Gerald Dworkin

As seems appropriate for second thoughts, I shall begin at the beginning—the definition of paternalism. Elsewhere, I defined the concept as “interference with a person's liberty of action justified by reasons referring exclusively to the welfare, good, happiness, needs, interests, or values of the person being coerced.” A number of critics have objected that confining the concept to interference with liberty is too restrictive in scope. Given the problem I was interested in, that is, the proper limits of state coercion, this restriction was reasonable, although even here one ought to be aware that the state has other ways of influencing people's behavior. It may refuse to enforce contracts, give in-kind rather than cash aid, set up licensing boards, require manufacturers to install seat-belts as original equipment, and so forth. If, however, one wishes to consider the issue of paternalism in other contexts, for example, in the professions, one will need a broader definition. Not all paternalistic acts are acts of the state. Not all paternalistic acts involve interference with liberty. The doctor who lies to her terminally ill patients, the parent who stipulates in her will that a child may not inherit an estate before the age of thirty, the psychiatrist who tells his adolescent patient that he must inform her parents of her drug use, the professor who refuses to recommend her Ph.D. student to a certain university because he will be “out of his league” – these are all cases of paternalism that do not involve the use of coercion or force and, therefore, on standard views of liberty do not involve restrictions on liberty.

The essential outlines of the debate over voluntary euthanasia have not changed very much since Glanville Williams and Yale Kamisar debated the issues almost fifty years ago. On the one hand, there is an appeal to considerations of autonomy and the relief of suffering: individuals should be able to choose the timing and mode of their dying and they should not have to suffer from pain and other modes of indignity such as incontinence, paralysis, muscular wastage, and mental deterioration. So far these would only generate a right or permission to take one's own life, but when we consider the problems in the context of end-of-life medical care and the uncontroversial duty of physicians to relieve the suffering of their patients we get a claim to assistance in dying.