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Identity-relative paternalism is internally incoherent
  1. Eli Garrett Schantz
  1. Indiana University School of Medicine-South Bend, South Bend, Indiana, USA
  1. Correspondence to Eli Garrett Schantz, Indiana University School of Medicine-South Bend, South Bend, IN 46617, USA; egschant{at}

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Identity-Relative Paternalism, as defended by Wilkinson, holds that paternalistic intervention is justified to prevent an individual from doing to their future selves (where there are weakened prudential unity relations between the current and future self) what it would be justified to prevent them from doing to others.1 Wilkinson, drawing on the work of Parfit and others, defends the notion of Identity-Relative Paternalism from a series of objections. I argue here, however, that Wilkinson overlooks a significant problem for Identity-Relative Paternalism—namely, that it yields unactionable and self-contradictory results when applied to choices where both options present potential harms to future selves.

To illustrate this point, let us consider the following:

A is an acclaimed oboist, for whom the practice and performance of music has brought deep joy throughout their adult life. A, however, develops a condition which will not only cause the rapid loss of their manual dexterity and capacity to hear, but will also certainly be fatal within the year. Suppose further that Drug Z, if taken now, will slow the loss of A’s dexterity and hearing, but will hasten their demise by a number of months.

A considers the choice of whether or not to take the drug. A believes that they have had a long and joyful life, but would, all else equal, like to spend as much time as possible with their family. However, A also understands that, without the capacity to enjoy the music which has been central to their life, that those remaining months would likely be joyless in a meaningful way.

Taking this background, let us consider the first of A’s options: to prioritise retaining their ability to enjoy music, and, therefore, to take the drug. Within this branch of the choice, there are two potential future selves: call these …

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  • Contributors This article represents the sole work of the single author.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.