Gerald Dworkin and Consent to Paternalism

In the text “Paternalism,” Gerald Dworkin argues that there are conditions where a person may not wish to take an action at the time of that act, but at another time, when they are thinking rationally and are able to recognize the benefits of the action, they would agree to let others force them into the same act. Under such circumstances, Dworkin would consider paternalism to be valid.  Dworkin applies this argument to the larger context of government and the creation of paternalistic legislation. He argues that certain laws are put in place for what is recognized overall by the people in a community to be in their best interests, even if  those people may not wish to obey that law after it is enacted. Dworkin offers the example of taxes. When the time comes for citizens to pay taxes, they might wish not to do so. However, it is in the community’s best interest that they do so in order for the government to provide public goods. Hence, it is the government’s responsibility to continue to enforce tax laws even if citizens may not wish to pay them. Dworkin argues that paternalism in these laws and others are justified because citizens may give their consent to a system of government to limit their autonomy in order to “safeguard” their interests. 

Dworkin’s argument does have merit. Paternalistic laws and legislation may be needed in order for a society to function, and realistically, not every citizen can be asked to give direct consent to a law before it is put in place. However, I do take some issue with the lack of clarity on what it means to give consent to a system of governance. For example, are you consenting to be governed paternalistically by simply being a citizen of a country? Furthermore, the argument relies on the assumption that a citizen’s initial consent is valid. A person may give their consent to paternalistic governance due to their inability to join another state or because of pressure to assimilate into a country’s culture. This consent would not be coming from the person’s genuine trust in a government body to act rationally in their best interests when they themself are unwilling to do so. 

Further issues can be found with Dworkin’s argument when it is placed in the context of medical care. Based on Dworkin’s argument it could be proposed that if a patient gives consent to a treatment plan early on, their physician is free to continue treatment if they believe the patient to be irrational when they later object to treatment whether the patient is truly irrational or not. Additionally, the problem once again arises of what it means to give valid consent. How can we be certain a patient is not being coerced into receiving treatment by others in their life? The best way to be certain of a patient’s consent is to provide them with multiple opportunities to withdraw it, something Dworkin’s argument does not take into account.

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