Kalle Grill

The philosophical debate on paternalism is conducted as if the property of being paternalistic should be attributed to actions. Actions are typically deemed to be paternalistic if they amount to some kind of interference with a person and if the rationale for the action is the good of the person interfered with. This focus on actions obscures the normative issues involved. In particular, it makes it hard to provide an analysis of the traditional liberal resistance to paternalism. Given the fact that actions most often have mixed rationales, it is not clear how we should categorize and evaluate interfering actions for which only part of the rationale is the good of the person. The preferable solution is to attribute the property of being paternalistic not to actions, but to compounds of reasons and actions. The framework of action–reasons provides the tools for distinguishing where exactly paternalism lies in the complex web of reasons and actions

Introduction: Preference, Choice and (Libertarian) Paternalism Kalle Grill & Danny Scoccia This special issue originated in a workshop organized by one of the editors, Kalle Grill, at Umeå University in March 2014, with funding from The Swedish Foundation for Humanities and Social Sciences. The theme of the workshop was Respecting Context-Dependent Preferences. Contributors to this issue who were also speakers at the Umeå workshop are Richard Arneson, Kalle Grill, Jason Hanna, Sven Ove Hansson, Robert Sugden, and Torbjörn Tännsjö. The other speakers at the workshop were Luc Bovens, Sarah Conly, Fabienne Peter and Danny Scoccia. Preferences are context-dependent when they are determined by circumstances other than the contents of the alternatives that preferences range over, such as the way alternatives are presented. As behavioral research increasingly indicates, many of our preferences are context-dependent in this sense. Context-dependence raises difficult issues for many areas of moral and political philosophy. Importantly, the fact that preferences are not in any obvious way based on settled values or considered judgments may cast doubt on liberalism’s stance on when paternalism is morally objectionable: What exactly is liberal antipaternalism supposed to protect, if not settled preferences? What about paternalism that operates by influencing the formation of preferences? Should we, as proposed by so called "libertarian paternalists", shape the choice environment so as to promote choices that are conducive to health, wealth and happiness over the long run? More generally, we may inquire what respect for persons should mean given the context-dependence of their preferences. Several articles in this issue deal with the plausibility of libertarian paternalism and the nudging it endorses. Sugden argues that those who take context-dependence to justify paternalism often rely on ideas of latent preferences that lack a convincing psychological explanation. William Glod argues that, because of informational constraints, nudging often fails to track people's actual preferences. Hanna, in contrast, defends nudging against the objection that it is manipulative. Andres Moles surveys some legitimate aims for which nudging can be justified. The remaining articles either take a more general view of context-dependence, or investigates it in some specific context: Arneson considers, in light of the debate on libertarian paternalism, the general concept of paternalism, and proposes a new theory for when paternalism is justified, in terms of a limited prerogative to be imprudent. Grill argues that respect for persons should be pluralist and include respect for their choices as well as their preferences, even when these two come apart. Tännsjö re-considers, in the light of context-dependence, his earlier rejection of any form of coercive care. Hansson contributes a historical perspective with a discussion of John Stuart Mill's three principles regulating the extent of individual liberty. The guest editors wish to thank the journal editors for giving us the opportunity to produce this special issue. We are grateful also to the reviewers who have helped in the editorial process, and to Margaret Dancy, the Managing Editor, for her friendly support throughout.

Paternalism means, roughly, benevolent interference: benevolent because it aims at promoting or protecting a person’s good; interference because it restricts his liberty without his consent. The paternalist believes herself superior in that she can secure some benefit for the person that he himself will not secure. Paternalism is opposed by the liberal tradition, at least when it targets sufficiently voluntary behavior. In legal contexts, policies may be paternalistic for some and not for others, forcing trade-offs. In medical contexts, paternalism can be an open or hidden aspect of the relationship between caregiver and patient.

As liberals, we would like each person to direct her own life in accordance with her will. However, because of the complexities of the human mind, it is very often not clear what a person wills. She may choose one thing though she prefers another, while having false beliefs the correction of which would cause her to prefer some third thing. I propose, against this background, that to respect a person’s will or self-direction is to respect both her choices and her preferences, with some priority given to those preferences that are informed and coherent. This is a pluralist answer to the neglected question, “respect for what?”

Two related asymmetries have been discussed in relation to the ethics of creating new lives: First, we seem to have strong moral reason to avoid creating lives that are not worth living, but no moral reason to create lives that are worth living. Second, we seem to have strong moral reason to improve the wellbeing of existing lives, but, again, no moral reason to create lives that are worth living. Both asymmetries have proven very difficult to account for in any coherent moral framework. I propose an impersonal population axiology to underpin the asymmetries, which sidesteps the problematic issue of whether or not people can be harmed or benefited by creation or non-creation. This axiology yields perfect asymmetry from a deliberative perspective, in terms of expected value. The axiology also yields substantial asymmetry for large and realistic populations in terms of their actual value, beyond deliberative relevance.

To nudge is to design choice contexts in order to improve choice outcomes. Richard Thaler and Cass Sunstein emphatically endorse nudging but reject more restrictive means. In contrast, I argue that the behavioral psychology that motivates nudging also motivates what may be called jolting — i.e. the design of choice content. I defend nudging and jolting by distinguishing them from the sometimes oppressive means with which they can be implemented, by responding to some common arguments against nudging, and by showing how respect for preferences over option sets and their aggregate properties may require the trimming of option sets, as well as helpful choice contexts.

This article first describes a dilemma for liberalism: On the one hand restricting their own options is an important means for groups of people to shape their lives. On the other hand, group members are typically divided over whether or not to accept option-restricting solutions or policies. Should we restrict the options of all members of a group even though some consent and some do not? This dilemma is particularly relevant to public health policy, which typically target groups of people with no possibility for individuals to opt out. The article then goes on to propose and discuss a series of aggregation rules for individual into group consent. Consideration of a number of scenarios shows that such rules cannot be formulated only in terms of fractions of consenters and non-consenters, but must incorporate their motives and how much they stand to win or lose. This raises further questions, including what is the appropriate impact of altruistic consenters and non-consenters, what should be the impact of costs and benefits and whether these should be understood as gross or net. All these issues are dealt with in a liberal, anti-paternalistic spirit, in order to explore whether group consent can contribute to the justification of option-restricting public health policy.