Fat, freedom and less advantaged citizens

If freedom is to be understood ‘negatively’ as the absence of external interference, we can think about distributive or social justice in terms of answering the following question: in which  circumstances is it permissible to limit some people’s freedom for others’ benefit?

Does justice require that we tax people to provide education for those who, otherwise, would go un-schooled? Is justice compatible with limiting people’s sexual freedoms because others think their practices intrinsically bad?

The answers to these questions are (in turn) yes and no. But where is the dividing line? Let’s start by looking at ‘lifestyle’ health problems caused by alcohol, food, and tobacco.

In the attempt to reduce costs and prioritize spending, lifestyle illnesses attract obvious attention; they seem avoidable and are expensive. For instance, under new UK NHS guidelines if all those eligible opted for weight-loss surgery, the cost would be £12billion. Alcohol use is ranked as the 6th highest disease risk factor.

One possible remedy is to refuse free treatment for lifestyle illnesses. But, while this would reduce costs, it may not affect the numbers. We are not fully-rational and we can be weak-willed or, as Aristotle put it, ‘incontinent‘. How many glasses of wine did you have over Christmas and how many do you wish you’d had?

Another solution is to ban the offending items. Some think this is the best approach to tobacco and others recommend it for fatty foods. But bans limit people’s freedom.

One response might be that bans don’t work anyway – witness prohibition. But this is too quick. Some bans do work – smoking bans in public places work. We should also differentiate between two separate questions.

‘Would a ban be morally permissible or desirable?’ is the philosophically interesting question. ‘If a ban were morally permissible or desirable, would it work?’ is a wholly different question.

You might think that if we know that a ban would not work we can ignore the philosophical question. But, as noted, some bans do work. Equally, if any ban were morally impermissible whether it would work or not is irrelevant. If we want to save effort, it may be best to focus on the philosophical question.

In which circumstances it is permissible to limit people’s freedom?

Here are two general claims which apply to lifestyle problems:

Greater freedom claim: greater freedom of choice only benefits individuals whose capacities are sufficiently developed so that they use those choices sufficiently wisely, i.e., without harming themselves. Examples of harm include addiction, ill health, gambling debts etc.

Crooked timber claim*: Modern societies will always include a non-trivial number of weak-willed people (possibly a large minority).

You might think that the greater freedom and crooked timber claims are false. But we will stipulate that they are true and see what follows.

If the two claims are true then, whenever we expand the range of people’s choices, we can predict that some people will develop addictions, have poorer health etc., who otherwise would not. These problems may be expensive to treat and will reduce the sufferers’ well-being.

You might think that free choice is so important that we cannot justify limiting it. Your freedoms are rights, and as Ronald Dworkin states, rights ‘trump‘ other goods. But is this correct? If freedom is the absence of external interference, it is clearly not the only valuable thing. Only hermits prioritize being left alone over everything else.

More generally, for any liberal who thinks that social justice requires that the interests of poorer or less able citizens should receive some kind of priority, the greater freedom and crooked timber claims are worrying.

One common response is that we should adopt policies that make the crooked timber claim false. We should educate people so that their wills are not weak and so that they make choices that don’t have damaging and expensive effects.

The philosophical response here is to stipulate some more. Let’s imagine that we know of no effective way of making the crooked timber claim false.

Alternatively, the practically-minded person might appeal to some evidence. In the UK a lot of money has been spent on education for a decently long period of time. But lifestyle problems seem to be getting worse. Death rates from liver disease have increased 400% since 1970.

What if we cannot stiffen people’s wills through education?

If the interests of poorer or less able citizens should receive some kind of priority, we may have to countenance limiting everyone’s freedom. The loss of freedom to able or ‘continent’ citizens (Aristotle again) might be off-set by the benefits to less able citizens.

These limits would never go as far as limiting anyone’s sexual freedoms but they may be very annoying. One of my favourite examples is the degree to which cash machines can make life harder for people who struggle with their finances.

When you could only access cash by speaking to a bank-cashier, over-spending required returning to the bank and asking a real person – who might know you and your finances well – for more money. Now it can be done without any human interaction.

Should we only allow people to withdraw money from a cash machine once a week? (If anyone needs more money they can speak to a cashier.) Inevitably, this would be tiresome for many people. But, if it helps the weak-willed, would limiting people’s freedom in this way be unjust? To put it another way, is this a case in which it is permissible to limit some people’s freedom for others’ benefit?

Frankly, I don’t know. But if the choice were between no help for the weak-willed and banning everyone from, say, crisps, over-use of cash machines, or fizzy drinks, there is a case for a ban. Whether, on any particular occasion, a ban would work is a question for another day.

* This is a translation of part a quote from Immanuel Kant. See.

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