Paternalism: The Case of Joyce Brown

• Study notes on cases involving the ethical implications of paternalistic policies

Case 1: Civil Commitment of Joyce Brown (Failer)

• Joyce Brown, also known as Billie Boggs, was forcibly committed due to schizophrenia under NYC's Project HELP.
• Project HELP allowed authorities to hospitalize homeless individuals with mental illness, even against their will.
• The justification was Brown's inability to care for herself due to her mental state.
• This case highlights the conflict between individual autonomy and the state's duty to protect vulnerable individuals.

Is the Policy an Example of Justified Paternalism?

• Some argue it was justified under public health ethics and proxy consent due to Brown's inability to make rational decisions.
• Supporters cite Feinberg’s proxy consent, where the state acts on behalf of someone incapable of informed decisions.
• Others argue it was unjustified under Mill’s Harm Principle, as Brown was not directly harming others.
• Mill's Harm Principle asserts individuals should be free to make choices unless they harm others.

Ethical Standards for Assessment

• Mill’s Harm Principle (Against Commitment): People should have autonomy unless they directly endanger others.
• Brown was only harming herself, thus commitment was an overreach and unjustified paternalism
• Feinberg’s Proxy Consent & Public Health Ethics (For Commitment): State intervention is warranted when someone cannot act rationally.
• Failure to intervene might result in self-harm or public disorder.
• Paternalism could be justified if Brown's condition made her incapable of rational autonomy.

Final Verdict

• Paternalism was justified if she lacked the ability to make rational choices
• Paternalism was unjustified if she was aware and competent but simply chose a dangerous lifestyle

Case 2: Britney Spears’ Conservatorship (Farrow & Tolentino)

• Britney Spears was placed under a conservatorship in 2008, granting her father control over her finances, medical decisions, and personal life.
• The justification was her purported mental unfitness to manage her affairs.
• She earned millions while legally restricted from making her own decisions.
• The case prompts questions about the balance between protecting vulnerable individuals and respecting their autonomy.

Is the Policy an Example of Justified Paternalism?

• Initially justified under medical ethics and Feinberg’s proxy consent if Spears was truly mentally incapable of managing her affairs.
• This temporary conservatorship could protect her from harm.
• Over time became unjustified under Mill’s Harm Principle as Spears demonstrated competence.
• Restricting a competent adult’s autonomy violates Mill’s principle that individuals should have control over their lives.

Ethical Standards for Assessment

• Feinberg’s Proxy Consent (Initially Justified): Proxy consent by her father was possibly justified if Spears was mentally unstable
• Proxy consent should be temporary and reevaluated.
• Mill’s Harm Principle (Unjustified in the Long Term): Continued conservatorship violated her right to self-governance if Spears was competent.
• The financial and legal control exerted over her exceeded what was necessary for protection.

Final Verdict

• Initially justified paternalism due to mental health concerns.
• Unjustified paternalism as Spears recovered but remained under strict legal control.

Case 3: Tennessee SB1 – Ban on Gender-Affirming Care for Minors (Skrmetti v. JW)

• Tennessee’s SB1 law prohibits minors from receiving gender-affirming medical care.
• The justification is minors cannot fully consent to treatments and long-term effects remain uncertain.
• This case presents a conflict between parental rights, individual autonomy, and state intervention.

Is the Policy an Example of Justified Paternalism?

• Justified if minors lack capacity to consent, with states acting on behalf of children’s future well-being
• Unjustified because it restricts individual and parental autonomy.
• Mill’s Harm Principle: Banning gender-affirming care causes harm if medical consensus supports it.
• Medical Ethics: Every major U.S. medical organization supports access.
• Feinberg’s Consent: Older adolescents can understand and consent to treatment.

Ethical Standards for Assessment

• Feinberg’s Proxy Consent (For Ban): The state may intervene if minors cannot fully understand medical risks.
• This argument weakens for older adolescents who can make informed decisions.
• Mill’s Harm Principle & Medical Ethics (Against Ban): Banning medically supported care increases harm (mental health risks, suicide rates).
• Mill would argue individuals (or parents, in the case of minors) should make these choices—not the state.

Final Verdict

• Unjustified paternalism: The law blocks access to medical care supported by professionals and interferes with personal and parental rights.

Case 4: Mozert v. Hawkins – Parental Censorship of Curriculum (Stankiewicz)

• Parents in Hawkins County, TN, objected to reading materials in public schools based on religious beliefs.
• They sought to remove books or exempt their children, limiting exposure to diverse ideas.
• This case examines the balance between parental rights and the state's interest in providing comprehensive education.

Is the Policy an Example of Justified Paternalism?

• Justified if parents have ultimate control over their children’s education, deciding what values they learn.
• Gutmann’s democratic education model acknowledges parental input in schools.
• Unjustified because it limits children’s exposure to knowledge.
• Mill’s Free Speech & Education: Exposure to diverse ideas is essential for democracy.
• Gutmann’s Ethics: Schools should educate for democratic participation, not cater to every parental objection.

Ethical Standards for Assessment

• Gutmann’s Democratic Education (Against Parental Censorship): Schools must prepare students for democratic life, not shield them from ideas.
• Parents cannot suppress public education for all students based on personal beliefs.
• Mill’s Free Expression (Against Censorship): Education should expose children to competing viewpoints.
• Shielding students from knowledge limits their intellectual autonomy.

Final Verdict

• Unjustified paternalism: Parents cannot restrict public education based on personal beliefs.

Overall Takeaways on Justified vs. Unjustified Paternalism

• Examples of justified paternalism (sometimes):
  • Joyce Brown’s commitment (if she lacked rational capacity).
  • Temporary conservatorship for Spears (if she was mentally unwell).
• Examples of unjustified paternalism:
• Extended conservatorship of Spears (when she was competent).
• SB1’s ban on gender-affirming care (interferes with autonomy).
• Parental censorship in education (Mozert v. Hawkins) (limits free thought).