Humans have a natural rebellious nature because they feel entitled to control their own life. They do not wish for someone else to coerce them into doing something even if they feel that it is in their best interests. Instead, they wish to be given the chance to choose an action that is in their best interests. When designing public health policy, it also best to limit coercion as much as possible because it will evoke more cooperation from the citizens.
Firstly, it is important to know that there are three forms of coercion: hard paternalism, soft paternalism, and maternalism. S. Holm describes hard paternalism as giving someone no option, soft paternalism as attempting to influence someone’s choice via manipulation of information, and maternalism as influencing someone’s decisions through guilt (Holland 392). Secondly, it is also important to know that no matter the circumstances, there will always be some level of outside influence on which decision a person chooses to make. The key is to make the person feel as if they have autonomously made the decision.
Obviously, hard paternalism can deter people from going through with a decision because they feel forced into their situation. D. Isaacs, H.A. Kilham, and H. Marshall assert that people “who are coerced into an action may be more likely to perceive the action as being risky than if they are persuaded into it (Holland 403). Essentially, when people are obligated to choose a default choice, they assume that there are underlying consequences that are not disclosed because these consequences will dissuade them from choosing that particular option. For instance, Simon Chapman argues that people are so hostile towards public cigarette smoking because they are forced to share the person’s toxic smoke. Nevertheless, people enjoy sitting around a warm campfire, where they, by choice, inhale its toxic smoke (Holland 408).
Meanwhile, the act of persuading, such as in soft paternalism and maternalism, forces one to unveil reasons why people should choose a certain option over other ones. This allows the person to feel that there are other options, but one particular choice is the best choice due to certain specifications. For example, educating people about the risks of obesity allows people to see that their life expectancy can be improved and their risk of disease can be lowered if they choose to diet healthily and exercise. Using soft paternalism, officials could lower insurance rates for those who live a healthy lifestyle. People still can choose to eat unhealthily, but it would not be in their best interest because they will have to spend more money to cater to a lifestyle that has been proven to shorten their lifespan. From a maternalistic approach, officials could inform parents that an unhealthy lifestyle could lead to a plethora of diseases such as asthma, diabetes, and heart disease that will lead to a poor condition of life as they grow up. Good parents should then feel guilty and thus decide to set a positive example for their children as well as ensure that their children follow this example.
Subsequently, compulsion may not be necessary in order to enact public health policy because simply giving the people an option will respect their right to choice, a key component of autonomy. One of the only instances in which compulsion may work is in a case in which a disease is immediately life threatening. This is because people value their lives and will do anything to preserve them, including subjecting themselves to mandated treatment. Still, people will view this mandate as a choice to do whatever it takes to save their life. In the end, people will comply as long as they feel that they are in control.
Sources:
Chapman, Simon. “Banning Smoking Outdoors Is Seldom Ethically Justifiable.” Arguing About Bioethics. Ed. Stephen Holland. New York: Routledge, 2012. 407-11. Print.
Holm, S. “Obesity Interventions and Ethics.” Arguing About Bioethics. Ed. Stephen Holland. New York: Routledge, 2012. 392-97. Print.
Isaacs, D., H. A. Kilham, and H. Marshall. “Should Routine Childhood Immunizations Be Compulsory?” Arguing About Bioethics. Ed. Stephen Holland. New York: Routledge, 2012. 398-406. Print.
I agree with Geovonni, that compulsion is not always an effective means of achieving public health goals. I do not believe that compulsion is the most sustainable policy approach, as it does not always rely on informed individuals. For example, when individuals are being forced into a public health policy, they often do not understand reasoning behind why the policy is important. Therefore, I not only believe that individuals should be given the option to make good health choices, but they should be given the tools necessary to make these good decisions. I believe that it is very important to focus on the role of education as a preventive health measure, particularly in children. This is important because you do not just want children to make the “right” decision, but you want them to understand the implications of the choice that they make. By fostering an environment that encourages individuals to make good decisions as opposed to one that forces them to make these decisions, the public health effects are more sustainable.
I definitely understand how hard paternalism can turn people away from trying to live a more healthier life. Hard paternalism can be forceful and can lead people away from eating healthy. Sometimes, however, forced paternalism is the best option that can start a lifestyle change. If someone lacks the proper knowledge, then it is best that someone teaches them the information. For example, placing citizens in jail or drug rehabilitation centers are examples of forced or strict paternalism. These citizens are forced to change their way and to act in different means in order to excel in jail and get a few breaks. It is his forced change of behavior that actually causes the improvement of the people in jail. These citizens in jail are forced to act with good behavior in order to eventually leave jail and live a free life. Forced paternalism, I believe, will encourage/ force people to live a free life. It is the beginning of understanding that there is a better way to live a healthful life, and that their rejection of these better health practices may not have been warranted. Parents force children to go to school, go to sleep, etc. Children do not know better when they ask to stay home or when they want to stay up all night. It is the same concept in individuals who may be living an unhealthy life, but just do not know they are or know how to fix it.
You make an amazing logical argument in your first paragraph. It speaks to me formally but also intuitively. However, the last line, or phrase that relates your conclusion to justifying limited coercion, came a little suddenly. I am left wondering, “but what about what is best for the PUBLIC health”? Thus we have a struggle between doing what is effective for both the individual and the public, and I am glad you address this as well, “The key is to make the person feel as if they have autonomously made the decision.” The idea that we want control applies in all situations, as we crave security. This rings true in the most confident of people, and in the meekest.
I was intrigued by the wood smoke and cigarette smoke comparison. I searched the web and found this: http://www.ehhi.org/woodsmoke/health_effects.shtml . This just goes to show just how much stigma can affect people’s health choices. Misinformation also plays a big part in this. In response to the rest of your post, the last paragraph made think about our perception of disease. Our health care system is set up mainly in a manner to combat infectious disease, a reactive system if you will. Infectious disease is the pinnacle of an immediate life threat. Unfortunately in the US, infectious disease is no longer the main killer. Chronic disease (hear disease, cancer, stroke) kills more Americans than anything else. Chronic disease is by no means an immediate life threat. We as Americans are still stuck in the mindset that we need to be looking out for immediate life threats above all else. Unfortunately with chronic disease, the immediate life threats come at a time where the majority of the damage is irreversible. It’s time we look at our lives through a larger lens and realize the true threat at this point in time. Interventions must be performed to change this mindset.