Thaler and Sustein discuss the idea of “Libertarian Paternalism,” to describe when and why paternalism is justified and often entirely inescapable. They raise many good points about the prevalence of paternalism in nearly every decision we make, but they also make arguments based on low-stakes decisions that are, at least in my opinion, less sound.
One of the first major points the paper argues is that there are not actually any “viable alternatives to paternalism” because someone must make a choice whenever presented with a decision that involves others. This is logical enough because any decision that involves others, even when they naturally don’t have a choice or knowledge of the decision, could be seen as a mild form of paternalism. However, the authors on to argue that there are really only three options for decision making by an authority figure:
- to make choices that are best for those effected (in this case best for the cafeteria customer)
- to make a random choice
- to consciously make a “malicious” decision that would hurt those effected (in this case make customers obese by arranging food a certain way).
While these are all alternatives, this is not a comprehensive list of options, intentions, and outcomes. For example, it is possible that the manager made a choice that she thinks is in her or the cafeteria customers’ best interest, or perhaps one that appears to be in the best interest of the customers, but actually has unexpected, adverse effects on them, her, or the cafeteria employees or revenue. Furthermore, decisions about the design and layout of a cafeteria are low-stakes compared to a treatment decision that is a life or death matter, or at a minimum can cause a patient unnecessary suffering and stress.
It is important that the authors value performing cost-benefit analyses of decisions at any level. The goal of the paternalism they aim to justify is to provide some choice, but to limit or entirely remove the possibility of poor choices being made. By nature, paternalism is “the intentional overriding of one person’s preferences or actions by another person…” (Beauchamp and Childress 215). This obviously means that autonomy is greatly compromised no matter what, and when this is the case, it’s imperative to be continually assessing the benefits and drawbacks of decisions and treatments. But even with this constant monitoring of the situation, allowing some decisions while limiting autonomy is tricky to accomplish.
This article draws many conclusions about paternalism and its justification based on a very narrow scope of decisions: the fate of retirement money and a cafeteria’s arrangement. Because of this, both the authors and readers must be extremely careful about applying these arguments and principles to patient care. Most decisions are not as straightforward as how much money a retirement account will make based on a binary choice. Emotional harms are also important to consider; patients or customers likely do not have a strong emotional attachment to the layout of the cafeteria they’re eating in, but they will certainly have strong emotional responses to their treatment, pain, and violations of their autonomy. Paternalism is not clearly justified or unjustified, and the benefits consequences must always be carefully and continuously weighed.
Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. New York: Oxford UP, 2001. Print
In the liberal paternalism reading, Thaler and Sunstein are close to making the assumption that it is ok to engage in forms of liberal paternalism since the outcomes of it are generally better than if the consumer makes their own decision. While outcomes may be better from paternalism when compared to patient choice, I would disagree with advocating for liberal paternalism in this case. A key component of patient autonomy is allowing patients to make their own decision regardless of the outcome, so to undermine that ability would be suppressing a role of the patient. This could potentially allow for groups in the future, such as insurance providers, to approve of a surgery a patient previously disagreed to because it would be cost-effective to the insurance company as well as the patient.