Recorded presentation

Thaddeus M. Pope, JD, PhD, Arnold & Porter, 1900 Avenue of the Stars, 17th Floor, Los Angeles, CA 90067, 310-788-8260, Thaddeus_Pope@aporter.com

The epidemics of today and tomorrow (e.g. obesity, tobacco) are increasingly behavioral in nature. And, increasingly, coercive measures or “lifestyle interventions” are proposed and implemented to combat these epidemics. These measures often restrict the voluntary, informed, and deliberate choices of individuals. Are these measures ethically justified (ala Dan Beauchamp, Dan Callahan, Larry Gostin) because in the aggregate they promote the “common good”? Or are they appropriately analyzed as instances of hard paternalism?

While largely conceptual, these questions are important because they frame the moral legitimacy of government action. However, these questions have proven to be very difficult to answer. Answering them requires choosing between competing paradigms: between the autonomy-oriented bioethics paradigm and the communitarianoriented public health paradigm.

But is this choice illusory? Is the public health orientation valid for lifestyle epidemics? Can public health ethics adopt a position that dissipates one of the longstanding and most troublesome issues in bioethics? Can public health legitimately espouse an ethical and political theoretical orientation that runs counter to the individualist liberalism in the United States and many Western nations?

No, it cannot. Courts, legislatures, agencies, and private institutions continue to analyze lifestyle interventions in the classical liberal terms of liberty-limiting principles. And they should so continue. But if it is hard paternalism with which we are dealing, what are the criteria by which we can distinguish justified from unjustified hard paternalism? I identify seven criteria and assess how well they account for our considered intuitions compared to the communitarian model.

Learning Objectives:

• Articulate the tension between individual liberty and the control of lifestyle epidemics
• Assess the competing liberal and communitarian paradigms for addressing the tension between liberty and public health.
• Recognize the conditions under which hard paternalism is morally justified

Keywords: Ethics, Bioethics

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Recorded presentation