[ 16 ] In the case of soft or weak paternalism, persons might hold all manner of preferences not in their best interest that are nonetheless not justifiably interfered with because the relevant compromising conditions do not obtain. In public health policy, soft paternalism has been evoked to justify interventions that limit the ability of adolescents to act on preferences for alcohol, drugs, sexual activity and driving. In recent years, public health policy and liberal governments have increasingly looked to interventions called 'nudges' to influence health behaviors in desirable directions. Nudges, understood typically as interventions in choice architecture, are the focus of libertarian paternalism. Libertarian paternalism defends interventions by planners (such as public health authorities) in the environmental architecture in which individuals decide and act in order to make it easier for people to behave in ways that are in their best interests (including their health), provided two conditions are satisfied (Thaler &Sunstein 2003; Thaler & Sunstein 2008). First, individuals are steered by these interventions in ways that make them better off, as judged by themselves. Thus, in libertarian paternalism there is no attempt to contravene the will of individuals, in contrast to what some hold to be a necessary feature of paternalism. Second, the interventions must not overly burden individuals who want to exercise their freedom in ways that run counter to welfare. In this sense, libertarian paternalism claims to be liberty-preserving, hence libertarian. A key conceptual question about paternalism is whether the interference with individual liberty must be against the person's will (Beauchamp 2010). If this feature is a necessary condition of paternalism, then libertarian paternalism is inappropriately titled. From the standpoint of public health ethics, however, whether libertarian paternalism is appropriately titled is less important than any moral issues it raises and how it is justified. There is a growing literature on the ethics of 'nudges,' much of it focusing on health (Saghai 2013a; Saghai 2013b; Quigley 2013; Hollands et al. 2013). Libertarian paternalism is grounded in the extensive empirical literature in cognitive psychology and the decision sciences that support claims about our cognitive limitations, bounded rationality and weakness of will. Although it raises challenging epistemic and political questions about how planners know what individuals judge is in their interest in specific policy contexts, libertarian paternalism may be well suited to
public health contexts in which there is broad public consensus in favor of health-promoting behaviors such as eating more fruits and vegetables or getting more exercise, and a general recognition that it is difficult for people to act as prudentially as they would like. Thaler and Sunstein suggest, for example, that salads rather than French fries could be made the default “side” on restaurant menus, with diners free to request fries if that remains their preference. At the same time, libertarian paternalism has been criticized for failing to take
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- Fall '19
- Public health ethics