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Author meets critics: precis
Against autonomy: justifying coercive paternalism
  1. Sarah Conly
  1. Correspondence to Dr Sarah Conly, Bowdoin College, 8400 College Station, Brunswick, ME 04011, USA; sconly{at}

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Too often, we as individuals do things that harm us, that seriously interfere with our being able to live in the way that we want. We eat food that makes us obese, that promotes diabetes, heart failure and other serious illness, while at the same time, we want to live long and healthy lives. Too many of us smoke cigarettes, even while acknowledging we wish we had never begun. We behave in ways that undercut our ability to reach some of our most valued goals, despite education and despite incentives to choose the right thing. What should be done?

If I were to try to harm someone else in a way that alters his future seriously and perhaps irrevocably for the worse, I would be stopped. When it comes to hurting myself, though, we have a common belief that it is wrong to interfere, even if I foresee that I will very much regret what I have done, often when it is too late to fix what I have let happen. I think this makes no sense. If it is permissible, even obligatory, to stop me when I do something that seriously interferes with someone else's chances of achieving the life he wants, I think it is equally permissible, and perhaps obligatory, to save me from myself. In this book, I argue for paternalism, and a particular form of paternalism I call coercive paternalism.1 The argument is that when individuals engage in behaviour that undercuts their own chances of happiness, state interference may be justified.

Why is this so offensive to so many? There seem to be three main arguments against paternalism:

  • First, some people argue that it is unnecessary, because if you choose something, that must be what you really want. If you habitually choose the large fries, it is because you would rather eat them than live a longer, healthier life. So, no help in getting what you want is needed.

How much simpler life would be if this were true! It is based, though, on a false picture of humanity. If we were perfectly rational agents, presumably, our choices would (barring ignorance) indeed reflect our most deeply held values. Modern research by behavioural economists and social psychologists shows, though, that our decisions are often made irrationally. As has by now been discussed convincingly and exhaustively (notably by Nobel Prize-winning Daniel Kahneman and Amos Tversky), we suffer from common, apparently ineradicable tendencies to ‘cognitive bias,’ which means that in many common situations, our decision-making goes askew. These biases are many and varied, but they have in common that they interfere with our appreciation of even quite simple facts, and lead us to choose ineffective means to our ends.

  • We care too much about liberty for state interference to increase our happiness. Even if the imposed choice gets us to the end we want, the costs of intervention are always too great, because the loss of liberty we undergo will make us more miserable than the attainment of any number of goals.

Again, this just does not seem to be true. We value liberty differently in different situations. In some personal choices, we greatly value the freedom to choose, and in others we do not care. We are already deprived of the liberty to consume many carcinogens by governments that take them off the market. That means I do not have the liberty to decide that perhaps I would prefer to have a maraschino cherry coloured with red dye #2, but I am quite happy about that. Doing research about food additives would be time-consuming and probably bore me to tears. We do not want the liberty to investigate and choose in every situation. If someone else bans trans-fats on our behalf or figures out what a reasonably healthy portion size is and forces restaurants to stick to those standards, I think we would get used to that loss of liberty very quickly. Not all liberty matters equally.

  • Where will it stop? There is no obvious cut-off, and so if we allow them at all, paternalistic measures will take over our lives.

This is probably the most common objection to paternalism and was a resounding theme in the popular reaction to New York City's attempt to ban soda servings over 16 ounces: the extra soda did not matter, but this, it was thought, was the beginning of the end for freedom of personal choice.

While popular, it is one of the less reasonable objections. We are quite used to doing just the sort of cost–benefit analysis this suggests is impossible; indeed, law depends on it. When we decide that theft of a car should be punished by law while theft of a paper clip should not, we consider whether regulation is worth the cost. Just the same sort of thing will inform our use of coercively paternalistic laws: some harms I do to myself are like the theft of a paper clip, and we should let them occur. Some are greater, but the resentment I may feel at pervasive interference would militate against interference. If, as is argued, there would be a net loss to our happiness if someone followed us around exhorting us to finish our five healthy helpings of fruit and vegetables every day, then the paternalist would obviously not suggest we do that, since the point of paternalism is to benefit us. In other cases, though, where a great effect can be achieved with relatively little cost, it is good to interfere in our freedom and make us do the thing that benefits us rather than the thing that harms us.

It is sometimes said that paternalism is not respectful, but just the opposite is true. In the long run, if we care about people and value their having happy, fulfilling lives, the most respectful thing we can do for them is help them get where they want to go. That is what paternalism is about, doing what is necessary, even if it is sometimes unwelcome, to allow people to live the lives they truly want to live.



  • Competing interests None.

  • Provenance and peer review Commissioned; internally peer reviewed.

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