Lifestyle Economics

State paternalism rests on shaky philosophical foundations

Our country is plagued with state paternalism, and it’s only getting worse.

From the sugar tax and its potential expansion to milkshakes, to the recent study published by University of Bath researchers calling for a steep increase in tobacco duty, public health campaigners love to justify intrusive, coercive strategies on the grounds that they make people healthier and, it is hoped, save lives.

Yet while the efficiency of such paternalist measures is debatable, it’s rarely acknowledged that they contradict one of the basic principles of civilised society.

Imagine the following thought experiment.

You’ve paid a visit to McDonald’s. In your desperate desire for fat and sugar, you clumsily trip over a mop, and before you know it have fallen into an elaborate contraption for slicing potatoes. Despite the best efforts of the management staff, your arm is badly mangled, and you are rushed to hospital. After examination, the doctors deliver their grim assessment: the arm must be amputated, or you will die. Before they can get to work on saving your life, however, they must obtain your consent. This would be the same regardless of your condition – if a competent, conscious adult doesn’t consent to a medical treatment, the treatment cannot be given, even if it means they will die.

This fundamental tenet of medical ethics reflects a much broader principle, integral to any free, liberal society: namely, that we cannot force help upon people without their freely given consent. Regardless of the consequences to their health or wellbeing, if an adult is deemed competent in the legal sense, we can only inform an individual of the risks of their behaviour or encourage them to accept our help willingly.

So why is it that if, instead of mangling my arm, I had gone ahead to queue for a full sugar Pepsi, the public health lobby would assume the right to ‘help’ me to be healthier without my consent, via a compulsory financial deterrent in the form of the sugar tax? Sin taxes, restrictions on portion sizes, government pressured reformulation – there is no opting out of these oppressive forms of ‘assistance’.

Of course, there are exceptions to every rule. While a doctor can’t make me accept an amputation for a mangled arm without my consent, they are perfectly within their rights to force me to accept treatment for infectious diseases like tuberculosis which carry harmful consequences for wider society. This idea, that force may be exercised against an individual to prevent harm to others but not to themselves, was famously argued in the nineteenth century by English philosopher John Stuart Mill in his pivotal work ‘On Liberty’, penned in response to the kill-joy prohibitionists of his own day.

He noted:

“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. His own good, either physical or moral, is not a sufficient warrant… The only part of the conduct of any one, for which he is amenable to society, is that which concerns others. In the part which merely concerns himself, his independence is, of right, absolute. Over himself, over his own body and mind, the individual is sovereign.”

Not keen to lose the argument, nanny statists have contrived one of the most pervasive lies in political discourse: that unhealthy living is “crippling” the publicly funded NHS, and thus affects other members of society adversely. Like all good lies, it seems to add up. Smokers are prone to lung cancer; fat people are prone to heart disease; heavy drinkers are prone to liver failure. All these conditions require treatment on the NHS, often for many years, and so it makes sense that they are costly.

This assessment, though, fails to account for a macabre but unavoidable truth – that smokers, the obese and heavy drinkers die younger, on average, than others. On this point, recent academic literature is clear: unhealthy lifestyles, far from putting a financial strain on the NHS, actually reduce it, over the lifetime of the individual. That’s not to say we should encourage people to die young to save the NHS money, but one cannot in good faith argue that the harm of these behaviours extends beyond the individual concerned.

Anyone who has lost a loved one before their time due to heart disease, lung cancer or other lifestyle-related ailments will know the pain these conditions can inflict. However, in a principled society, there are certain remedies which, even if effective, should simply be beyond consideration due to incompatibility with our values. Coercive, nanny state paternalism is one such method.

Anyone who is genuinely concerned about public health should be pushing for real, evidence-based approaches like extending cookery classes in schools and encouraging smokers to switch to e-cigarettes. Yet the public health campaigners who are hell-bent on purging sugar from our menus and making smoking ruinously expensive to all but the wealthiest, are nothing more than modern day puritans. We indulge them at our peril.


Rowan Wright is a mathematics student at the University of Cambridge who is particularly concerned with the rise of nanny state paternalism pertaining to diet. In his free time he enjoys mountaineering, continental cooking and playing the classical guitar.

2 thoughts on “State paternalism rests on shaky philosophical foundations”

  1. Posted 28/08/2018 at 14:07 | Permalink

    While I agree with the thrust of the argument, this statement is not true:

    “On this point, recent academic literature is clear: unhealthy lifestyles, far from putting a financial strain on the NHS, actually reduce it, over the lifetime of the individual.”

    The academic paper linked to does not say this. It merely concludes that reducing obesity and smoking levels will not avoid rising medical costs – a very different conclusion to the one suggested. In fact, there have been many studies and they differ in their findings- some imply rising costs, some imply falling costs. Some look just at medical costs, some look at other costs as well.

    It is fair, however, to say that it cannot be be assumed that reducing smoking and obesity levels will save the NHS money, but neither can you reasonably assume the opposite.

  2. Posted 30/08/2018 at 15:19 | Permalink

    Checked out the IEA website for the first time today, prompted by a BBC radio piece on banning energy drink sales to minors, with an IEA rep countering the proposal, then saw this piece!

    When it comes to “shaky foundations” perhaps these include your claim that “recent academic literature is clear”…because a parallel paper on the specific link that you yourself included unequivocally concludes “Having diabetes is associated with substantially higher lifetime medical expenditures despite being associated with reduced life expectancy”

    also check out

    You also, very rightly in my opinion, raise the informed consent issue, so would I be correct in assuming you’re a strong proponent of mandatory “traffic light” food/drink labelling, alongside complementary education on the health risks of sugar, saturated/trans fats etc??

    Very coincidentally, like you am a keen mountaineer, so intrigued to know what/how the wheeler dealing free market approach the IEA seems to promote to the world will actually help protect the rapidly dwindling cryosphere, beautiful mountain glaciers and icefields included.

    All best


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