The ethics, limits, and politics of public health saving ourselves from ourselves
By Leigh E. Rich and Michael A. Ashby
The tension between a notion of the “common good” and individual liberty is one that political theory knows well. Indeed much of human political history is written around this central theme. In health matters, for example, we are now quite used to state regulation of products and practices that harm life or limb. The state, having a responsibility for the welfare of its citizens, has an accepted role—a duty, even—to mitigate exposure to harm, a sort of presumption in favor or even a casus belli in wars against public danger. The force majeure that justifies these regulations, including those associated with behavior and consumption, is the preservation of life itself and as such has found increasing support since the late 20th century in both the political process and the court of public opinion. Laws promoting smoking cessation and the use of seat belts or prohibiting drinking and driving and drug and alcohol abuse are all grounded in both common sense and scientific justifications that are hard to argue against. But as public health regulations have come into their own—turning from tobacco and alcohol to what we eat and how much—it is a reasonable necessity to ask where the limits of such state intervention and regulation might lie, lest excessive control infringe upon or even remove personal agency, risking both transgressions against autonomy and a Prohibition type of backlash that could undermine the public health impacts of well-intentioned policy. In other words, at what point should the state stop saving ourselves from ourselves? And what role does personal responsibility play—though we also must ask how much can be expected when structures in a capital-driven society purposefully seek to weaken self-efficacy (individuals’ confidence in their ability to enact and carry out healthful decisions) or obstruct agency (individuals’ actual capacity)? In societies where external loci of control are avidly sought when things go wrong, to what extent is it possible to experience personal misfortune without public liability? When is it “my responsibility” and when is it up to the government to restrict “my choices” as I cannot myself? [continued …] 
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Rich, Leigh E., and Michael A. Ashby. 2013. From personal misfortune to public liability: The ethics, limits, and politics of public health saving ourselves from ourselves. Journal of Bioethical Inquiry 10(1): 1–5.
