In the article discussing public health initiatives to combat obesity and their ethicality, Holm argues that there are three different forms of paternalism: hard paternalism (direct coercion), soft paternalism (giving unwanted information or foreclosing some options for action), and maternalism (control by inducing a guilty conscience). He then applies these types of paternalism to a discussion of the ethics behind obesity interventions. The first question is whether it is justifiable to promote a person’s own health or well-being, if they do not want intervention. I immediately thought of the ethicality of posting calorie counts at restaurants. If the person does not want the information, this is most definitely a form of soft paternalism, and even a little bit of maternalism as guilt may prevent someone from ordering what they want. But is it justified? 

Recent Studies 

Recent studies have found that while an estimated 15% of restaurant customers used calorie listings to help them choose healthier foods, the majority of listings were too confusing to guide diners to make healthier decisions.  Programs like these often encourage businesses to work towards putting healthier and more nutritious items on their menus as they know that customers will be provided with the nutritional facts in an easy and convenient way. For example, it is embarrassing for McDonald’s to have to disclose that 20 Chicken McNuggets is 860 calories. Thus this provides both an incentive for business owners to provide healthier alternatives as well for consumers to make healthier eating decisions.

Autonomous Decision Making 

Misinformation, along with busy lifestyles and too many unhealthy choices, has been pegged as one of the leading causes of the obesity epidemic. In order for consumers to make a fully autonomous decision based on informed choices, they must have enough information to do so. While it is likely that the calorie listings encourage people to make healthier decisions, the information provided is in no way biased. The calorie listings are simply stating the facts and thus I don’t think it is fair to view them as a bias or a source of forced paternalism. I think the main question is whether or not society or the state is justified in interfering in our personal choices. But is it really interfering if they are only helping us make a more well informed decision? I argue that no. The displays of calorie values are ethical as well as important to the health of our society.  There is no loss of freedom or autonomy in being provided the extra information, in fact autonomy is actually increased as more information allows one to form a better informed decision.

Changing Relationship

In the past, the physician patient relationship was one of complete trust. Physicians thought they knew everything about medicine, and patients had few other ways of gaining information so they did as they were told.  The relationship was deeply rooted in paternalism.  However, the influx of medical information readily available in our society as well as a new emphasis on personal care is driving patient empowerment.  In addition, the limited time physicians have to spend with their patients have led to less personal relationships and a dramatic decrease in listening to the patient’s concerns and problems.  In our time, physicians have little knowledge of their patient’s desires, mentality, and values, which can affect the way they administer treatment.  One study even showered that resident doctors spend 12% of their time interacting with patients compared to 40% of their time interacting with the computer.  It is difficult to form relationships with patients in this small window of time.

Role of Consent in New Relationship

         Robert Veatch argues that consent it a transition concept, an innovation that is only useful as a transition to a more thoroughly revisionary conceptual framework. Veatch argues that with the little information physicians truly know about their patients, their personalities, and their values, there is no way that they can even guess what is in the overall best interest of the patient.  Veatch believes that in order for a physician to guess what is the best course for the patient, three assumptions must be true regarding a theory of the good.

1. The physician must determine what will best serve the patient’s medical interests.
2. The physician must determine how to trade off health interest with other interests.
3. The physician must determine how the patient should relate the pursuit of his or her best interest to other moral goals and responsibilities that may conflict.

In our day and age, Veatch believes it improbable to expect a typical medical professional to be able to fulfill even one of these, let alone all three.  In addition to arguing that since a physician has little relationship with the patient, they often cannot accurately determine what is in their best interest, Veatch also argues that physicians are only experts in one component of well-being (medical) and therefore are unable to determine what constitutes the good for another being.  

Where Do We Go From Here?

Veatch argues that there are two alternatives to informed consent.  The first option being to emphasize the concept of choice rather than consent.  Since physicians have no way of knowing what is in the patient’s best interest, they should present the patient with a list of plausible treatment options with the potential benefits and risks of each, allowing the patient full autonomy and choice in their course of action.  This seems extremely implausible.  A more realistic, but still a stretch, of an option is pairing physicians and patients based on their “deep interests” including religious and political affiliations, philosophical and social inclinations, and other worldviews.  This would put both provider and patient on the same page of what values are necessary and essential part of health care decision making and allow physicians to provide the course of action that best falls in line with patient’s views and values.

To me, these two alternatives seem a little farfetched.  I think where we need to start is by changing the paternalistic physician-patient relationship to more of a partnership.  Physicians need to embrace listening, and think of themselves as more of a health coach then the end all and be all of medical knowledge.

Leon Kass argues in the article “Why we should ban the cloning of humans: the wisdom of repugnance” that we need to enact a universal ban on cloning, as cloning is an insult to both morality and human dignity.  What I found so interesting about Kass’ argument was that he describes not only to the logical but also the emotional consequences of cloning.  Kass uses the feeling of repugnance to do just this.

The Process of Cloning:

Cloning is the process of creating a cell, cell product, or organism that is genetically identical to the unit from which it was derived. The nucleus of a mature and unfertilized egg is removed and replaced with a nucleus obtained from a specialized cell of an adult organism, which contains almost all the hereditary material.  While experts make it clear that cloning is not like Xeroxing, due to differences in environment and circumstances, the clone with share the same genome as the donor.

Argument of Revulsion

Kass argues that there is a reason most people feel deep revulsion to the idea of cloning human beings, a feeling similar to the one we get when considering cannibalism or incest.  He describes potential situations that could arise in the future if cloning is allowed in order to bring about disgust and emotional fears in readers such as: the mass production of identical human beings, women giving birth to and rearing a genetic copy of herself or someone in the family, replacing someone who has died with an exact copy, the narcissism of those who clone themselves, and the hubris required to control life and control destiny allowing man to play God in a way that is not natural.  Kass understands that revulsion is not entirely a valid argument, since there are plenty of examples of things that our ancestors would have been repulsed now that we see perfectly normal. However, he describes repugnance as the emotional expression of deep wisdom; wisdom beyond reason’s power to fully articulate.

Cloning Goes Against the Natural:

While I thought the emotional argument Kass posed was strong, he does not leave it to stand-alone.  He supports his argument by providing evidence as to why cloning would be damaging to the children, the family dynamic, and the process of human procreation. Kass argues that sexual reproduction is established by nature and is a process that should not be influenced by human design. He worries that cloning threatens confusion of identity and individuality and that the cloning of human beings represents a giant step toward transforming procreation into manufacture, straying from the natural and pushing children to become products of human will and design rather than a result of a loving family.

Reflecting on Kass’s Argument:

I can see where this argument for the need to maintain a traditional family and reproduction system may not appeal to some people, however I agree with his desire to maintain the natural cycle of birth, procreation, and death. I think Kass does a good job of appealing to both the emotions and logic of readers and was effective in convincing me that cloning humans is something that needs to be banned worldwide.

Sources: Kass, Leon R. “Why We Should Ban the Cloning of Humans: The Wisdom of Repugnance.” Arguing about Bioethics. London: Routledge, 2012. N. pag. Print.