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The best of all possible paternalisms?
  1. Neil Levy
  1. Correspondence to Dr Neil Levy, Florey Institute of Neuroscience and Mental Health, Melbourne, VIC 3010, Australia; nllevy{at}

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I am grateful to the commentators, for their kind words (those that have some!) and for their probing challenges. They range in the views they express, from those who seem to think I have not gone far enough in questioning the value of autonomy to those who think I have not challenged it at all. Given this diversity, it seems best to address their remarks sequentially.

J D Trout is sympathetic to my project, and highlights his own work which supports it.1 Indeed, Trout's work—together with Michael Bishop and his own stand-alone writing—was an important influence on the views I advanced in the original paper. Unsurprisingly, given the influence his views have had on mine, I find little to disagree with in Bishop's proposals. What I find most useful in his commentary is his insistence that, given the data about human decision-making, some aspect of autonomy is threatened no matter what approach we take. As he points out, while policies that ‘depreciate a person's momentary wish’ might be seen as threatening some aspect of autonomy, policies that allow for unconstrained choice show at least an equal degree of ‘contempt for autonomy’ by making it probable that the agent makes a choice that she regrets because it is not in accordance with her own values. In the original paper I had argued that properly understood, autonomy supports policies that provide soft constraints on choice—constraints that steer and nudge, but which do not prevent the agent who insists on a particular course of action from taking it. Bishop may be right in suggesting that autonomy is not …

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  • Competing interests None.

  • Provenance and peer review Commissioned; internally peer reviewed.

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