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Am J Public Health. 2008 Jan;98(1):15-21. Epub 2007 Nov 29.

Autonomy, paternalism, and justice: ethical priorities in public health.

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School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA 01003, USA.


With attention to the field of public health ethics growing, significant time has been devoted to identifying a sound ethical justification for paternalistic interventions that override individual autonomy to prevent people from adopting unhealthy behaviors. Efforts focused on specifying the conditions that warrant paternalism, however, are largely misplaced. On empirical and ethical grounds, public health should seek instead to expand individual autonomy to improve population health. To promote autonomy, the field should redirect current efforts toward clarifying principles of justice. Although public health's most highly visible stance is associated with an egalitarian conception of "social justice," it is imperative that public health professionals address gaping divisions in public understandings of justice. I present recommendations for initiating this process.

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