Paternalism

I'm one of three people kicking off a student discussion tonight on paternalism. Here's a draft of what I intend to say:

One way to think about people is as vehicles. The Indian philosopher Nagasena and the Greek philosopher Plato compared a person to a chariot, and whoever said that life is a highway had a similar idea. Paternalism can be understood as taking over someone else’s steering wheel, forcing them to go in a direction that is not the one they have chosen. Put like this it sounds like a form of carjacking or kidnapping, something very bad indeed. It’s hard to say exactly why kidnapping people is wrong, or to articulate what is so bad about it, just as it is hard to say why imprisoning people is so bad (assuming that prisoners are fed and housed, and not subjected to unlawful assaults). But we know that it is very bad to be in prison or to be kidnapped. Freedom seems to be a fundamental value, not something to violate without a very good excuse.

Paternalism is not literally kidnapping, but it is forcing people to live as if you and not they are the boss of them, the person in charge or ruler of their life. So it is like kidnapping, and perhaps almost as bad. It does seem to some people as though it needs a very good excuse, and perhaps it can never really be excused at all. That is, perhaps the only time when paternalistically forcing someone to do, or not do, something without their consent is when they actually do consent in some sense. Most obviously this would be if they actually did consent retroactively. For instance, I save you from a burning building despite the fact that you insist you want to stay and watch the pretty flames. Once your acid trip is over, you thank me for saving your life. You have given me retroactive consent, and my paternalism is forgiven.

Another kind of consent would be hypothetical consent. Here you never actually do agree to what I have made you do, but the idea is that you would consent if you were more enlightened. The word ‘paternalism’ comes from the Latin for father, and it is widely accepted that parents do have the right to make their children eat their broccoli, go to school, etc., because children are not yet fully rational. We might feel the same way about forcing mentally ill people to take their medicine. And so, perhaps, when someone behaves irrationally (driving drunk, taking cocaine, gambling away their life savings, etc.) we might be justified in acting paternalistically toward them. When they have sobered up they might acknowledge that we did the right thing. But even if they don’t, they would do so if they were rational. Irrational people have no right to be left to their own devices. That’s the idea, anyway.

This is tricky though, because who is rational and who is not is a judgment call. Is it irrational to snort cocaine, or just dumb? Do we have a right to intervene every time anyone makes a bad decision? Should large sodas be illegal? Should stupid haircuts be illegal? It’s hard to know where to draw the line, and so it’s tempting to say that every adult should be allowed to do whatever they like as long as they don’t harm anybody else.

There are two problems with this. One is that people make some really bad decisions. Can we really stand by while people destroy their lives? Friends don’t let friends… My neighbor is not my friend, but I don’t have to be inhuman in order to respect other people’s autonomy (self-rule, being the boss of themselves). That is, it seems like a funny kind of moral code that demands we let people suffer when we could, perhaps, easily prevent their suffering. Another problem is that very little does affect only yourself. We’re living in a society, as George Costanza said. If you die, someone else has to clean up your body. If you lose all your money, say by gambling, someone else will have to provide for you. We could, arguably, just leave bodies to rot and the poor to starve, but a) this is simply unacceptable to many people, and b) it would still affect others anyway. Rotting corpses are a health hazard, and starving masses are a recipe for revolution or at least crime. People who do not take care of themselves put others at risk.

Does this give those others a right to insist that people not gamble too much, not take dangerous drugs, not drive without a seatbelt, etc.? I think so. (Just don’t ask me where to draw the line. The point of democracy is to draw lines like this.) But perhaps this isn’t really paternalism any more. It isn’t saving people from themselves, but saving others from the irresponsible.

What about non-legal cases? There is a kind of passive paternalism when you don’t allow someone to make their own informed decisions, by keeping relevant information from them. A doctor might do this by not telling you that you have only a few weeks to live. Or you might decide not to tell a friend that their spouse is cheating on them. There isn’t the same kind of risk to the general public that I described before in these cases, and I don’t think the answer is simple. Some people prefer to know things like this, others don’t. So retroactive consent is hard to predict. What is rational is also hard to know. It might seem that being fully informed is the rational choice. But information might make certain courses of action very hard to take. If they are the right courses to take, then maybe it would be more rational to choose not to know the awful truth.

Take the case of someone who has little time left to live. If he carries on as normal because he does not know that he is soon going to die then his life is kind of absurd, almost ridiculous. The same goes for a man whose wife is cheating on him. It might be cruel to allow someone to live in this absurd way, despite the pain that they would feel on finding out the truth. But what if this pain threw them off track? If the dying man now spends his last days so terrified that he feels unable to get out of bed, was it really kind to tell him he is dying? He has autonomy but no life. Generally I think it is better to know and to let other people know the truth, even when it is painful. But I don’t think I can at all prove that it’s better.

There is a kind of heroic ideal that believes in brave honesty, but I don’t know how honest (or brave) we can be. It is not possible to know everything, or to pay attention to everything. So ignoring some things is not cowardly or dishonest, just inevitable. Death might be one of these things. I don’t mean that we should just pretend it isn’t going to happen, but I doubt we can fully anticipate it either. If that’s right, then the choice isn’t between full honesty and cowardly fantasy, but between degrees of ignorance. And some attempts at maximum honesty might amount to little more than masochism. If you want to do that to yourself it’s up to you, but it would be hard to say that you would always be justified in inflicting it on someone else. So passive paternalism might sometimes be justified, when the truth is just too painful. When in doubt, though, I’d say we let people know the truth so they can steer their lives accordingly.