PATERNALISTIC INTERVENTIONS

As I suggested earlier, paternalistic intervention involves a conflict between the risk hierarchies of a benefactor and an intended beneficiary. So paternalistic intervention is is based on the supposition that a benefactor's cost/benefit analysis (at least sometimes) trumps the assessment of a targeted beneficiary AND that the intervention will, in fact, leave the beneficiary "better off." Being made "better off" could mean either an unwanted benefit or an unwanted lessening or removal of a harm. The lessening or removal of a harm could mean either reducing the probability of its occurance or reducing its magnitude. Moreover, justified paternalistic intervention implies empirical evidence that the intended intervention, will in fact, leave the beneficiary "better off" in either the long-run or short run. So the question is whether a beneficiary will (in fact) be better off or not as the result of a given paternalistic intervention.

In assessing whether a beneficiary will be better off or not must take into account the full range of known costs and benefits. Paternalistic intervention invariably requires the use of coercive force, which is often an under-valued cost. The degree of coercive force is, obviously, contingent upon the degree of resistence offered by the intended beneficiary. Sometimes beneficiaries are relatively submissive and make a calculated decision to submit to the benefactor: "It's not worth fighting over!" When the beneficiary offers resistance intervention requires more coercive force. So some interventions require high degrees of physical coercion and inflict greater or lesser injuries on the beneficiary: black eyes, bruises, broken bones etc. Sometimes injuries result, not only from the interdiction process, but also from subduing the resistant beneficiary long enough to provide the benefit. Sometimes the interventions themselves inflict costs, which are euphemistically described as "side-effects. Most anti-psychotic drugs turn out to have serious long-term and short-term side effects, including suicidal thoughts, sexual dysfunction, and loss of energy etc. Thus the overall "redounding good" of any intervention must take into account the amount of coercive force required to get the job done and the side-effects of the intervention itself.

With the benefit of 20/20 hindsight, let's take a look at a few of classic large group paternalistic interventions. In the nineteenth century psychiatrists believed that the mentally ill were "better off" locked up in a mental hospital where they could be bled and force-fed emetics and purgatives. In hindsight, we know that those were unjustified interventions. In the mid-twentieth century, psychiatrists believed that electro-shock therapy and lobotomies left patients better off than bloodletting, emetics, and purgatives. Today we have a long list of modern drugs that have been proven to be either unsafe, ineffective, or both: DES, Fen Fen etc.

So despite the dismal record of well-meaning paternalistic interventions, and despite the fact that most interventions benefit the benefactors (and third parties), why do we accept paternalism as a social practice. I believe we all have a biological predisposition to submit to group-based authority, even when there is little evidence to suggest that authoritative interventions are any more reliable than anyone else. In other words, we blindly submit to group-based authority and rarely question it. This is probably a remnant of our Pleistocene hunter-gatherer brain. Therefore, it is very difficult for us to question socially-designated authorities. The social processes that we employ to manufacture experts is intriguing. Just think about how we ceremoniously bestow these "experts" with credentials: advanced degrees, licenses, etc.

PATERNALISM: HARM AND RATIONALITY

So under what conditions, if any, is paternalism morally justifiable? In the Western philosophical tradition justified paternalistic intervention, has focused on detailed philosophical analysis of the interwoven concepts of harm and rationality. First of all, since John Stuart Mill, the Western liberal tradition has distinguished between “harm to self” and “harm to others” and that paternalism, by definition, must target “harm to self.” Justified governmental intervention in regard to “harm to others” involves different principles and arguments. As stated in my previous essay, most human actions and paternalistic interventions affect others. So, with all this in mind, for now let’s focus on “harm to self.”

Paternalistic intervention is, by definition, an act of beneficence, where an individual (or group) coercively violates the liberty of another individual (or group) in order to prevent and/or remove “harm.” Well, what is harm? I don’t think I can improve much on Joel Feinberg’s definition, as the “invasion of an interest.” What is an interest? Well, it’s “anything you have a stake in.” If you have a “stake” in something, it means that, ultimately, your pleasure or pain is at stake. We all have an interest in a lot of different things, but obviously, we value some interests more than others. Let’s call these individual and collective rankings “interest hierarchies.”

Are these interest hierarchies “objective” or are they “relative” to individuals, small groups, or large groups? One might argue that interest invading harms are objective to the extent that harm can be measured in terms of magnitude and probability. Magnitude is the sheer degree of harm: "Death has greater magnitude than embarassment." Probability is the sheer likelihood of that harm. Thus, some harms are of great magnitude (death), but improbable (while flying); others are lesser in magnitude (embarrassment) but highly probable (farting in public). Moreover, the magnitude and probability of harm can be assessed over both the short-run and the long-run. Hence, most of us agree that Russian roulette is a high-magnitude, high-probability harm over the short run; smoking is a high-magnitude, high probability harm over the long run. (For the sake of argument, let’s assume that our beliefs about the causal relationship between smoking and cancer are true. My only point here is that smoking and Russian roulette are different.)

But in the real world, magnitude cannot be measured in a vacuum. It is always relative to other harms and benefits, and therefore subject to trade-offs. Therefore, rationality and irrationality are about those "interest hierarchies," risk-taking and trade-offs. We take risks when we either “do things” and when we “don’t do things,” therefore paternalistic interventions can either force us to “do things,” or prevent us from “doing things.” J.S. Mill suggested that irrational persons take irrational risks; that is they do things (or don’t do things) where the potential (or actual) costs of those actions exceed the potential (or actual) benefits. In short, irrational risks are not worth taking relative to an interest hierarchy. Unfortunately, he didn’t provide much insight into what this might mean in the real world. So what kinds of risks are rational?

Bernard Gert argues there harm is more or less objective. He observes that, unless a person has a good reason to do otherwise, rational individuals tend to avoid: death, pain, disability, and loss of opportunity. So what’s a “good reason” to choose death? Well, most Americans living in the twenty-first century agree that it is not, necessarily, irrational to choose death over suffering high levels of intractable pain or disability. But what happens if suicide is sometimes a rational act, relative to a large group, but irrational relative to a small group or an individual? If a teenager wants to jump off the bridge because of social embarrassment (farting in math class), then that it seems objectively irrational. After all, over the long run, embarrassment is, at most, a low magnitude short-term harm. But note that our large group, small group, and individual judgments are based the assumption that it is irrational to kill one's self out of embarrassment. Objectively speaking, embarassment is a mow magnitude harm, therefore suicide, a major harm, can never be justified. But in many parts of the world, embarrassed fathers routinely kill their daughters in the name of “honor” (embarrassment) and many daughters commit suicide after dishonoring (embarrassing) their fathers. Although most American believe that honor-based suicides are irrational (and immoral), how does one go about establishing an objective, universal standard?

So here lies the basic paternalistic dilemma. If our individual interest hierarchies are at least influenced by small groups and large groups, what does personal liberty mean in this context? (I'll address this in the next essay.) And, when there’s a conflict between individual and collective interest hierarchies, which interest hierarchy prevails over the others? Whose risk-assessment trumps whose? Large-group communitarians tend to empower large group hierarchies (American's), and small-group communitarians tend to empower small group hierarchies (Roman Catholic's), and libertarians empower individual hierarchies (Ron White's). But the question for libertarians is whether paternalistic intervention can ever be morally justified? As stated at the outset, traditionally that question has involved the analysis of rationality and harm. But another approach to this question is to take a closer look at how human knowledge underlies specific paternalistic interventions.

Pure and Impure Paternalism

Let’s begin with a fundamental distinction between pure and impure forms of paternalism. Paternalistic intervention is an intentional act of beneficence where a benefactor violates the liberty of a beneficiary in order to provide an unwanted benefit. Beneficiaries and benefactors can be either individuals or groups. Within group-based paternalism, we can also differentiate between governmental paternalism (state paternalism) and non-governmental paternalism. Under state paternalism government acts as the benefactor by exercising the coercive power of government via regulations and taxation. For now let’s focus on group-based state paternalism.

Pure state paternalism is where the group whose liberty is being violated is identical to the group that may benefit (seat belt laws). Impure paternalism is when the group whose liberty is violated is larger than the group that is targeted for benefit. (laws that restrict access to sudafed)

Another feature of state paternalism is that it often benefits the benefactor and/or third parties, and therefore, masks conflict of interest and corporate welfare. Most paternalistic laws are initiated by providers. In modern societies, acts of pure paternalism are extremely rare. After all, in the “real world” of state paternalism, politically well-connected third parties almost always benefit such as: daycare centers, beauty salons, tatoo parlors, mental institutions, drug companies, psychologists, and psychiatrists. Seat belt laws benefit the engineers and manufacturers that produce seat belts. Drug laws benefit the alcohol industry and criminal organizations. (Admittedly, this is an empirical observation. If I'm wrong, please correct me!)

Now what can we say about those intended paternalistic benefits? Well, the fact of the matter is that many (if not most) paternalistic interventions enforced by the state, benefit the providers much more than the targeted beneficiaries. Do you really believe that laws that restrict access to marijuana protect anyone other than pharmaceutical companies, local police departments, and the employees of the Drug Enforcement Agency? (Another empirical observation!) As a modest proposal, let me suggest that justified paternalism requires that beneficiaries actually benefit from their loss of liberty. Libertarians tend to be highly critical of state paternalism because it rarely benefits intended beneficiaries and almost always masks corporate welfare. I’ll try to develop this theme in subsequent blog entries.