Dworkin’s Defense of paternalism

In Dworkin’s discussion of paternalism, he accepts the idea that the society could at times defensibly restrict an individual’s liberty for the main reason of self-protection but under certain circumstances. At the same time, Dworkin supports societal restriction not only for the protection of self but also for the protection of others. For the reason of self-protection and the protection of others, Dworkin presents us with a warranty to which paternalism should be guaranteed (Dworkin 1997). In his discussion, Dworkin takes the issue from the position of Mill idea of anti-paternalistic. As opposed to Dworkin, Mill presents us with his opinion that any individual should not be compelled to do that which society wants even if it will be better for him to do so.

Dworkin however does not fully support paternalism but instead argues that some forms of limited state paternalism should be justified under specific conditions that are rational for every individual to agree and not to be forced into. In a government that is representative, rational citizens should agree on some form of restriction on their liberty as long as their interests and those of others are not interfered with. In such a case I believe the state would bear a heavy burden of having to show and prove to its citizens the particular nature of the conditions in which individuals are restricted. In paternalism from the view of Dworkin, the government apart from restricting its citizens should also determine the probability of certain future occurrences.

In a nutshell, Dworkin supports paternalism because he thinks the society cannot be trusted to design decisions for every individual. For this reason, he also thinks that experimentation is the only way in which the government can determine the best ways its citizens can live (Dworkin 1997). Paternalism according to Dworkin should be warranted because actions that influence one person could also influence the rest of the society as well thus causing direct harm to the society. The government should be guaranteed to practice paternalism because sometimes forcing people to make rational decisions could be for their own good. For instance, paternalism is evident in gun control laws, laws that restrict open use of drugs, gay marriages, suicide and polygamy. According to Dworkin, the state should intervene in the life of every person engaged in the above mentioned behaviors.

Dworkin defends paternalism only when it enhances an individual’s ability to make rational decisions in the future. Paternalism is justified and supported by Dworkin if it prevents an individual from making irrational decisions that may cause harm to the well-being of others. Making a choice to take an addictive drug would prevent an individual from making rational decision and so the state is allowed to intervene. Refusing to tie your seatbelt or failing to be part of a blood transfusion activity would be acting in against your own well-being and the government is also encouraged to intervene. In reading Dworkin’s article, we should take note of two things. First and foremost Dworkin draws a high level distinction between impure and pure cases in which paternalism should be justified (Dworkin 1997). A policy is understood as paternalistic if it is out to reduce the available dangerous opportunities to a person for his own good. Secondly, Dworkin gives us a strategy that justified paternalistic intervention which is wholly direct to non-consenting adults. In this strategy, he specifically proposes a necessary condition of irrationality where paternalism is justified (Dworkin 1972).

Goldman and response to Dworkin’s position

Alan Goldman refutation of paternalism stands out in a way that is not so extraordinary. He does not refute general paternalism but refutes paternalism from the medical field. He claims that patients should be presented with the right to determine their treatment, make choice of how they should be treated and agree to the specific treatment terms and conditions. Every decision regarding the future of patients should be left for them to decide because they are in full control of their lives regardless of the effects of their choices. In this manner, Goldman maintains that paternalism is total disrespect to patient autonomy which should be one of the values of clinical procedures (Goldman 1980). On the other hand Ackerman forms his opinion on paternalism in support of doctors intervening in patient scenarios. Just like Ackerman, I think respecting patient autonomy would be a distorted action because autonomy in the case of patient care is mere noninterference.

On such a prevalent hands-off view, doctors are expected to be good and honest technicians in providing their clients with significant data about their future and that of their illnesses. Lack of paternalism fails to respect autonomy Ackernman argues because it fails to recognize the numerous factors that compromise on autonomy such as cultural and social constraints, illness and the host of psychological constraints. I think Goldman is on the right track in responding to paternalism because he takes into account the aspect of being independent. However, the case of doctor and patient requires full paternalism as addressed well by Ackerman. In order to restore autonomy in medical procedures, doctors in fact need to deal with the social, psychological and cognitive that is required for full functioning.