Paternalism in Healthcare and Health Policy

This chapter provides conceptual clarity about paternalism along with a framework for ethically assessing paternalistic actions in both clinical practice and health policy. Not only does paternalism remain common and formidable in both contexts but also it has gained new momentum over the last two decades, for instance, as “neopaternalists” have offered arguments for governmental policies that, at a minimum, seek to protect or benefit individuals through shaping or steering their choices without actually limiting or coercing those choices. This chapter examines the nature of paternalism, particularly by probing its moral foundations and limits and drawing several distinctions that bear on its justification (weak and strong, pure and mixed, hard and soft). It also considers circumstances in which different types of paternalistic interventions may be justified, and, finally, assesses the “new paternalism,” based on behavioral economics and psychology, that now figures in many proposals for health-related public policies.