PubMed1989
Paternalism is one of the most problematic ethical issues in public health promotion. In the article an attempt is made to elucidate the matter by examining the theoretical characteristics of paternalistic attitudes and action on the one hand, and actual Finnish anti-smoking policies on the other. The attitudes adopted by Finnish health authorities toward smoking are strongly paternalistic, i.e. based on the idea that the general public is not to be relied on in assessing the health risks of tobacco use. Surprisingly, however, the actual governmental anti-smoking measures in Finland cannot be truthfully described as overtly constraining. Since paternalism implies restrictions on personal freedom for the individual's own good, many branches of smoking control fall outside its proper scope: for instance, restrictions on smoking in public premises can almost always be justified by referring to the harm inflicted by smokers on the other people. But most of the Finnish governmental anti-smoking measures which can be classified as paternalistic are also justifiable. Some of them concern minors only or mainly minors, and thus can be defended as instances of authorities' parental concern for our children. Some are freedom-restricting but only in a weak sense and are based on the idea of informing people about the dangers of smoking, while leaving the final decision up to them. In the last analysis, there is but one regulation that meets the criteria of wrongful paternalism, and that one, the ban on strong tobacco brands, may not be important enough, in practice, to raise major ethical controversies.