A Reexamination of Hard Paternalism

Abstract

Autonomy, the preeminent value in bioethics since the 1970s, has come under increasing attack in recent years. One outcome of this attack is that many bioethicists now recognize that the presumption in favor of autonomy can be rebutted for hard paternalistic reasons, at least under some circumstances. Unfortunately, bioethicists have failed to specify those circumstances.

Yet, this failure is understandable. There is a conceptual obstacle to establishing systematic criteria for the justifiability of hard paternalism: there is no adequate definition of hard paternalism. If we aren't clear about which acts are correctly described as hard paternalistic acts, then we cannot coherently morally assess hard paternalism.

In this paper, I address this problem, offering a comprehensive definition of hard paternalism. Specifically, I argue that six factors must be considered. (1) Presently, hard paternalism is typically defined only in terms of whether the subject's conduct is substantially autonomous. Thus, if the subject acts substantially free from cognitive and volitional defects, then interference with her action is hard paternalism. But hard paternalism must also be defined in terms of: (2) the identity of the paternalistic agent and the agent's relationship to the subject, (3) the motive of the paternalistic agent in restricting the subject, (4) the manner in which the agent restricts the subject, (5) the nature of the subject's restricted conduct, and (6) the importance of the restricted conduct to the subject.

Keywords: autonomy, paternalism, bioethics

JEL Classification: I18, K10, K32