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As Sarah Conly notes in the précis of her important new book, there is considerable evidence that human beings are prone to make decisions that do not advance their own ends.1 Whereas some have argued for forms of libertarian paternalism such as ‘nudges,’2 ,3 Conly defends a more expansive use of straightforwardly coercive paternalism beyond such uncontroversial policies such as seat belt laws and requiring prescriptions for drugs. We should seriously consider banning trans fats and large portions in restaurants and a total ban on cigarettes.
I am largely sympathetic with Conly's project although it is doubtful that preventing people from harming themselves is ‘equally’ permissible with preventing people from harming others. It need only be permissible enough. I am also sympathetic with an underlying thesis of Conly's book, namely, that the justifiability of policies turns largely on empirical considerations of costs and benefits rather than appeals to abstract moral principles. But a commentator's job is not to praise or express sympathy. And so I do.
First, Conly's book focuses on coercive paternalism by the state. She does not discuss paternalistic interventions that are (1) not coercive or (2) undertaken by individuals. And these are a central concern in medical ethics. Is it …
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