Table Of ContentGovernment Paternalism
Government
Paternalism
Nanny State or
Helpful Friend?
Julian Le Grand
and Bill New
Princeton University Press
Princeton & Oxford
Copyright © 2015 by Princeton University Press
Published by Princeton University Press
41 William Street, Princeton, New Jersey 08540
In the United Kingdom: Princeton University Press
6 Oxford Street, Woodstock, Oxfordshire OX20 1TW
press.princeton.edu
Jacket illustration: All icons courtesy of the Noun Project (thenounproject.com).
Marijuana icon designed by Edward Boatman. Money icon designed by Nick Levesque.
Syringe designed by Alberto Rojas.
All Rights Reserved
ISBN 978- 0- 691- 16437- 3
British Library Cataloging- in- Publication Data is available
This book has been composed in Sabon Next LT Pro and Helvetica Neue LT Std
Printed on acid- free paper. ∞
Printed in the United States of America
10 9 8 7 6 5 4 3 2 1
Contents
Preface vii
1 Introduction 1
2 What Is Paternalism? 7
The Interference in Freedom 8
Promoting the Good 16
The Question of Consent 18
Conclusion: A Definition of Paternalism 22
3 Types of Paternalism 25
Legal Paternalism 25
Soft and Hard Paternalism 26
Means and Ends Paternalism 27
Perfectionism 30
Volitional and Critical Paternalism 33
Moral Paternalism and Legal Moralism 35
Other Categories of Paternalism 36
Conclusion 38
4 Paternalism in Practice 41
Types of Government Intervention 42
Nonpaternalistic Justifications for State Intervention 53
Do Nonpaternalist Justifications Explain Paternalist
Laws and Regulations? 59
Conclusion 77
5 Paternalism and Well- Being 79
The Classical Economic Model and Its Challengers 80
The Evidence on Reasoning Failure 82
Ends- Related Paternalism 101
Conclusion: Means- Related versus Ends- Related Paternalism 103
V
VI Contents
6 The Nanny State: The Challenge from Autonomy 105
Autonomy 106
Autonomy and Motivation 108
Soft Paternalism 111
Autonomy Failure from External Causes 112
Autonomy Failure from Internal Causes 116
When Should the Soft Paternalist Intervene? 119
Does Soft Paternalism Avoid Offending Autonomy? 121
Overriding Autonomy: Hard Paternalism 127
Conclusion 131
7 Libertarian Paternalism 133
Definitions 134
Nudge Ideas: The Case For 135
Nudge Ideas: The Case Against 139
Conclusion 145
8 Paternalism and Policy 147
The Groups Affected: Well- Being and Autonomy 147
Types of Policy 151
Smoking 154
Pensions 159
Assisted Suicide 161
Conclusion 166
9 The Politics of Paternalism 167
Can the State Do Better? 167
Will the State Do Better? 170
Conclusion 174
10 Nanny State or Helpful Friend? 177
Bibliography 183
Index 195
Preface
A few years ago, one of us (Julian Le Grand) had the privilege of being sec-
onded to No. 10 Downing Street to work as the health policy adviser to the
then prime minister, Tony Blair. On the second day of his appointment, he
got into an argument with the secretary of state for health, John Reid. The
previous day Le Grand had been discussing with the prime minister the
possibility of banning smoking in public places, a policy that had been
successfully implemented in California and was coming into force in Ire-
land. Tony Blair was interested in the idea, although he indicated that, as in
the United States, it might be better left to local, rather than central, govern-
ments to decide.
In contrast, the secretary of state was unhappy with the idea of a ban on
smoking in pubs and restaurants. He was on public record as having pointed
out that smoking was one of the few pleasures left to poor and disadvan-
taged people in our society, and he was reluctant to add to their burdens.
However, he did accept that there was a problem of passive smoking— of
damage to people’s health from the inadvertent inhaling of others’ cigarette
smoke— and had some suggestions for dealing with it. For instance, why
not set aside a room in every pub or restaurant reserved entirely for smok-
ers? They would have to carry in their own drink and food—n o bar or
restaurant staff (the chief victims of passive smoking) could enter. But, once
in the room, smokers could smoke to their hearts’ content, being able to
enjoy the activity without disturbing anyone else and, crucially, only put-
ting themselves at risk of harm.
Le Grand found this suggestion difficult to counter. He felt instinctively
that the health dangers associated with smoking are so great that all smok-
ers should be discouraged from smoking, and that anything putting signif-
icant barriers in their way—a nd there was little doubt that banning smok-
ing in the principal public areas for social activities for all would indeed be
a significant barrier— was desirable. On the other hand, he recognized that
we do live in a society that values individual autonomy and freedom. The
secretary of state was far from alone in disliking the paternalism implicit in
the smoking ban proposal. Those advocating the ban, including Le Grand,
VII
VIII Preface
had received voluminous correspondence decrying the “nanny state” and
pointing to the dangers of infantilizing the population by treating them as
children incapable of making their own decisions. The critics argued that, if
people knew about the risks of smoking but nonetheless judged that the
pleasure they got from the activity outweighed those risks, then, if no one
else were harmed, why should they not indulge in the activity? Did the gov-
ernment really have a right to intervene to save people from themselves? Was
government paternalism justified? Or was John Stuart Mill right when he
argued in his famous book On Liberty that the only legitimate reason for
governments to intervene in an individual’s behavior was to prevent harm
to others, and that to promote the individual’s own good was “not sufficient
warrant” to justify such intervention?
The policy of banning smoking in public places in England was eventu-
ally implemented, though not until several years later, after Le Grand had
stepped down as policy adviser and there was a different secretary of state.
But since then issues involving questions about paternalistic government
similar to those raised by the smoking ban have moved up the policy
agenda. Obesity, apparently driven by individuals’ eating too much and ex-
ercising too little, is on the rise. Life expectancy has increased dramatically,
but people are not saving enough for their pensions during their working
lives; too many of them look as though they are going to have a long old age
but a miserable one mired in poverty. And there have been a number of
well- publicized cases where terminally ill patients were denied the right to
die, or to be helped to die, at the time and place of their own choosing—
despite often impassioned pleas from themselves and their caregivers. In
each of these cases, as with the smoking ban, the key question was: what
should be the role of the state or, more precisely, the role of the government
of the state? Is it part of the role of the government to try to restrict the
amount or type of food that people eat? Should it compel people to save for
their pensions? Should it prosecute friends and relatives who help the ter-
minally ill kill themselves?
Bill New wrote his PhD thesis on the general topic of state paternalism
and published a seminal article based on the thesis in the highly ranked
journal Economics and Philosophy (New 1999). In discussion it seemed to
both New and Le Grand that the time was right for a development of their
ideas to see if they could successfully meet what might be thought of as the
John Stuart Mill challenge: are there circumstances in which the individ-
ual’s own good is sufficient warrant to justify a paternalistic intervention?
If so, what are those circumstances, and how best might the government
intervene?
This book is the result of that collaboration. We should assure the impa-
tient reader that we do not duck the challenge. In fact, we argue that Mill
was wrong. There are circumstances when it is legitimate for a government
Preface IX
to act paternalistically; moreover, there are ways of doing so that do not
suffer, or suffer only minimally, from the erosion of autonomy that many
associate with the nanny state. However, the route to that conclusion goes
through some dense forest, and we ask for the reader’s indulgence in allow-
ing us to try to clear out a good deal of undergrowth on the way.
In writing this book we have incurred too many debts fully to list here.
But we must particularly thank Jonathan Roberts, who has read and edited
the whole manuscript and made invaluable suggestions for improvement.
We are also most grateful to Albert Weale, David Owen, and two anonymous
referees who also read the whole manuscript and made extremely helpful
suggestions, almost all of which we have taken on board. We have had use-
ful discussions with many people on the topics that form the central thesis
of the book, among whom we should mention particularly Robert Goodin,
Tony Hockley, Adam Oliver, and Matthew Rabin. And we do appreciate the
patience of our editors at Princeton University Press, who have waited an
unconscionably long time for the final manuscript to emerge.
