Commenter “Jim Nicholas” had this to say on yesterday’s thread about Sarah Conly’s book Against Autonomy
Are we willing to or do we want to let persons suffer all of the consequences of their dumb mistakes or impulsive choices? Do we want a society in which there are no life-guards who attempt to rescue those who swim too far, in which there are no mountain rescue teams for those who do not realize their limits, in which there are no bankruptcy protections for those who tried and failed, in which we close the hospital doors to those whose heart attacks are caused by over-eating?
To the extent a society is willing to try to mitigate some of the consequences of bad decisions, that society pays a price for decisions of the individual. If so, is it unreasonable that society has some say about the decisions of individuals that are highly likely to be costly to society?
I am not sure that the balance between individual freedom and responsibility to others is an easy balance to achieve.
Conly’s book, and the ensuing discussion, was not so much about whether or not to let persons suffer the consequences of their dumb mistakes or impulsive choices. It was about Conly’s suggested remedy of preventing them from making those choices in the first place. That’s why it was called “Against Autonomy” rather than “Against the Consequences of Stupid Decisions.”
The proper analogy for the case of the swimmer who gets into trouble and must be rescued by a lifeguard is not to ban the rescue, but to ban ocean swimming in the first place. Rescuing the swimmer is done after the fact, but the person retains his/her autonomy to choose to swim in the ocean. Rescuing a swimmer is not compromising his/her autonomy at all, unless that swimmer is trying to commit suicide.
Naturally, the situation is not as clear and easy to conceptualize as that. There are difficult decisions to make, but they are more likely to be about financial consequences—such as, for example, whether society should pay for the increased health care costs of smokers. But that last question only really comes into play if we decide to foot the bill for other people’s health care in the first place—i.e. Medicaid, or universal non-private health care, or requiring that hospitals treat all comers regardless of ability to pay. That’s a different, although related, decision, because it’s a slippery slope from those decisions to one to limit personal autonomy and choice based on the costs of that decision to treat everyone regardless of financial ability.
I want to also call attention to one particular point that same commenter made, when he asked whether we should “close the hospital doors to those whose heart attacks are caused by over-eating.” My answer would quite obviously be “no,” but not only because I am somewhat of a libertarian. It’s also because the science is, as they say, “unsettled.” We have no idea whose heart attacks are caused by overweight and whose are not.
It is a fallacy to think that, because an overweight person has a heart attack, he/she has caused it through the mechanism of overeating. Plenty of overweight people are just fine, and plenty of thin people have heart attacks. At what point does it become clear that a particular overweight person’s overeating has caused a heart attack? And, to take it even further, since our understanding of the mechanisms by which some people end up overweight and others do not is primitive at best, at what point (and for whom) can we conclude that a particular person’s overweight is the result of a choice? All overweight people don’t even overeat as compared to many thin people, although some do.
I’m not saying these issues and their solutions are completely clear. But Mill’s harm principle is still a good basic guide:
[T]he only purpose for which power can be rightfully exercised over any member of a civilized community, against his will, is to prevent harm to others. His own good, either physical or mental, is not a sufficient warrant.
I would add that mere financial harm to society at large or the public purse is not enough, unless the person’s act is criminal as well (for example: embezzlement, theft, fraud, which ordinarily also result in direct harm to another person or a company).
[NOTE: When I mention commenters’ names, I always put the names in quotes, as I did here for “Jim Nicholas.” This may seem silly, but I do it for two reasons: the first is that for almost all commenters, I don’t actually know whether the names they use are their actual names or pseudonyms. The second is that, even if I did know that information, I wouldn’t use a person’s real name without getting that person’s permission to do so.]