Paternalism vs. Individual Rights

(morning group)
Was Chase justified in causing Dibala to
Answer with reference to at least 2 of the
following 3 ethical systems:
Virtue ethics
Kantian ethics (deontological ethics)
(afternoon group)
Could a doctor be morally right to kill a cancer patient who has
only 6 months to live in order to give his heart to a heart patient.
Without the new heart, the heart patient will die in 2 hours. With
the new heart, he could live for 30 healthy years. No other heart
is available.
Answer with reference to one of these three ethical systems:
› Virtue ethics
› Kantian ethics (deontological ethics)
› Utilitarianism
What would someone who disagree with you say?
February 21: Smoking should be banned in
public places
February 28: Apes should be granted basic
human rights
March 13: It is wrong to eat meat
February 21: Smoking should be banned in
public places
March 6: It is wrong to eat meat
Videos should be like a short documentary on a
topic related to the course
15-20 minutes for 3 people groups
20-25 minutes for 4 people groups
Some video clips from other sources may be
used, but the source must be clearly indicated.
No more than 30% from other sources
You should give me your proposed topics
We know what’s best for you.
The state should protect people from themselves.
The state is modeled after the family
Very popular historical understanding of the
state’s relationship to its citizens
Aristotle compared the family to the state, the
head of household to the monarch, the wife,
children and slaves to the subjects
Five relationships:
1) Ruler to Subject
2) Father to Son
3) Husband to Wife
4) Elder Brother to Younger Brother
5) Friend to Friend
In every relationship except friend to friend, the relationship is
hierarchical, with the former using his wisdom and power
to govern, guide and protect the latter.
John Stuart Mill
“On Liberty” 1859
Rejected paternalism in favor of freedom
Proposed the harm principle:
That principle is, that the sole end for which mankind are warranted,
individually or collectively, in interfering with the liberty of action of
any of their number, is self-protection. That the only purpose for
which power can be rightfully exercised over any member of a
civilized community, against his will, is to prevent harm to others. His
own good, either physical or moral, is not sufficient warrant. He
cannot rightfully be compelled to do or forbear because it will be
better for him to do so, because it will make him happier, because,
in the opinion of others, to do so would be wise, or even right... The
only part of the conduct of anyone, for which he is amenable to
society, is that which concerns others. In the part which merely
concerns himself, his independence is, of right, absolute. Over
himself, over his own body and mind, the individual is sovereign.”
Utilitarianism (Mill)
› Mill’s view: if the harm principle is followed, the
greatest good for the greatest number will result
› Problem: is that true? What if violating rights
leads to an increase in the general welfare? E.g.
putting an innocent person in jail to avoid violent
riots, likely deaths
Lockean justification
› People by nature are free and equal
› Everyone has an inborn right to life
and liberty
“We hold these truths to be self-evident, that all men are
created equal, that they are endowed by their Creator with
certain unalienable Rights, that among these are Life, Liberty
and the pursuit of Happiness”
 Known to be true by immediate understanding or by definition and
requiring no proof or explanation, e.g. “I think therefore I am”
 Obviously true to all right-thinking people, esp. morally self-evident
 Cannot be denied, surrendered
or taken away
Motorcycle helmets
Smoking in public places
Smoking privately
Illegal drugs, e.g. marijuana, cocaine,
Refusing life-saving medical treatment on
religious grounds for yourself/your children
1) The right to free speech
 2) Euthanasia
 3) Heroin
 4) Cigarette smoking in public places
(debate next week)
 5) Medical marijuana (debate?)
In the ideology of the United States, freedom of
speech is one of the most important freedoms
Even in the U.S., though, there are restrictions
on freedom of speech, e.g.
Shouting fire in a crowded theater
Calling for overturn of the government
Revealing state secrets
Inciting a riot
Perjury (lying under oath)
Many countries have more extensive
restrictions to free speech. E.g. Germany
the following are illegal:
Malicious gossip
Hate speech
Holocaust denial
Rewarding and approving crimes
Insulting faiths and religious beliefs
What kind of limits to free speech are
Is causing offensive considered causing harm
(hence falling under the harm principle?)
What about offensive language, pornography,
satirizing political and religious leaders
Some use of symbols are protected by
freedom of speech laws and some aren’t, e.g.
wearing a swastika, burning the flag, defacing
a picture of the king
Ideas, like people, need defense
The public are the judge, not the state or a stateappointed authority
Seemingly wrong ideas should be defended as
vigorously as possible, so the public can make an
informed decision
Examples: communism is good, capitalism is good,
women are inferior, smoking is not bad for your
health, gun control is unnecessary
Defending ideas legitimately can involve
promoting controversial views and philosophies,
finding and promulgating evidence and putting
facts into favorable contexts, but not lying.
An idea that seems wrong might be right. Only open
debate can ensure that we eventually arrive at the truth.
Outlawing the expression of a wrong-headed idea
doesn’t get rid of the idea, but just drives it underground.
Countering wrong-headed ideas requires the correct
ideas to be clarified and sometimes improved
“…there ought to exist the fullest liberty of professing and
discussing, as a matter of ethical conviction, any doctrine,
however immoral it may be considered…. If all mankind
minus one were of one opinion, and only one person were
of the contrary opinion, mankind would be no more
justified in silencing that one person than he, if he had the
power, would be justified in silencing mankind.” (Mill, On
“I disapprove of what
you say, but I will
defend to the death
your right to say it”
(Evelyn Beatrice Hall,
describing the beliefs
of Voltaire)
“Let a hundred flowers
bloom, let a hundred
schools of thought
contend” 百花齐放,百
家争鸣 (Mao Zedong)
“Good death”
Voluntary: with patient’s consent/at
patient’s request
Non-voluntary: patient is unable to
Involuntary: against the explicit desires of
the patient
“Advocates of voluntary euthanasia contend that if a person
1) is suffering from a terminal illness;
2) is unlikely to benefit from the discovery of a cure for that illness
during what remains of her life expectancy;
3) is, as a direct result of the illness, either suffering intolerable
pain, or only has available a life that is unacceptably
burdensome (because the illness has to be treated in ways
that lead to her being unacceptably dependent on others or
on technological means of life support);
4) has an enduring, voluntary and competent wish to die (or has,
prior to losing the competence to do so, expressed a wish to
die in the event that conditions (a)-(c) are satisfied); and
5) is unable without assistance to commit suicide”
Stanford Encyclopedia of Philosophy, Voluntary Euthanasia
Active euthanasia
› Assisted suicide
› Lethal injection, provision of lethal substances,
suicide machine
Passive euthanasia
› Voluntary refusal of food and fluids
› Voluntary refusal of life-saving treatment
› Toxic/lethal dosage of pain relieving drugs (e.g.
› The doctrine of double effect
Refusal of medical treatment
Ceasing life support for brain dead/legal
dead patient
Ceasing life support for patients in
persistant vegetative state
“Do not resusitate” (DNR) orders via living
will or family decision
Illegal in most countries
Legal or decriminalized in:
The Netherlands
Germany (passive) (as of June 25, 2010)
The U.S. states of Washington, Oregon and Montana
Many other countries with unclear or contested laws,
e.g. Canada, Japan
Washington State
Public referendum
85% turnout
 58% for
 42% against
Right to privacy and autonomy
› the harm principle
Equal access
Humanitarian: reduce pain, suffering, loss of dignity
› utilitarianism
Effect on doctors and doctor-patient relationship
› Original Hippocratic Oath includes “I will not give a lethal drug
to anyone if I am asked, nor will I advise such a plan”
Hope of cure or “medical miracle”
Open to abuse
› Possibility of patients being pressured by hospitals or families
Slippery slope: eroding our idea of the sanctity of all
human life
Highly addictive
High fatality rate of users
2004 U.K. Study
Heroin: 744 deaths/40,000 users (1.9%)
Cocaine: 147 deaths/800000 users (.018%)
Tobacco: 114,000 deaths/12.5 million users (0.9%)
Ecstasy: 33 deaths/800,000 users (0.004%)
Ideological argument
Harm principle
› People have the right to do whatever they
want with their own lives and bodies as long
as it doesn’t harm other people
› Heroin only directly harms the user
› So, people have the right to choose whether
or not to take heroin
Practical arguments:
› Criminalization does more harm than good
Waste of resources
High rate of relapse among ex-prisoners
Forces users into criminal activites/criminal world
Makes it hard for people to seek treatment
HIV infection rate higher where heroin is illegal
Arguments against ideological argument
1) Denying the harm principle:
People need to be protected from themselves
2) Claiming the harm principle doesn’t apply here:
a) Heroin does harm others, e.g. families, society
But is this kind of harm covered by the harm principle?
b) Harm principle is supposed to protect individual autonomy,
but addictive substances erode autonomy
Argument against practical arguments
Decriminalization would be even more
harmful than criminalization
Required reading
Stanford Encyclopedia of Philosophy, at: entry on Paternalism
Suggested readings:
J.S. Mill, “On Liberty”, full text at:
Ronald Bayer, “Ethics of Health Promotion and Disease
Prevention” at:

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