The Government and You: The Ethics of Paternalism

While it may be for our own good, sometimes policies are implemented that restrict our

personal freedoms. However for the most part, we accept the justification for these

paternalistic policies based on other practical aims; that is, policymakers don’t want to restrict

our freedom, they just want to maximize social wellbeing. Take for example seatbelts: pretty

much everyone wears a seatbelt without thinking about it, though most vehicles still have that

annoying warning noise when someone’s seatbelt isn't on. We don’t care that our freedom to

move about unencumbered in a vehicle is restricted by the law, because we know that it keeps

us safe (and it really isn’t much of a burden). But it isn’t always so straightforward. Can the

same principle be applied to gun regulation? What about gambling, tobacco, or alcohol?

These bring us to the central question. Is paternalism justified and ethical if it is promoting

overall wellbeing and prosperity at the expense of individual autonomy?

One of the first problems we run into is trying to define what actually constitutes wellbeing

for an individual. If this is the goal of public policy, then there must be some way to determine

what it looks like, how to measure it, and how to distribute it fairly. Objectively, there are

many proxies that can be used to define wellbeing, such as income, personal achievement,

health, and capabilities, among others. These can be measured fairly easily, and can give us a

pretty decent idea of how well off someone is. Where it gets tricky is with the subjective

views of wellbeing, such as preference satisfaction and/or hedonism. If wellbeing is

only derived from the satisfaction of preferences, then wellbeing will not be maximized if

any preferences are unsatisfied. Paternalism aims to curb certain behaviors, many of which

are preferences that people have, such as smoking. If you want to smoke, but you cannot

smoke, then you are not happy. Paternalism may have saved the day by preventing your

inevitable lung cancer, but it didn’t maximize your wellbeing.

In medicine, the common practice of doctor-patient communication is shared decision

making. Patients are involved in the process of determining a treatment plan, and are guided

by the expertise of their doctor while still maintaining autonomy. But when shared decision

making breaks down due to differences in values, unfair/unreasonable patient demands, lack

of regard for the patient's own life, etc. – paternalism takes over. This is referred to as

selective paternalism. Could this model be applied to public policy? If personal freedom is of

the highest concern, then it seems there should be some sort of buffer before paternalism takes

over in order to maximize autonomy as much as possible. But policymakers aren’t doctors,

and their constituencies are larger than a single patient. It just isn’t possible to consider the

preferences of individuals when designing policies. While we may try, it’s often more

politically feasible to evaluate the aggregate preferences of groups or communities. It’s also

important to consider how long policy actually takes to implement. By the time we need

paternalism to take over (for example, to address a public health crisis), it may be too late.

What policymakers consider are groups much larger than a singular patient. These groups

may include socioeconomic classes, local communities, racial groups, age cohorts, and

various other subsets of the greater society. Policy is created to address a problem, but unlike

in medicine, individuals affected by the policy (but not the problem) may have less incentive

to solve it due to their own preferences, unlike a patient seeking treatment. This is one of the

huge problems paternalism faces in public policy. Maximizing one individual’s wellbeing

might be at the expense of another's. How can we even hope to maximize wellbeing when it

can’t be concretely defined?

Another issue with paternalism (especially when relying on preference satisfaction as the

main measure of wellbeing) is that in attempting to maximize someone’s wellbeing, it may

actually be decreased due to a preference not being satisfied. Maybe even just having

personal autonomy hindered is enough to diminish wellbeing. Should the government have

the power to claim that it knows what’s best for someone? Going back to the example of

smoking: imagine that hypothetically, the government knows that smoking causes harmful

diseases and it concludes that the costs outweigh the benefits, so it bans smoking altogether.

Lives are saved, and hospital budgets are less strained on treating preventable diseases, but

personal freedoms are limited. The government is involved in the lives of individuals down to

the personal choices they make. When examined in this way, we can conclude from this

hypothetical that this is not ethical. We may also consider the fact that smoking isn’t entirely

just a personal choice, however. Others can be affected harmfully, even if they are not

smokers themselves. When viewed in this way, the government may be obligated to step in,

because this is now a public health issue.

This is the lens through which paternalism should be viewed in public policy. Individual

choices in which the effects are constrained to that individual cannot and should not be

unreasonably controlled. Only when the behavior (and/or its effects) extends beyond the

individual is paternalism ethically justified. The question remains, though: How far can the

government go to protect the public until the degradation of individual autonomy overrides

any societal benefit?