Uncommon Common Sense

By Bill Frayer

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Is Coercive Paternalism Ever Justified?


Bill-Frayer-2010My friend, Luis Romero, recently sent me a copy of a book review from the New York Review of Books, thinking I might find the subject interesting. The book Against Autonomy, by Sarah Conly, argues that government and other organizations are sometimes justified in using coercion to require people to make choices “for their own good.” 

This topic has been the focus of much debate already.  John Stuart Mill, the utilitarian philosopher, has argued that it is indefensible for government to compel people to act in a particular way to prevent harm to only themselves. This is a popular libertarian position. For example, most would agree that the government should not prevent people from eating an unhealthy diet even if eating such a diet increases their risk of premature death. 

Of course, we already accept some forms of government coercion. We are required, in the US and Canada, to obtain prescriptions before we purchase many medications. We are forbidden to drive without insurance or without a seat belt. And we are forced to pay taxes to support policies with which we may strongly disagree. In the United States, one of the most contentious examples of government coercion revolves around the “individual mandate” requiring everyone to purchase health insurance. 

Sometimes, the argument for coercion is justified by the evidence that people who choose to behave irresponsibly are, in fact, causing harm to others. Those who forego medical coverage, for example, are still cared for in emergency rooms. When they cannot pay their bills, the cost is necessarily passed on to others. Conly argues that what she calls “coercive paternalism,” or forcing people to behave in a particular way, is sometimes justified. 

Many people have a “present bias” which may cause them to focus on present circumstances rather than the future. Even though they may have a long-term goal of living a long, healthy life, they are blinded by the present and have trouble exercising the self-restraint necessary to stop smoking, exercise and eat a healthy diet. Conly believes it is justifiable to “help” people accomplish their long-term goals by limiting portion size in restaurants, for example. 

If the benefits of the coercion outweigh the costs (usually, the loss of autonomy) then, she argues, the coercion is justifiable.  If there is a more effective method for achieving the same ends, without coercion, like a public education campaign, the coercion is not justifiable. The most controversial coercion she proposes is a ban on cigarette smoking. She believes that the huge benefit to public health, and the lack of any other effective, non-coercive measure, justifies such a draconian step.  Of course, such paternalistic, “nanny state” measures are controversial and not likely to be passed. 

Nevertheless, as we decide what the proper role of government should be, we must consider what types of coercion we will accept.  We accept some types of coercion and reject others.  Where should we draw the line?

Note: I received feedback from a physician friend on my January column on over-diagnosis of medical conditions.  While he generally agrees with the column, he disputed the fact that “normal” blood pressure was once considered 160/100. He noted that level has always been considered high and should be regulated by medication.



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