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- Hoboken, New Jersey
I’ve been thinking a lot about the decline of paternalism in American society—especially in the context of medicine and government authority. It feels like we’re slowly shifting from a world where institutions and professionals make decisions for us, to one where we’re empowered to make decisions for ourselves, even if those decisions carry tremendous risk or lead to outcomes that not only others don’t approve of, but destructive to our own health and the public health system at large.
Take medical autonomy, for example. There was a time when doctors could (and should) override a patient’s will, “for their own good.” Now, in many countries, patients have the legal right to refuse treatment—even life-saving treatment. The idea that someone can say, “No, I’d rather die than undergo this procedure,” and have that wish respected, is a huge step toward genuine personal autonomy, even if it leads to unambiguously negative outcomes from a utilitarian framework.
We see the same trend in end-of-life care. Medical Assistance in Dying (MAID) is now available in several countries, and the moral panic around it is being steadily replaced by a more respectful, adult conversation about suffering, dignity, and self-determination.
Even drug policy, traditionally one of the most paternalistic areas of law, is slowly evolving. Psychedelics are being decriminalized or legalized in places like Oregon and parts of Canada. Marijuana is legal in many states and countries now, not because people finally see it as mostly “harmless,” but in part because people finally realized that adults have the right to assess risk and make their own choices.
It makes me wonder—could we be witnessing the long, slow death of paternalism? Or is this just a temporary pendulum swing? Do you think we’ll ever reach a point where people are truly free to live and die on their own terms, without being second-guessed by the state or the medical establishment?
I’m just concerned about the conventional public health wisdom of “sacrificing individual rights for the public good” is dying, and it’s much more than just conservatives and conspiracy theorists who condone this. That a broad distrust of government, somewhat shaped by legitimate reasons (corruption, inefficiency, rent-seeking) will lead people to have diminished solicitude not just for collective action, but for one another.
Curious to hear what others think.
Take medical autonomy, for example. There was a time when doctors could (and should) override a patient’s will, “for their own good.” Now, in many countries, patients have the legal right to refuse treatment—even life-saving treatment. The idea that someone can say, “No, I’d rather die than undergo this procedure,” and have that wish respected, is a huge step toward genuine personal autonomy, even if it leads to unambiguously negative outcomes from a utilitarian framework.
We see the same trend in end-of-life care. Medical Assistance in Dying (MAID) is now available in several countries, and the moral panic around it is being steadily replaced by a more respectful, adult conversation about suffering, dignity, and self-determination.
Even drug policy, traditionally one of the most paternalistic areas of law, is slowly evolving. Psychedelics are being decriminalized or legalized in places like Oregon and parts of Canada. Marijuana is legal in many states and countries now, not because people finally see it as mostly “harmless,” but in part because people finally realized that adults have the right to assess risk and make their own choices.
It makes me wonder—could we be witnessing the long, slow death of paternalism? Or is this just a temporary pendulum swing? Do you think we’ll ever reach a point where people are truly free to live and die on their own terms, without being second-guessed by the state or the medical establishment?
I’m just concerned about the conventional public health wisdom of “sacrificing individual rights for the public good” is dying, and it’s much more than just conservatives and conspiracy theorists who condone this. That a broad distrust of government, somewhat shaped by legitimate reasons (corruption, inefficiency, rent-seeking) will lead people to have diminished solicitude not just for collective action, but for one another.
Curious to hear what others think.
