘bad’ choices, thus preventing inequalities between them and those with better decision-making skills. This paper seeks to clarify and advance our understanding of the egalitarian argument for paternalism. Arneson’s argument adds an important and often neglected dimension to the debate about paternalism but also raises a number of questions about equality, paternalism and the relationship between the two.
This work was first presented at the ‘New perspectives on medical paternalism’ workshop at the University of Hamburg in March 2012 and benefited greatly from the comments received. I would also like to thank Kalle Grill and Thomas Schramme for their helpful comments on an earlier draft.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Notes
- 1.
In Jefford et al.’s (2005) study with Australian oncologists, the most commonly voiced concerns about giving patients information about unsubsidised drugs were about causing the patient and their family distress and mentioning a drug to patients even though they probably wouldn’t be able to afford it.
- 2.
Note that strictly speaking we are dealing with impure paternalism here, where third parties are restricted in their liberties so as to protect other agents from making ‘bad’ choices.
- 3.
On the relationship between the distributive and relational views, see also Schemmel (2012). The possible implications of the relational approach for questions surrounding health are considered in Voigt and Wester (forthcoming).
Bibliography
Anderson, Elizabeth. 1999. What is the point of equality? Ethics 109: 287–337.
Arneson, Richard J. 1989a. Equality and equal opportunity for welfare. Philosophical Studies 56: 77–93.
Arneson, Richard J. 1989b. Paternalism, utility, and fairness. Revue Internationale de Philosophie 43: 409–437.
Arneson, Richard J. 1990. Liberalism, distributive subjectivism and equal opportunity for welfare. Philosophy and Public Affairs 38: 158–194.
Arneson, Richard J. 1991. A defense of equal opportunity for welfare. Philosophical Studies 62: 187–195.
Arneson, Richard J. 2000. Luck egalitarianism and prioritarianism. Ethics 110: 339–349.
Arneson, Richard J. 2005. Joel Feinberg and the justification of hard paternalism. Legal Theory 11: 259–284.
De Marneffe, P. 2005. Avoiding paternalism. Philosophy and Public Affairs 34: 68–94.
Dworkin, G. 2011. Paternalism. In Stanford encyclopedia of philosophy, ed. Edward N. Zalta. http://plato.stanford.edu/entries/paternalism/.
Edwards, Sarah, and James Wilson. 2012. Hard paternalism, fairness and clinical research: Why not? Bioethics 26: 68–75.
Elliott, Carl, and Roberto Abadie. 2008. Exploiting a research underclass in phase 1 clinical trials. The New England Journal of Medicine 358: 2316–2317.
Feinberg, Joel. 1986. Harm to self. Oxford: Oxford University Press.
Goodin, Robert. 1991. Permissible paternalism: In defense of the nanny state. The Responsive Community 1: 42–51.
Jansen, Lynn, and Steven Wall. 2009. Paternalism and fairness in clinical research. Bioethics 23: 172–182.
Jefford, M., J. Savulescu, J. Thomson, P. Schofield, L. Mileshkin, et al. 2005. Medical paternalism and expensive unsubsidised drugs. British Medical Journal 331: 1075–1077.
Scheffler, Samuel. 2003. What is egalitarianism? Philosophy and PublicAffairs 31: 5–39.
Schemmel, Christian. 2012. Distributive and relational equality. Politics, Philosophy and Economics 11: 123–148.
Schmidt, Harald, Kristin Voigt, and Daniel Wikler. 2010. Carrots, sticks, and health care reform – Problems with wellness incentives. The New England Journal of Medicine 362: e3.
Shiffrin, S. 2000. Paternalism, unconscionability doctrine, and accommodation. Philosophy and Public Affairs 29: 205–250.
Thaler, Richard, and Cass Sunstein. 2008. Nudge: Improving decisions about health, wealth, and happiness. New Haven/London: Yale University Press.
Voigt, Kristin. 2007. The harshness objection: Is luck egalitarianism too harsh on the victims of option luck? Ethical Theory and Moral Practice 10: 389–407.
Voigt, Kristin. 2010. Smoking and social justice. Public Health Ethics 3: 91–106.
Voigt, Kristin. 2012. Incentives, health promotion and equality. Health Economics, Policy, and Law 7: 263–283.
Voigt, Kristin, and Wester, Gry. Forthcoming. Relational equality and health. Social Philosophy and Policy .
Wilson, James. 2011. Why it’s time to stop worrying about paternalism in health policy. Public Health Ethics 4: 269–279.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2015 Springer International Publishing Switzerland
About this chapter
Cite this chapter
Voigt, K. (2015). Paternalism and Equality. 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_6
Download citation
DOI: https://doi.org/10.1007/978-3-319-17960-5_6
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-17959-9
Online ISBN: 978-3-319-17960-5
eBook Packages: Humanities, Social Sciences and LawPhilosophy and Religion (R0)