The New Alcohol Guidelines: Paternalism or Just Good Advice?

By Ben Saunders, Associate Professor in Political Philosophy at University of Southampton (@DrBenSaunders, Academia.edu).


Beer

The UK government recently announced new guidelines on the consumption of alcohol, recommending no more than 14 units per week (for both men and women), adding that there should be some drink-free days each week, and stressing that there are no ‘safe’ levels of alcohol consumption. The guidelines also recommend complete abstinence during pregnancy – an issue that I won’t touch on here, though colleagues in Southampton’s Philosophy department have been conducting important research on pregnancy, including the demands made on pregnant women, with implications for this.

While some health campaigners have welcomed this move, others have described this as another instance of ‘nanny state’ interference, or hyperbolic and puritan, with Nigel Farage hitting the headlines for advocating mass protest. Amongst political theorists, such objections are usually expressed in the (still unfortunately gendered) language of ‘paternalism’. The objection is that to interfere with someone’s conduct for their own good is to treat them as a child, rather than to respect their autonomy.

Traditionally, paternalism has been something of a ‘dirty word’, though recently some political theorists have endorsed state paternalism, using ‘nudges’ or even coercion to promote the good of citizens. These discussions raise important issues about the legitimate role of the state, which cannot be satisfactorily addressed here. However, even for anti-paternalists, it is not clear that the government’s guidelines are objectionable.

One classic anti-paternalist argument comes in John Stuart Mill’s 1859 On Liberty. In this work, Mill defends what has come to be known as the ‘harm principle’ or ‘liberty principle’, according to which the only legitimate reason for state or society to restrict individual freedom is in order to prevent harm to others.

Mill does not, however, forbid all interference, but only coercive interference. He thinks the state has no business prohibiting alcohol, powerfully attacking the temperance movement of his time. He adds that no one should be punished for conduct that does not harm others. As I’ve argued elsewhere (eprints), it seems that he would reject minimum pricing measures for much the same reason: though not intended as a punishment, like a fine, such measures make certain choices more costly (and, unlike taxation, cannot be justified on grounds of necessity).

But Mill does permit state or society to seek to persuade others to mend their ways. It’s perfectly legitimate, in Mill’s view, to encourage someone to drink less, provided that one does so through rational argument, rather than by threatening her with punishment. Such measures, though not coercive, might still be considered paternalistic, since they involve an attempt to alter another’s conduct for her own benefit. Nonetheless, if this is paternalistic, then Mill is not opposed to all paternalism, but only the coercive kind.

In light of such considerations, it seems that the government’s latest guidelines are legitimate state action, since they merely offer advice and are not backed by any sanctions. In fact, there is more to be said than this; it is not merely that such guidelines are compatible with autonomy, they may even be necessary for it.

As I argue, in a forthcoming article, the traditional interpretation of Mill’s principle as relying on a self-regarding/other-regarding distinction does not adequately capture Mill’s real concerns. The principle would be better formulated in terms of preventing non-consensual harm, which in principle permits some interference with ‘self-regarding’ conduct. For example, Mill asserts that it would be permissible to temporarily prevent someone from crossing an unsafe bridge, in order to warn him of the danger. If the person is unaware of the risk, then he cannot consent to bear it; but once apprised of the risk then it should be up to him whether or not he is willing to take the chance.

Before I can make an informed decision as to whether the pleasures of alcohol are worth the associated health risks, I need to be aware of what those risks are. Consider, for a moment, a contrary case, in which people are unaware of the dangers. Suppose, in fact, that the government were to cover up evidence of health risks, perhaps because beholden to the alcohol industry or reliant upon tax revenues. In such a scenario, those who choose to consume alcohol, without knowing the dangers it poses, cannot be said to have voluntarily accepted the consequent risks, so they would suffer those harms involuntarily or, at least, non-voluntarily.

Mill insists that each of us should have the final authority to decide how to balance benefits and (risks of) harm in our own lives, but we can only do this when we are aware of the risks associated with choices, such as alcohol consumption. Thus, it is not simply that public education does not prevent people from making their own choices, but it actually facilitates rational choice. It seems that even an anti-paternalistic liberal, like Mill, ought to welcome government guidelines that inform people of the dangers of alcohol consumption.

There is, however, one possible ground to object to the latest government guidelines, since they do not simply impart information, but also recommend a particular consumption limit (14 units per week), even while stressing that no amount is ‘safe’. This recommendation was apparently reached by considering an acceptable level of risk, in lights of the risks involved in other regular activities, such as driving. Few activities, if any, are risk free.

However, it should be up to each of us to decide how much risk we are willing to accept. A set of guidelines more in keeping with Mill’s liberal principles might compare the risks of particular levels of consumption with a variety of other activities. For example, they might list other activities that are similarly risky to consuming 7, 14, 21, or 28 units per week. This will enable us to make a better informed choice about the risks of heavier drinking than the new guidelines, which seek to make the risk trade-off for us.

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