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Sarah Conly's Against Autonomy: Justifying Coercive Paternalism is a concise and coherent argument worth considering by students and the lay public interested in the intersection of philosophy, politics, and psychology. It is written in plain language with minimal philosophical jargon, and is both accessible and eminently readable. Paternalism is controversial - it asks the question of whether it is justified for us to step and change or limit the decisions another person can make and we see it occurring in a variety of cases - law, mental health, medical decision-making, etc. Conly proposes a reasonable framework for justifying specific scenarios when we can rightly limit the choices people can make - so long as we are helping people reach their long-term goals, we can place limits on the means available to them and the choices they can make.
There are several recurring concerns in the book, but I will focus on two central themes here. First, Conly spends a significant amount of time discussing issues in personal respect and autonomy (our ability to be self-directing), and presents a sympathetic model of human thought and decision-making capability. The recurring theme is that there are limits to our cognition - we can make mistakes in our reasoning at conscious and unconscious levels which prevent us from attaining our goals. Consequently, it is possible that paternalistic interventions can be justified when they attempt to reduce these errors and help us to overcome these barriers to our success. Conly makes a compelling case that this does not insult our sense of worth or show disrespect to us - pointing out that we are being unrealistic in our understanding of what we can and cannot do is not disrespectful, but is instead honest and accurate. To put it more simply - recognizing these biases and errors is a reality check, and an important one if we really want to attain our goals. Building on this, Conly argues that a paternalistic intervention can serve help the individual meet these goals, or at least to get a more accurate picture of what someone's goals should be.
Second, Conly strongly emphasizes that her focus is on the individual's long-term goals, rather than imposing a long-term value on the individual (i.e., any intervention we propose will be one in line with what the person wants to accomplish, rather than what we think the person should want). Conly draws a distinction between paternalism and perfectionism, explaining the latter as an attempt to impose upon the person to make him/her "better" or "perfect" morally, spiritually, etc., as these ideas of perfection tend to be reflections more of the perfecting agent's wants rather than the person being perfected. The fact that people can disagree about what constitutes perfection demonstrates this subjectivity, and per her argument, explains the need to distinguish paternalism from perfectionism. This is a controversial point, and one that will be explored shortly.
In order to evaluate the acceptability of a proposed paternalistic intervention, Conly proposes four essential questions:
• Does the intervention advance long-term goals? These long-term goals are understood to be person-specific, but potentially true for others. For instance, Conly argues that long-term health and well-being is sufficiently common enough of a motive to be generalized to all people, while ideas of spiritual or moral perfection are not. Consequently, paternalistic interventions might be justified in the former case, but not the latter.
• Is the intervention effective? Conly notes that it makes no sense to introduce legal constraints where they won't be effective. Simply put, we should not introduce impractical and ineffective paternalistic constraints when they won't actually be fixes.
• Are the benefits of the intervention worth the costs? "Cost" is understood to be a complex concept, incorporating both material as well as psychological well-being. It is entirely possible that we may harm people in the process of attempting to help them by denying them happiness, undermining their sense of control and efficacy, taking sources of pleasure away from them, etc. These are morally relevant factors - solutions that cause more harm than good are, at best, morally questionable and probably unjustified.
• Is the intervention the most efficient way of preventing the activity? We have an obligation to weigh the economic impact and opportunity costs of our proposed intervention, and solutions that require less of us should be considered first (i.e., we should look at less paternalistic options before more paternalistic options).
Positive answers to these questions suggest that the proposed paternalistic intervention is justified, but there is still a consideration for other empirical concerns (which are stressed throughout the book - it is not meant to be simply a theoretical exercise, but a potential tool in guiding policy). Conly then applies these to a number of different actual policy questions (e.g., the New York trans-fat ban, cigarette bans, public assistance spending on soda, etc.), demonstrating which meet the criteria for paternalistic intervention and which might not.
There are two areas of critique that are worth addressing. First, there seems to be a sense of relativism underlying paternalism as understood here which both helps and hinders Conly's argument. On the one hand, there is an essential concern with paternalistic agents simply forcing their values on other people, which is perfectly reasonable - there are plenty of examples in public life of individuals in power who seek to use it to advance ideological, political, or religious ends that stem from their own particular belief set, and we tend to see such efforts as bad. For instance, there is a strong sense in the United States that personal liberty should be respected, different views should be tolerated, etc. As such, we can be sympathetic with arguments against paternalism. Conly addresses this by including in her case studies issues in public health, as it is entirely reasonable to assume that most people would want to be healthy and would appreciate efforts that yield better health (which makes it easier to attain their goals in life). Conly stresses, however, that this could also be extended to other areas of life (for instance, limits on the debt we could acquire), and suggests that this could be extended to other facets of personal decision-making. All aspects of our lives could potentially be impacted, but she convincingly argues that there are practical limits on this paternalism and that certain questions or areas simply would not be feasible to control (e.g., relationships, careers, etc.). Consequently, while it is *possible* to extend paternalism to all areas, it is pragmatically unlikely and not an essential concern. At issue, however, is that there is *still* an attempt to impose values on individual. Conly warns us against generalizing our own wants and experiences, but this is an essential part of her argument.
It is reasonable to assume that many, if not most, people would share her assessment regarding the desirability of health as a stepping stone towards life goals, for instance, but this is still an assumption that invites disagreement and concern about forcing people to adopt a long-term goal with which they disagree. It is entirely possible to imagine a moral agent who recognizes and appreciates her reasoning, but ultimately rejects it or makes long-term health of secondary concern to another goal (money, for instance). In these cases, it would seem that the paternalistic policy that is justified for those who share her assessment becomes unjustified for those who do not and, consequently, becomes an exercise in imposing value upon them. This can be extended beyond issues in public health and apply broadly to any issue for any population - the fact of disagreement (moral, legal, political, etc.) demonstrates that subjective ends are not necessarily universal or generalizable. Conly does note that she is focusing on limitations on means rather than ends (i.e., that she is not justifying telling people what they ought to value or placing limits on the ends people can seek, but merely limiting some of the means they might employ if they are keep the person from being to realize his or her long-term goals), but it is not clear that this is sufficient distinction - a limitation on means seems to suggest a necessary preference for one end over another (limiting trans-fats to avoid obesity or necessarily means that avoiding obesity is a desirable goal). This begs the question as to whether this paternalism is an example of perfectionism in disguise. Additionally, since individual differences in concepts of perfection is a reason for her to reject perfectionism, it is unclear why it would not also serve as a justification for rejecting paternalism.
The second issue with the argument is the rejection of perfectionism and whether the rejection itself is necessarily appropriate. The previous concern about relativism is significantly reduced if we simply argue that we're trying to make people better, and then engage in a discussion of what constitutes better. The fact of disagreement is also less of a concern - it's entirely possible for people to be mistaken about ends, their desirability, the opinions they hold, and so on, due to a lack of information, misunderstanding, miscommunication, groupthink, etc. Conly's argument repeatedly stresses that we are not the best judges of our own abilities and that our self-concept can be skewed - it is not clear why this could not be extended to the ends that we seek as well. This is, however, difficult territory - Conly rightly points out the wide variety of opinions on what constitutes perfection, and this is not an easy task. However, the fact that a question is difficult does not necessarily make it an impossible task, and the pursuit of an answer can be very informative and helpful to the questing agents. While arguments about personal opinions have a post-modern appeal, it is difficult to imagine a scenario where we do not prefer historical progress. It just seems wrong to say that women are not better off in 2013 than 1900 (economically, politically, etc.) or that African-Americans are not better off now than in 1850. A sense of social "progress" seems incoherent if there is no external, objective standard (a sense of where we ought to be that guides us), and it seems morally empty to leave the issue at "things are different, not better." It may be hard for us to define this standard and there is certainly room for argument about criteria, but this does not necessarily equal impossibility or a fruitless exercise. The same pragmatic concerns could apply here as well - "ought" necessarily implies "can", and it would be reasonable to exclude a perfectionist policy that requires people to do something impossible. Ultimately, it seems as if perfectionism is abandoned without sufficient justification, and that there is at least room for Conly's desired paternalism that is consistent with a perfectionist framework.
Overall, the book is coherent and generally very well-argued. The reinforcement of the findings of cognitive psychology and economics are quite germane, and are indicative of a larger shift in understanding human agency, and the need for policies and laws that facilitate reaching our long-term goals. As Conly rightly notes, freedom involves a paradox: too much can be limiting, and hurt us more than it helps.
© 2013 Matthew A. Butkus
Matthew A. Butkus, PhD, Assistant Professor - Philosophy, Dept. of Social Sciences, McNeese State University