Sarah Conly, it is fair to say, is no great believer in autonomy, which she defines as the ‘ability to order our lives according to our decisions’ (2). According to her, respecting autonomy is making us too fat, too unhealthy, causing us to get in too much debt, stopping us from saving for the future and is not geared toward supporting equality and mutual respect. Instead, we should adopt ‘a better approach’ (1) of coercive paternalism and ‘save people from themselves by making certain courses of action illegal’ (1).
Against Autonomy: Justifying Coercive Paternalism is a reaction to Mill's claim in On Liberty that ‘the only purpose for which power can be rightfully exercised over any member of a civilised community, against his will, is to prevent harm to others’. Mill's argument was that adults in the maturity of their faculties generally know what is best for them. When others interfere with an individual's desires for that individual's own good they often get it wrong and cause unhappiness.
In contrast, Conly believes new evidence from the fields of psychology and behavioural economics has cast doubt on the idea that we are rational agents ‘well-suited to determining what goes on in our own life’ (2). Research indicates that we are prone to things such as stereotyping and present bias and we are too often influenced by the descriptions used in the presentation of our options: people are more likely to choose a medical procedure with a 20 per cent chance of success than one described as having an 80 per cent chance of failure, for example (21–22). The author suggests that this flawed thinking establishes that we are actually ‘frail creatures’ (20) who ‘too often get things wrong in ways that can hurt us profoundly’ (20). We are not, in other words, rational creatures best-suited to determining how to achieve our own ends. As Mill ‘failed to adequately reckon with human psychology, as we now know it to be’ (9) the grounds for respecting autonomy are ‘shaky’ (2).
It might be countered that a few examples of flawed thinking does not show that our judgments are essentially irrational or that we are so useless in our reasoning ability that the government should step in instead. However, whether we are rational or not is fundamentally an empirical question of which I am far from equipped to solve and so I shall presume Conly is correct on this matter.
This premise – that we are irrational – will be familiar from the ‘Nudge’ theory proposed by Cass Sunstein and Richard Thaler. They share Conly's belief that we frequently engage in poor thinking but assert that because we usually see the status quo as the most attractive option we should ensure that it is the best option for us by ‘nudging’ people into making better choices rather than just banning things. Healthy food could be put on eye-catching displays, for example. The most notorious archetype of this method of shaping behaviour is the flies that Amsterdam's Schipol airport has painted on its urinals to improve men's ‘aim’ and result in less ‘spillages’ in the gentleman's lavatories.
Conly rejects nudge theory, however. Apparently it ‘fails to give us the results that we want’ because people still have the option to ‘pursue bad courses of action’ and it is ‘manipulative’ so gives us ‘the worst of both worlds’ (8). Coercive paternalism, on the other hand, by just taking options away, may not respect people's ability to choose well for themselves but Conly thinks this scarcely matters as the paternalist does not believe such aptitudes exists anyway (8). She also dismisses better education as an alternative, believing that as, for example, there are still a number of people who start smoking each year (albeit in radically reduced numbers) it is an ineffective way of helping people achieve their ends of leading healthy lives.
For Conly's paternalism is, on the face of it, a paternalism of means rather than ends. She does not intend to adopt a moralistic or perfectionist view of simply prohibiting things because they are sinful or bad for people (125). Instead, she acknowledges that while it is possible that only a given individual truly knows what they enjoy, and so is the only person that knows what their ends are, it is not the case that ‘he is the best person to choose the means to reach that end’ (53). So if a person values happiness and tries to achieve this by playing the lottery because they believe they have a good chance of winning then they are mistaken with their means (43). Paternalistic legislation, says Conly, should not control every aspect of a person's life but step in when they are likely to make decisions that interfere with their ability to reach their goals (72).
In this respect, the initial premises in On Liberty and Against Autonomy are both utilitarian: we should do what has the best consequences for people. Both authors see what is best as the reaching of one's own ends. But Mill thinks the best way to do this is to let people make their own choices; Conly prefers the blunter option of using paternalistic legislation to take bad options away.
When, then, should paternalistic legislation be permitted? Conly highlights that we all accept some paternalism from governments – few would support people being allowed to self-diagnose what medication they should receive without a prescription from a doctor – and suggests that for paternalism to be the appropriate strategy it must meet four criteria: first, the activity to be prevented on paternalistic grounds really is one that is opposed to our long-term ends. In other words, interference is justified on paternalistic grounds ‘only when it reflects an individuals’ actual values, not the values we might like them to have' (150); second, coercive measures have to be effective; third, the benefits have to be greater than the cost (and the fact that we value choosing things for ourselves is included in this cost-benefit analysis); and, lastly, the measure in question needs to be the most efficient way to prevent the activity (150–151).
Applying this method, Conly rules in favour of a ban on trans-fats, cigarettes and large portion-sizes in restaurants but leans against preventing people from using food stamps to buy soda, banning alcohol, forcing people to have arranged marriages or setting up committees to select people's jobs for them.
These applications, alas, are by far the weakest part of the book. Most could accept that a cost-benefit analysis may point towards banning trans-fats: if the food still tastes good, as Conly insists, then there are very little costs involved given such enormous health benefits. Most liberals are unlikely to go to the stake over such a restriction. With her other examples, though, it is far less clear-cut. Cigarettes undoubtedly cause a lot of problems and it certainly would be A Good Thing to get as few people smoking as possible. But Conly skims over the fact that people might actually enjoy smoking for its own sake and is Panglossian on the costs: such a ban is unlikely to be effective and could result in a black market (169–172). The futility of bans on narcotics throughout the ages should have given her pause for thought on this issue.
Similarly, Conly fails to fully comprehend that some people gain pleasure from eating large portions of unhealthy food (165). In her attempt to paint this as against everyone's ends she states: ‘These may be the same people who spend tends of billions of dollars per year on trying to lose weight through Nutrisystems, Weight Watchers, Jenny Craig, Herbalife, thousands of diet books, gym memberships, and machines that will magically jiggle the fat away’ (168). But then again, they might not be. And even if they are, occasionally eating a large portion of food is not inconsistent with a healthy lifestyle. While limiting portion sizes would undoubtedly help some people achieve their ends, for others it would interfere with them. Yet this is merely one example of Conly's habit of painting her own experiences as one that is uniform throughout humanity. Apparently, ‘we’ all plan to only buy fruits and vegetables when we go to the supermarket but then become ravenous beasts after the merest sniff of the bakery aisle (79). Speak for yourself, one might respond, not all people want to eat healthily all of the time and some actually set out for the cheesecake.
This highlights a major defect with Conly's thesis. She overestimates why long-term ends should be preferred to short-term ones and never fully rebuts the idea that the fact that people do things that are bad for them might show that they actually want to do those things – that those things are their goals – rather than a flawed means to other objectives. The boundary between means and ends is not always a clear one and government intervention, being a very blunt instrument, would have a hard job banning things that only hinder people's means rather than their ends. Consequently, Conly's theory appears far less means-orientated than she insists it is. Indeed, she seems to limit people's ends exclusively to having a long, healthy, lifespan with savings to support them and she is too quick to discount the idea that people see smoking, wasting money on holidays or eating unhealthily themselves as an end (169–172). People enjoy making their own choices even if it results in, say, smaller pension pots and Conly has deprecated many of the costs involved in restricting people's options. Given this, it is far more likely that her theory, being utilitarian and relying on a cost-benefit analysis, would rule in favour of respecting autonomy in many more situations than she anticipates. Her rose-tinted view of government intervention is, ultimately, unjustified.
Nonetheless, Against Autonomy is probably the strongest case for paternalism that liberals will have to face. The fact that it can be faced, however, does not diminish the fact that this iconoclastic book is a tightly-argued, interesting and lucid work of philosophy.
