Since Mill's seminal work On Liberty, philosophers and political theorists have accepted that we should respect the decisions of individual agents when those decisions affect no one other than ...themselves. Indeed, to respect autonomy is often understood to be the chief way to bear witness to the intrinsic value of persons. In this book, Sarah Conly rejects the idea of autonomy as inviolable. Drawing on sources from behavioural economics and social psychology, she argues that we are so often irrational in making our decisions that our autonomous choices often undercut the achievement of our own goals. Thus in many cases it would advance our goals more effectively if government were to prevent us from acting in accordance with our decisions. Her argument challenges widely held views of moral agency, democratic values and the public/private distinction, and will interest readers in ethics, political philosophy, political theory and philosophy of law.
If someone else bans trans-fats on our behalf or figures out what a reasonably healthy portion size is and forces restaurants to stick to those standards, I think we would get used to that loss of ...liberty very quickly. If, as is argued, there would be a net loss to our happiness if someone followed us around exhorting us to finish our five healthy helpings of fruit and vegetables every day, then the paternalist would obviously not suggest we do that, since the point of paternalism is to benefit us.
...the act we are preventing must be contrary to the person's long-term ends (as smoking is contrary to our goals of health and long life); the intervention must be effective; the benefits must be ...greater than the costs; and the intervention in question must be the most efficient way of reaching the desired effect: that is, it has to be the intervention with the greatest margin of benefits over costs that is possible in the situation. ...the fact that a choice is irrational is not in itself a sufficient reason for banning it, on my account (ref. 3 , pp. 150-2).
The right to health care is a right to care that (a) is not too costly to the provider, considering the benefits it conveys, and (b) is effective in bringing about the level of health needed for a ...good human life, not necessarily the best health possible. These considerations suggest that, where possible, society has an obligation to provide preventive health care, which is both low cost and effective, and that health care regulations should promote citizens’ engagement in reasonable preventive health care practices.
Mr Pugh thinks that I nonetheless may be suggesting we should prioritise some ends over others, so that my account does allow for a kind of back-door perfectionism. ...he suggests that I require that ...we prioritise health over the ends met by the unhealthy consumption of 'whiskey, cigarettes and fried food', whose protection Joel Feinberg worried about. Since Gerald Dworkin agrees with my position that paternalism need be neither insulting nor disrespectful, I haven't a great deal to add to his account.
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