Philosophy 220

1. Philosophy 220 Focusing on Addiction Through a Haze of Cigarette Smoke: Goodin and Shapiro

2. Goodin on Paternalism and Rights • Project: “carve…out a substantial sphere of morally permissible paternalism” (199c1). • One obvious obstacle: Rights. If we think about rights primarily in terms of freedom of choice (à la Boaz) then paternalism is in conflict with rights. • If we think about rights as protected interests, then there is no necessary conflict.

3. Interests and Preferences • Clearly, not every understanding of interest is going to mollify the rights theorists. • Attempts to define interests ‘objectively’ and then use these definitions as grounds for paternalistic purposes is not going to be acceptable to many. • Linking the concept of interest to that of preference helps, because then an interest looks like a type of choice.

4. What about that Sphere? • The upshot of the link between interests and preferences is that the sphere of morally permissible paternalism is defined by reference to what people value. • “In paternalistically justifying some course of action on the grounds that it is in someone’s interest, I shall always been searching for some warrant in that person’s own value judgments for saying that it is in the person’s interest”(200c1). • It is important to recognize that it is certainly possible that a person’s actions or statements may not always be consistent with specific value judgments.

5. The Importance of Context • Goodin makes one more contribution to our understanding of morally permissible paternalism. • He insists that paternalism is only an option when the stakes are high. • Threat of serious harm. • Significant life-shaping potential.

6. Preferences and Paternalism • Review of preference-focused justifications for the employment of moral paternalism reveals that such employment is appropriate only when policy makers are correctly convinced that your preferences are: • Relevant • Settled • Preferred • Yours

7. Relevant Preferences • The general assumption is that people should be free to act on their preferences. • However, it is not always that case that specific preferences are relevant to a particular choice. • In the example of Ms. Cipollone (201), her preference for a particular brand of cigarettes based on the (false) belief that it was safer than other brands is irrelevant because it is false. • On the assumption that a relevant preference is desire for health and well-being, paternalistic prohibition could be morally acceptable, or at least minimally offensive.

8. Settled Preferences • Some preferences express long term commitments or considerations; others are more transitory, rooted in immediate circumstance. • Paternalism may be justified in a potential conflict between these two orders of preference. • Ms. Cipollone thought smoking was glamorous when she was young but this was not necessarily her settled position.

9. Preferred Preferences • We often rank our preferences in terms of our perception of their importance to us. • Not uncommonly, conflicts of preferences can emerge between preferences of different rank and typically we choose to satisfy the preference that ranks higher. • This approach can justify paternalism in the name of the higher ranked preferences. • Ms. Cipollone smoked while pregnant even though her preference for the health of her fetus was of a higher rank than her preference for smoking.

10. Your Preferences • Relying on something like the analysis of dispositional coercion we saw from Mapes (sexual morality), Goodin highlights that some preferences we have are not really ours, but are shaped by the will of others. • In these cases, paternalism may be justified to protect our own preferences from being trampled by those that come from elsewhere.

11. Smoking Policy • The practical implication of all of this is that a range of paternalistic limitations on tobacco use seem justifiable. • This is true from a consideration of the preferences (and thus interests) of smokers, even when a stated preference of theirs is to continue to smoke. • Of course, there are implications for the analysis of the moral status of paternalistic control of the use of other drugs.

12. Shapiro on Addiction and Criminalization • Shapiro links arguments like those of De Marneffe and Goodin in favor of prohibition of certain forms of drug markets or use to their acceptance of the standard model of addiction. • The pharmacological properties of drugs and their effects on the brain account for why some drugs are (highly) addictive. • Shapiro argues that the standard model fails and thus that the arguments based on it fail as well, before offering another model with different policy implications.

13. Problems with the Standard View • The central claim of the standard view is that the obsessive behavior displayed by the addict is ultimately to be accounted for in terms of the pharmacological effects of the drug. • Central concepts of this account include: cravings, tolerance, and withdrawal symptoms. • What kind of explanatory mechanism do these concepts provide? • Most drug users do not become addicts and many addicts do not consistently use (205c1).

14. Another View on Addiction • Shapiro advocates a competing view of addiction developed by Norman Zinberg. • Two concepts that it adds to the mix are “set” and “setting.” • Set: the mindset of the individual • Setting: social context of drug use. • A virtue of this approach is that it coheres with our common-sense conviction that explanations of human behavior are never simple causal claims; neither are accounts of human valuing.

15. Setting • Drug use in hospitals rarely leads to addiction. This suggests that quantity/dosage and duration of use are much less significant than setting. • Vietnam (206c2). • Alcohol and social control • Example of middle-class cocaine use (207c1).

16. Set • Foci of evaluation of set’s effects on drug use are expectations, personality and values. • Expectations: “interpretation of a drug’s effects depends on expectations” (207c2). • Personality and Values. Common sense predictions turn out to be most accurate. • Psychologically healthy people are likely to engage in controlled, moderate drug use (207c2). • Strongly motivated people make drug use a component of life, not the dominant factor (Ibid.).

17. Case Study: Cigarette Smoking • Why is it so hard to stop smoking cigarettes? • Pharmacology. • Setting. • Set. • Conclusion: arguments that criticize legalization on the basis of feared explosion of addiction are based on an inadequate theory of addiction; a more adequate theory undercuts this fear.