The Weight of Paternalism on the Public Health Scale

In Public Health Law In an Age of Terrorism: Rethinking Individual Rights and Common Goods, Gostin examines public health law and the deficiencies associated with the current policies. He claims that there has been little emphasis on modernizing the laws to accommodate the recent advances in public health and constitutional law (Gostin 374). “Reform of public health law is essential to ensure that public health agencies have clear missions and functions, stable sources of financing, adequate powers to avert or manage health threats, and restrains on powers to maintain respect for personal rights and liberties” (Gostin 374-375).

During his argument, he challenges critic’s concerns about personal libertarianism and the protection of personal rights in the event of a national wide medical emergency.  For Gostin, compulsory power is necessary for public health because the government has the right to prevent individuals from endangering others. “The state undoubtedly needs a certain amount of authority to protect the public’s health” (Gostin 381). This action obviously compromises the individual’s autonomy in certain situations and creates moral concerns for authorities.

In addition to his argument, I think it’s important for critics to recognize how these policies come into play and who writes them. As Americans, we have the civil liberty to vote for policy makers, state representatives and even the passage of certain laws. While the individual’s current right may be undermined at the time of an emergency, they have the capacity to exercise their personal liberty in voting for state representatives and legislative officials.

You cannot remove paternalism from public health. As Thaler and Sunstein have pointed out, “some kind of paternalism is likely whenever such institutions set out arrangements that will prevail unless people affirmatively choose otherwise” (Thaler and Sunstein 390). The public voted for such regulations and must comply with them accordingly. In the realm of public health policy we often forget where the law initially stems from. It’s the people.

As citizens, we have the ability to exercise our autonomy towards choosing which paternalistic approach we like the most; perhaps it’s the one that promotes the most personal freedom. Regardless of the policy outcome, paternalism and public health go hand in hand.


Thaler, Richard H., Sunstein, Cass R. “Behavioral Economics, Public Policy, and Paternalism: Libertarian Paternalism.” Arguing About Bioethics. London: Routledge, 2012. 386-391. Print.

Gostin, L.O. “Public Health Law in an Age of Terrorism: Rethinking Individual Rights and Common Goods.” Arguing About Bioethics. London: Routledge, 2012. 374-384. Print.

6 thoughts on “The Weight of Paternalism on the Public Health Scale

  1. I agree with your conclusion that paternalism is an inseparable part of public health. Public health’s focus is on the public, which means that there is a person or group making decisions for a large population. In class we have been discussing some of the negative aspects of paternalism in regards to public health, especially in the case of vaccinations. Vaccinations are a part of public health, but a small part.

    There are many other issues within public health that take a paternalistic stance that people do not think about. Public health can include health education, surveillance, infection/pest control, disaster preparedness and environmental health control such as occupational health, sanitation and hygiene or food and drug safety (Resnik 2007). All of these strategies assist to promote population health and utilize degrees of paternalism. Restaurants have to meet certain health requirements in order to remain open, sewers have restrictions on their location and structure and companies have restrictions of working environments to ensure employee health. Aspects of public health and health promotion may promote individual responsibility and investment in their own health (Resnik 2007). Changes based on health promotion can include participating in safe sex or deciding to walk to work to get exercise (Resnik 2007). An individual can make this decision on his or her own, but the initial policy gets them thinking without making it seemed forced upon them. In conclusion, public health policies are paternalistic in nature and at times allow people to make their own decisions.

    Resnik, D.B. (2007). Responsibility for health: personal, social, environmental. Journal of Medical Ethics, 33 (8):444-445. Doi: 10.1136/jme.2006.017574

  2. What I found most interesting about the article you wrote your post on is the simple fact that in the state of emergency, the government has always encroached upon many of the liberties that are used to argue against the MSEHPA. The legislation doesn’t establish anything new in that regard; however, it clearly defines potential government actions and more importantly sets the standards and conditions under which they are accepted. Which to me, sounds better than remaining ignorant to the value of paternalism and handling these aspects of crises only when they arise.

    Some degree of paternalism is necessary in nearly all aspects of life. Our workforce has grown more specialized for a reason: not everyone can be an expert in everything. There need to be initial decisions made that help to guide people towards options that will benefit them and society in the long run. A little paternalism goes a long way in creating a more harmonious, and healthy, society.

  3. Your argument focuses on a key point that we often forget as citizens of a democracy: we have the right to choose. Unfortunately, everyone’s desires cannot be expressed by the government; thus, it is the government’s job to determine which options will have a maximum benefit for the largest amount of people. Additionally, if we find fault with the government’s manner of choosing the best policy, we still have the power to change how the government operates and enacts these policies. We as a people decided to make the government paternalistic because we gladly accept a representative democracy. Most people wouldn’t argue against this form of democracy because if we did the government would move more towards anarchy than democracy. There are just too many people with different opinions and levels of expertise for a direct democracy, and not everyone trusts that every citizen is well informed to make decisions on public health policy. Essentially, we have the autonomy, not the policy makers.

  4. While the people may elect a representative, their needs and interests are not necessarily guaranteed to show up in the laws that these representatives are voting on. I do believe though that with some many differing views among citizens, it is necessary for the government to set in place laws that promote the benefit of the majority. There is some degree of choice making that the government must do that doesn’t allows necessarily involve the interests of every single person. With public health, many times people are uneducated as to what is best for them in certain situations. The solution to this is having knowledgeable professionals aid policy makers in creating public health guidelines for a general population full of some people who may not know how to act in a way that is of the most benefit to them.

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