Paternalism in Public Health: A Moral/Ethical Quandary

[Pranab Chatterjee]

Hi!

Reading this Perspectives article in the NEJM (http://www.nejm.org/doi/pdf/10.1056/NEJMp1303698) re-awoke in me a debate that I have been having for a while now. Are public health policies that impose bans and restrictions (on harmful behavior patterns) an infringement of the basic individual right to choose?

We speak about giving patients the right to autonomy, to choose whether and how to get treated. But should, on principle, this right to choose end only at that? Can we not choose to "live fast die young"?

In an ideal world, I think, we need not have bans on anything. Informing and empowering people to adopt healthy lifestyles would be more fruitful, it seems to me, in the long run. Yet, I stay confused - what about the greater good? What about health for all? Should we have the right to choose to harm ourselves?

I have babbled about it extensively on my blog here: http://scepticemia.com/2013/04/18/new-york-soda-rule-raising-the-debate-on-paternalism-in-public-health/

I wanted to sound out people on what they think and thought that this might be an interesting point to talk about in the Group. Being a little "on the fence" about this issue, I would appreciate some feedback or thoughts on this matter.

Regards,

Pranab

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Pranab Chatterjee

MD, PGY-1

Department of Community Medicine

University College of Medical Sciences, New Delhi

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