Relational conceptions of paternalism: a way to rebut nanny-state accusations and evaluate public health interventions

S. M. Carter, Vikki Entwistle, M. Little

Research output: Contribution to journalArticlepeer-review

24 Citations (Scopus)
19 Downloads (Pure)

Abstract

Objectives

‘Nanny-state’ accusations can function as powerful rhetorical weapons against interventions intended to promote public health. Public health advocates often lack effective rebuttals to these criticisms. Nanny-state accusations are largely accusations of paternalism. They conjure up emotive concern about undue governmental interference undermining peoples' autonomy. But autonomy can be understood in various ways. We outline three main conceptions of autonomy, argue that these that can underpin three different conceptions of paternalism, and consider implications for responses to nanny-state accusations and the assessment of public health interventions.

Study design and methods

Detailed conceptual analysis.

Results

The conceptions of paternalism implicit in nanny-state accusations generally depend on libertarian conceptions of autonomy. These reflect unrealistic views of personal independence and do not discriminate sufficiently between trivial and important freedoms. Decisional conceptions of paternalism, like their underlying decisional conceptions of autonomy, have limited applicability in public health contexts. Relational conceptions of paternalism incorporate relational conceptions of autonomy, so recognize that personal autonomy depends on socially shaped skills, self-identities and self-evaluations as well as externally structured opportunities. They encourage attention to the various ways that social interactions and relationships, including disrespect, stigmatization and oppression, can undermine potential for autonomy. While nanny-state accusations target any interference with negative freedom, however trivial, relational conceptions direct concerns to those infringements of negative freedom, or absences of positive freedom, serious enough to undermine self-determination, self-governance and/or self-authorization.

Conclusion

Relational conceptions of autonomy and paternalism offer public health policymakers and practitioners a means for rebutting nanny-state accusations, and can support more nuanced and more appropriately demanding appraisals of public health interventions.
Original languageEnglish
Pages (from-to)1021-1029
Number of pages9
JournalPublic Health
Volume129
Issue number8
Early online date24 Apr 2015
DOIs
Publication statusPublished - Aug 2015

Bibliographical note

This work is funded by NHMRC grant 1023197. Stacy Carter is funded by an NHMRC Career Development Fellowship 1032963.

Acknowledgements
An early version of this work was presented at a workshop on paternalism held on Friday 8 November 2013 at the Centre for Agency, Values and Ethics at Macquarie University. We thank
participants in that workshop for their helpful comments. Thanks also to Prof Catriona Mackenzie for her helpful comments on an earlier draft of this manuscript and to Prof Paul Benson for providing us with an early version of his work on stereotype threat.

Keywords

  • paternalism
  • autonomy
  • nanny-state
  • public health
  • ethics

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