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Welcome to, rationally speaking, the podcast, where we explore the borderlands between reason and nonsense. I'm your host, Julia Gillard. And with me today is Professor Jessica Flanagan. Jessica is an assistant professor at the University of Richmond, where her work focuses on applied ethics and normative ethics. And she's recently published a book titled Pharmaceutical Freedom Why Patients Have a Right to Self Medicate. That's the argument that we're going to be talking about today. Jessica, welcome to the show.

Thank you for having me. So patients having the right to self medicate is basically the idea that if patients want to take pharmaceuticals for some medical condition, they should be able to do that without getting permission from a doctor in the form of a prescription. And when I first encountered your argument, just like the topic, sentence, version of your argument, I sort of assumed that you were going to be saying the version of it that I've heard before, which is basically patients should have this right because people have the right to autonomy.

And even if they make decisions that are bad for them or it make them worse off, that's still trumped by the fact that they should be able to make decisions about their own body. And that argument is somewhat interesting, but it's not that interesting to me because you kind of have to buy into the premise that autonomy is this fundamental right that trumps people's welfare. And if you don't buy into that, then it's kind of a non-starter. But then as I kept reading your essays on the topic, I noticed you were saying something much more interesting than that.

You were saying that the right to self medicate doesn't depend on sort of accepting these fundamental values around autonomy.

It's actually something that follows logically from other rights that we have already granted patients as a society and sort of the field of medical ethics, namely the fact that patients have the right to refuse treatment and that they have to give their informed consent before doctors can treat them.

That kind of logically implies that they also should have the right to self medicate. Right. So of a very interesting form of the argument. So would you mind just, you know, laying out the basic case, maybe start with what is the right to refuse treatment? What does that entail? And then how does that imply that patients should have the right to self medicate?

Yeah, that's a great summary. So the right to refuse treatment is something that we all take for granted nowadays in medical ethics. But it wasn't always something that was taken for granted, emerged legally as legally protected and widely accepted throughout the 20th century. And so today, when you go to the doctor's office in a clinical context, you have the right to make an informed decision about your own care, even if your doctor disagrees with you. So your doctor may, for example, recommend a treatment and say if you refuse this treatment, you'll have really bad medical consequences.

If you refuse a blood transfusion, for example, bad outcomes. Nevertheless, you would be within your rights to say, I understand that I have bad medical outcomes, but nevertheless, I'm going to refuse the blood transfusion. And there's different justifications for why we grant patients the right to refusal and why we see it as a kind of moral progress that patients now have the entitlement to refuse even medically advisable treatment. So, like one justification for letting patients refuse nowadays is that it'll have better medical outcomes, even though the thing that the thing that refusal rates entitle people to do is to refuse treatment when they disagree with the medical expert.

Nevertheless, having as an institutional role, the right of refusal promotes a better doctor patient relationship, more trust between doctors and patients so medical outcomes could be promoted. But also just health should be just about medical outcomes. It could have good consequences on balance to let patients refuse, because even though the doctor might be the expert about what's good for a patient's health, the patient is the expert about what's good for her life as a whole. So what's the case?

And which what's best for someone's health might not be what's best for them more broadly. Right. So, like, think about the example I gave earlier about refusing a blood transfusion. Some people have religious commitments. So it's not that their view is that blood transfusions are bad for your health when medically indicated they're not denying the medical outcomes favor a blood transfusion, but they deny that a blood transfusion would be in their interest as a whole because they conceive of their overall interest as being living in accordance with their religion and not necessarily doing the thing that promotes health on balance.

And a doctor will be the expert about. Health plausibly, but the religious patients, the expert about how health and religion weigh against each other in her life as a whole and the judgment about whether or not it's in a patient's overall, all things considered, interest to make her a feasible decision. If you think that that should just be informed by whoever the expert is, therefore, we have a reason to think that the patient is generally going to be the expert, because the relevant thing in question is not what's good for health, but what's good for a person's life.

And also that there's a third thing, which is, of course, we all know people who aren't necessarily the best decision makers in their lifestyle also. And we could think about cases like that in medicine. So you could imagine a person who's refusing lifesaving therapy that will be effective for misguided reasons or you try to convince her. But she's not persuaded. And it really is the case that a refusal decision, for example, like refusing chemotherapy will on balance mean that she has like less well being or that her interests are frustrated over the course of her life or that she doesn't live as long as she could have.

Even then, it still is for the autonomy reasons that you cited earlier, wrong to force people to undergo medical treatment when they don't consent to it. Yeah. So there's kind of three different reasons that you have a right to refuse grape.

And maybe before you answer the rest of the first question that I posed to you, maybe you could just tell us a little bit about how did this increasing respect for patient's right to refusal and I guess increasing respect for patient's autonomy? How did that happen over time? Was there some impetus or was it just like a very gradual societal values shifting around this?

It was gradual in a way, over the course of the 20th century. So medical battery wasn't considered like illegal or morally wrong. What is medical battery like performing treatment on a person in a way that they didn't consent to on a person's body? So the good doctor of informed consent has two parts. One is like you can't just do stuff with people's body if they didn't say it was OK. And then another is that you also have to tell them they have to be informed.

So it sort of includes rights against force, but then also rights against deception. And people didn't really have either of those rights on the table before 1914, at least not legally protected. And there was this woman named Mary Schodorf, who was undergoing an examination under ether, and she previously had said, I don't consent to any kind of surgery. But then her physician did a hysterectomy. This was in nineteen thirteen. So then she woke up, found out that the surgery had been performed on her, suffered a series of complications related to the surgery and sued.

And that's sort of the landmark case and kind of getting informed consent rights on the table for patients. And that was 19 14. Nevertheless, it was slow going and it wasn't widely accepted in medicine even a generation ago. So like in nineteen sixty seven, they did a surgery survey of oncologists and 90 percent of oncologists in the late sixties said that their usual practice was to just not tell people that they had cancer if they thought that finding out that they had cancer or would have been bad for them.

Wow. So that's pretty recent. That's, you know, within some people's memory. And so, yeah, in 40 years, the practice of medicine has really radically changed to recognize that in clinical context, patients have the authority to make these intimate personal decisions about their bodies. Great, so then returning to the second part of the question that I'd ask you, how does this how do those reasons that you cited for giving patients the right to refusal and the right to informed consent, how do those imply that we should also, in your view, give patients the right to self medicate?

So I use this thought experiment like imagine two patients, Debbie and Danny, Debbie has diabetes and her doctor is like, you know, like you should definitely start insulin treatment. And Debbie understands the risk of refusing insulin, but she's also, like, not willing to live by a schedule. She thinks it's not her overall interest to have to monitor medication all the time. So she's and she knows herself and she's like, you know what? I hear what you're saying, but I'm just going to give it a shot without insulin and I'm just going to try diet and exercise.

That's within Debbie's rights. Now, imagine the same patient, the same condition, diabetes, the different patient, Danny. He has diabetes. And his doctors like, you know what, for now, let's try a diet and exercise. And Danny's like, you know what, Doc? Like, I know myself and it's like, I'm not going to do it. I'm investing time and energy in that. And I'm also really worried about what's going to happen if I fail at this.

I just want to go straight to medication. Now, there's nothing intrinsic about the risks of access versus refusal. That means that a patient would be well qualified to make a refusal based decision against medical advice such that we would grant for that entitlement, but not well qualified to make an access based decision about her treatment in the same way or his or her treatment. And there's also nothing about people making decisions about their own bodies. That means that they would have rights against being coercively prevented from making their own decision in the refusal context, but not have rights against encountering legal threats or penalties in the access based case.

You might think there's kind of an asymmetry because it feels different to be refusing versus wanting to have access. So there's like a case that sort of brings out the point that, like having access to a treatment is also a right against interference. So take, for example, reproductive choice. So if women have rights to contraception or rights to abortion, a law that made it so that they were legally prohibited from having effective access to those types of choices would be an interference with their ability to make a decision about their body, even though it's an interference with other people's ability to provide an access to the necessary means to make those decisions about their bodies.

It's still in prohibiting people from providing effective access to a treatment decision that's still a form of interference with a person's ability to make that treatment decision. So you you did sort of put your finger on the part of this argument that had been where I have the most hesitation, which is the sort of the idea that there's the symmetry. And and I I think I would have framed the symmetry slightly different than you did. I would have said that that there is well, at least two different kinds of thing that we mean by autonomy, where one is the right to do things that we want to do to our bodies, and the other is the right to not have other people do things to our bodies that don't want them to do.

And it seems so. And the latter is the thing that the right to refusal is designed to protect. And it seems to me that we as a society, sort of people's moral intuitions in general, put more importance on the latter, kind of in the same way that like I mean, this isn't the same dichotomy, but it feels kind of analogous, the same way our sort of folk moral intuitions put more importance on or there's more of a prohibition against causing harm than there is against failing to prevent harm.

So we would judge someone more harshly if they killed someone as opposed to if they simply failed to stop a murder from happening. And you could certainly argue that there is no logical reason to prioritize one over the other, sort of from a pure consequentialist basis. Someone dies either way. But nevertheless, if if our project here is to say, look, the moral sort of rules and norms that we as a society have already accepted imply a right to self medicate, then the fact that our moral intuitions feel this asymmetry between these two different kinds of autonomy, between the right to do things to our body and the right to not have other people do things to our body.

That asymmetry, if it exists, whether or not we think it's justified, seems relevant. Does that make sense? Yeah. So there is there's two things. The first is you're saying like, well, it seems like there's a difference between the right to do something versus the right to not have other people interfere with you. And I do think that there is a relevant moral distinction between causing harm and interfering with people versus allowing harm to happen. And I think that's a very fundamental part of morality.

So denying the kind of thing that some consequentialist will say, OK, but I think that legal restrictions that prevent patients from accessing the necessary means to their treatment are themselves a form of interference. We just don't see it as much. So people think that their refusal case, it's very vivid if somebody disrespects your right to refuse treatment because it consists of force against the person cutting open someone's body and taking out organs or something like that, or tricking a person like lying to them, that's a form of interference as well.

But threats of force are also a form of interference and the legal penalties that people face if they provide access or if they access the drug illegally treatment illegally. Those are also a form of interference against a person. So if I want to interfere with you, I could lie to you. I could force you to I could use force against you physically restraining you or I could threaten you. And the policies that I'm talking about are backed by coercive threats.

So they are coercive. Sounds like the first order. So maybe the the disagreement here, the difference between our views on this policy is contained in the word interference. Like it feels a little bit like you're sort of lumping together some things that feel very different to me under the same word of interference where like preventing people from doing things that they want to do counts as a form of interference, but so does, you know, physically mutilating someone against their will.

And I would like classed the latter as being very different violation of autonomy than the former and wouldn't classify them both as interference.

Why do you think that those are different? So, like, if I threatened somebody with, like violence or imprisonment or like I use it's a threat that's backed by physical force to get them to do something. I agree that that's in some ways different from physical force. But effectively, it seems like it is definitely a form of interference. And if the person doesn't comply and then they're subjected to other kinds of penalties, I mean, you could think that it's a justified use of force with legal penalties.

But that's just the thing. That's a question. But whether it is for us or not is different than whether it's justified or not. So to make sure I understand your argument, you're you're acknowledging that people do see those forms of interference as different and and that they. Placed more importance on laws to protect people from the sort of core physical interference than they do from the legal interference. Right. But you're saying that sort of that distinction isn't really justified.

And if people paid attention to the the logical structure of the two, they would realize that their moral intuitions also should similarly forbid the kind of legal interference for people to do things to their own body. Is that yeah, I mean, my thought is say that you think that interference because you're saying like, well, what do you mean by your parents say that you think that interference just is a violation or a presumptive violation of somebody's authority to make choices about their own body or make choices that they have a right to make legal penalties presumptively also would violate that.

I mean, it could be justified. So there are some legal penalties that interfere with your ability to make your own choices, but it's justified. So, like things that say like, oh, you can't push people or you can't hurt people or something that would interfere with my autonomy to hurt people, but it would be a justified law. But whether or not it's interference, definitely like that doesn't settle the separate question of whether it's justified. But what I'm saying then is these laws do interfere with people's choice.

And since we already think that that range of choices ought to be legally protected in this context, I notice that since we reject this kind of interference, that range of choices, the kind of interference from physicians, for example, then you should reject also legal interference with that range of choices, interference by public officials, and the same reasons that we support rights of informed consent and we reject interference by physicians, the medical outcomes, epistemic outcomes, the violations of autonomy, your health, your well-being and your rights.

Those same reasons that we think that there shouldn't be interference by doctors and medical choices are also reasons to think there shouldn't be interference by public officials. So I see that people are much more accepting of interference by public officials than they are of doctors. But they didn't used to be accepting of interference by professionals in that. I know of public officials in the past, people thought that rates of self medication were a thing and they didn't accept interference by public officials.

And they did think that it was OK for doctors to interfere in these clinical contexts. And so so you're pointing to the idea that our intuitions are more malleable than we might think that they are because they have shifted over time. Right.

And this is like my second point when you were like, well, we as a society think X, but not life. I was like to say that we as a society, like I don't even know first, like I don't know who that would be, but like the kind of the being social value, whatever that is, that shifts over time. And it, I would hope, should be informed by the force of argument. So like one thing that the argument that I'm presenting, I should say, is like, look, there's this inconsistency and how we're approaching medical choices.

We should change our mind. We could change it one of two ways. We could ditch medical autonomy in the clinical context and be like, oh, I guess I don't care that much about informed consent after all. Or you could reject paternalism and affirm medical autonomy in the public health context, which is what I favor. And I think that is the wrong way to go to say to resolve the asymmetry by abandoning informed consent, we should reject the paternalistic policies instead.

So to take a somewhat different tack. Now, we've been talking about the third reason of the three reasons you cited that that underlie this right to refusal and that's autonomy. But the first two were sort of they were empirical. They were reasons to think that we end up with better outcomes. Patients end up with better welfare if they have the right to refusal, both because of the better relationship it promotes between patients and their doctors, and also because it allows people to choose things that are actually better for themselves because they're the best judge of that.

So I'm wondering maybe the differing intuition between the case of right to refuse treatment and the case of right to self medicate? Maybe the difference in intuition is because I or other people who don't already agree with you. Suspect that the consequences, the empirical consequences of a right to self medicate will be large enough that they kind of outweigh the autonomy consideration that like patients will end up making bad enough decisions for themselves, that it's sort of the benefits of autonomy are outweighed by that.

So maybe you could talk a little bit about what you estimate empirically, the consequences to be to welfare of a right to self medicate. Yeah, so so I'm not a social scientist, so I'm not, like, out there like doing my own studies of the impacts of some medication.

You could also just talk about, like, how bad the consequences would have to be for you to no longer support the right to self medicate. Like, I don't know if we thought that 90 percent of patients would end up taking drugs that would kill themselves unintentionally, like, that's a very extreme case. But just to sort of lay out the spectrum would be autonomy considerations still dominates even then, etc.. I mean, you can you can give evidence that you know of about the actual empirics if you want, but I think this is the main thing that I'm interested in.

Yeah. So first of all, talk about the Express Act, which is that there's not a lot of research on the effects of these policies, that it's hard to get a good research design. It's like, oh, I randomly assigned you to a party system, but there is some research and the research is not what you would think. And so people think like, oh, if we didn't have prescription requirements, people would accidentally overdose all the time.

But there is some evidence from the 70s that middle income countries in Europe that didn't enforce prescription requirements actually had lower rates of accidental poisoning because people made riskier choices. If they thought that their self medication choices were authorized by a physician, they're more likely to make risky choices around drugs. And I think the evidence is stronger when it comes to the approval process, which we haven't talked about as much with self medication. But the right to use unapproved drugs, drugs that are still awaiting approval because the approval process kills people in two ways, kills people because it forces them to wait for a potentially life saving drug.

So people die because the law prohibits of accessing something that could potentially help them. And it also has a bad effect of discouraging innovations. Others, by raising the cost of developing a new drug for new drugs, get developed. And that also leads to a loss of life. So I do think that the consequences of respecting right to self medication might be surprising to people. That said, like, I'm not as confident in the empirical arguments as I am in the more kind of deontological arguments, because it's contingent like we could imagine a world where it went the other way.

And then you're kind of saying like, well, if we did imagine that world, would you change your mind? And I. What it as much, because I think that rights should take priority over consequences, and so you mentioned at the beginning that you're not like a sort of. Autonomy first. Person with your moral theory, and I guess I'm not a I'm not an autonomy only.

Yeah, I think that well-being matters, that I think that the promotion of another person's well-being is constrained by their rights. So I think that people have the right to make decisions that are bad for their own welfare.

Now, we could talk a little bit about externalities, maybe like if people make decisions that are bad for other people's welfare, they don't necessarily have a right to that like like people taking antibiotics when they aren't actually necessary and that creating strains of antibiotic resistant bacteria, for example.

Exactly. So I do not think that people have a right to use antibiotics. That's one of the few cases of self medication, which I don't think that people have rights to because of these negative externalities. But I also think that's true in refusal cases. So I don't think that people have rights to refuse certain vaccines under certain cases as well, because I think that being unvaccinated is in some cases tantamount to baptizing yourself. So it's similar to you have a right to own a gun.

That might be fine. I have rights of my God, but I don't have a right to shoot it in the Fourth of July where I could expose somebody to a risk of significant harm. I right to make decisions about my body. That's fine and generally have discretion or a body. I don't have the right to shoot measles into the air, though. Right.

And actually, now that you mention it, we do already forcibly quarantine people sometimes if they have a contagious illness and we have no other options, right? That's right.

And so I don't think that bodily rights are so strong that they entitle people to expose other people to an undue risk of harm that would violate their rights. So there are limits. But that's and that's also true for antibiotics. Bazoft medication case. Yeah. Are there any other costs that you think or harms that you think would result from a right to self medicate? Other than the obvious one of some patients taking drugs that are, you know, bad for them that they wouldn't have taken under the current system?

Because people talk about social costs like cost to the health care system. If people hurt their health, if people damage their health in some way, that that imposes costs on other people because other people are going to have to bear the costs of paying for their health care.

Yeah, that's like a standard a standard way to justify paternalism about health across all dimensions, like taxes on sodas and etc..

Yeah, I think if you scratch the surface of that argument, though, it it doesn't hold up on whatever conception you have of what we're doing with bearing the cost of health care. So some people say, well, we would all have a moral obligation to provide people with health care. But if you make a bunch of risky decisions and damage your health, then we're going to have a moral obligation to provide you with even more. But if I have the moral obligation to provide you with health care that isn't silenced in any way, necessarily by you requiring more.

Right. If I have a duty to care for the sick, the sick are preemptively liable to be interfered with or have their rights limited just because they're going to subsequently exercise their right.

I guess the word requires doing a lot of work there. Like you can say, they don't require more. They're choosing to take on more because they're choosing to eat a lot of saturated fat or something like that. And actually, I think probably my example of a soda tax was a bad example of paternalism, because that is a tax is kind of a way of internalizing the externalities of making it so that people can choose to to worsen their health if they want to, and they're just paying it for themselves.

So paternalism would be more like banning sodas or something like that.

I think that the tax is paternalistic. OK, but I see that that yeah, that's a that's a more controversial case. So like a clearer case would be like a ban on something. So you can't buy heroin at Walgreens that's paternalistic. And then people will say like, oh, but if we let people buy heroin at Walgreens, then they have bad health effects. We have to pay for it. And I think if somebody has a right to something, they can't be made preemptively liable to be interfered with or have their other freedoms limited in virtue of the fact that they're going to subsequently exercise that right.

Or we can't limit how they exercise their bodily choices just because we're going to have to pay for it down the line. If we have a standing general obligation to pay for people who are sick, you might think like we don't have that obligation. Health care is just something that it's beneficent we provided or that you provide by consent. There's no duty to provide health care for people. If that's the case, then you could just not provide it to people who you think have acted in a way that makes it so that they are responsible for their negative health outcomes.

I don't think that that's a good way to go. I think it's kind of expressively bad to send that signal towards people, but. I don't think that you can say to a person, oh, in virtue of the fact that we don't like your choices, we're not complied with health care unless you told them in advance that that was what was going to happen, in which case maybe they would waive right to health care. But whether you think health care is a right or not.

Either way, whatever justification you have for providing people of health care, that's not those two justifications aren't going to justify paternalistic limits on people's choices on the grounds that their choices are going to have social costs. So it sounds from the way I'm understanding your argument, it sounds like you're pointing at the right to refusal laws as you're pointing to the logic behind those laws as also applying to any kind of thing that people might want to do to their bodies and that in your in your paper and I assume in your book, although I haven't actually read the book yet, just your papers on the subject, in your paper, you're focusing explicitly on the right to self medicate.

But it sounds like the exact same logic would apply to the right to take illegal drugs or the right to, I don't know, not wear a seatbelt or like is there any distinction between the right to self medicate and all of these other rights to take risks with your body that you think your argument applies more to one than the other? And if not, why did you just focus on the right to self medicate? I think that self medication has a clear parallel with informed consent, and I think informed consent is something that a lot of people already accept.

So that's a good foundation to build an argument against paternalism with respect to drug policy. And so self medication includes things like the right to die, the right to use recreational drugs in addition to investigational drugs and prescription drugs. But that's nice because there's an asymmetry, because it's we're just talking about health oriented drug choices when it comes to access and refusal.

And so if you can make that case, then that's sort of a good kind of thin end of the wedge to push to push a more general argument against paternalism in other contexts. I don't think that there's that symmetry. So it's not like, oh, you believe in informed consent. You shouldn't believe in seatbelt laws. I have other arguments against seatbelt mandates which are similar in structure, in that they are built on a kind of pluralistic moral foundation where it's about both the consequences of the laws and also the rights violations of the laws entail.

But they don't kind of appeal to this initial symmetry between refusal prices and access choices. However, more generally, I do think that my argument is strategy for all of these cases is one of ethical standards. So I think that there's like a lot of double standards and justifications for public health paternalism and public policy more generally, where we hold public officials for laws to lower moral standards than we would hold people to in private contexts. And I think that that's a general theme.

So so I think that sometimes people will say things about public officials where they are saying, look, I wouldn't be able to treat a person in that way, you know, so if I found out that my neighbor was growing some plant that I didn't like, I wouldn't be able to go to my neighbor's house. Like, I don't like that you're growing that plant. Stop it. And you certainly can't sell that plan to other people or on fire.

And what plant could you possibly be talking about?

But if a public official thinks that, yeah, they will have to ban marijuana and people from growing marijuana in their own homes than they're permitted to. And you can have lots of arguments for why public officials have the moral authority to do it in certain cases. But I don't think that we often go through those arguments. I think that sometimes there's a law and people just think like, well, I guess we as a society think that that's OK because it's a law.

But we should question the law by the same kinds of standards of moral reasoning and justification that we hold our own conduct to a law could be just or unjust. A public official could be doing the right thing or doing the wrong thing. And we shouldn't think that just because something is a law that it's getting it right. Morally, I think we have a lot of status quo bias when it comes to just accepting our current system of law. But then, I mean, you're familiar with this.

I don't know if there's this nice juristic, which is the universal test, where people are very accepting of existing policies or existing state of affairs, but then they oppose any kind of change.

So or they have to they require the change to justify itself very strongly. That's right. That's right. They have a they have an initial reluctance to accept any kind of change. So the example that's given by the people who wrote the paper on their first test, they foster Matoba or it's like speed limits, like, oh, like the law that says sixty five miles per hour, that's a really good law. We shouldn't go up to eighty five miles an hour.

And it's like, oh well if you just switch your perspective and you think like, well if you think that adding 20 miles per hour to speed limit would be bad, maybe we should subtract 20 miles per hour from the speed limit in the other direction and go from sixty five to forty five. But no, no, that would be a horrible policy change. So does illustrate that we sort of accept the laws that we have as being optimal, even from a consequentialist standpoint, not even just from a moral standpoint more generally, but having optimal consequences.

But why should we accept that? So you think like, OK, like the drug laws we have right now, like we shouldn't legalize all of the recreational drugs because that would just be like chaos. You might go like, OK, here are some other drugs that cause a lot of social harm, like alcohol, like, oh, we tried that before. That was terrible. But why would we think that, like, right now we're at the optimum when it comes to the justice of our laws.

In our correspondents before the show, you mentioned that when one is building a case, an argument in applied ethics, it's you think it's fine or or good to appeal to multiple different kinds of reasons. I think the way you've done in your case, for the right to self medication, you've appealed to the right to autonomy. You've also appealed to positive empirical consequences. And you in our preshow correspondence, you said even if those reasons are internally inconsistent, you think that's still a justifiable way to argue?

I'd be curious to to hear more about that.

I'm not saying that to say I don't have my own view about what the right underlying moral theory is or what the right balance or moral reasons would be. But I don't think that when you're doing applied ethics, it's a promising approach to start off and be like, OK, premise one, utilitarianism is true. Premise to this is what's going to maximize utility conclusion. We should just do it, because if I don't accept the first premise, then your argument isn't going to in any way raise the price of my own beliefs.

And so I see philosophy in general, including applied ethics as being, yes, you want to convince people, but you also just want to engage with them where they are in a way that will raise the price of their beliefs. So even if they don't, when you say the price of their beliefs, what do you mean? Like the make it so that they understand what holding their belief is would require them to commit to more generally on it.

So I think it's very easy for people to just not question necessarily what their cluster of constellation of beliefs is. And every belief is going to have drawbacks. And so when you're doing applied ethics, like it'd be great if people were like, oh, totally sold of self medication, I'm on board. And so, like, that's like my first order thought is like that would be the best. But I also think, like, if you are going to disagree with my conclusion, notice that disagreeing with this conclusion also has a bunch of entitlements and commitments that would require much further defense.

And those are undefended, I think. And so I think that when you're doing applied ethics, you always have those two goals in mind. So the first goal is to advance an argument for your thesis, which is what you think is the correct thesis. And then the second goal is, well, if you're not going to be able to of this as at least let me show you the terrain, the argument of terrain and show what must be done in order to discount my thesis.

And so that's the first reason I do that. And then the second reason I do that is because we haven't figured it out yet. When it comes to the correct moral theory, there's still moral uncertainty. And so any given person might think that they have the right moral theory or if you're working on figuring out the right moral theory is but building a applied ethical case in a pluralistic foundation that appeals to several moral theories, this sort of hedge. So it's a hedge against that kind of moral uncertainty where it's like, OK, like the consequentialist.

They'll have some reasons to get on board with this countians of the ontologies will have some reasons. And not everybody is going to get with me with my argument all the way. Not everybody's going to endorse full rights of self medication. For example, consequentialist will accept paternalism whenever it works to promote well-being or Kantian types more. But I can bring as many people as I can along with me as far as I can. And if I'm doing that, then I'm also hedging against my own kind of higher order.

Moral uncertainty about. The truth of my own kind of underlying moral foundation that I think is true. OK, well, that's probably a good place to stop. Before I let you go, Jessica, I wanted to ask you for a recommendation for our listeners of a paper or book in your field, like your sort of subfield of, I guess, either applied or normative ethics, whichever one that you think is sort of a good example of reasoning or arguments, like something you'd want to sort of represent the field to to someone who isn't an expert in it?

Well, I think that one thing that's good is to read things that you really disagree with. And I've learned a lot by reading a book that I really disagree with, but I love. And it's called Whose Body Is It Anyway? By Tharp. And it's about similar topics, but she is very skeptical of having this sort of extremely strong commitment to bodily autonomy. And so she argues, for example, that something like the kidney tax could be justifiable.

So just in the same way that the government taxes people's labor to redistribute from people who have a lot of economic resources, the rich to the poor, maybe the government could tax people's kidneys to redistribute from the kidney rich or the healthy to the kidney poor, the unhealthy people who suffer kidney disease.

Where does the tax? Is the tax paid in money or in kidneys? It's paid in. Oh, no tax. Yeah, kidney compensation. And in principle, like government taxing your labor is also a tax on the use of your body that's redistributed. And, you know, you might think that it's even more burdensome for somebody to give a percentage of their income, depending on the percentage, than to give a kidney one time. And so there's no reason in principle to think that it could be taxed.

It's going to be more burdensome taxes. And I just love the argument because it's really revisionist and it really challenges it really raises the price of your belief with respect to thinking that there's a strong presumption that you have a right to your body and it's really well done. She has other arguments against the strong commitment to bodily rights that I hold. And so that's a fun book. And there's a paper that's based off of it, too. That's great.

I was on a similar set of questions. Yeah, totally disagrees. It's a good companion piece to yes. And or your book, I think.

And then I'm going to add one more person who would disagree, which is also Sarah Connolly has a book called Against Autonomy. And it's just like the opposite of my anti paternalism views. It's a defense of public officials being paternalistic towards people arguing that this kind of autonomy principle is really overblown. And I learned a lot from her book, too. So I would say if you're interested in the topics I've been talking about, but want to get the opposite take and also see really good examples of philosophical argumentation and fun take those would be two books.

That's so great. Can I just say how much I appreciate that your picks for this episode are two books that you vehemently disagree with, but I appreciate that I've I've experimented in the past with asking guests to recommend books that they that they strongly disagree with, but still like a respect. And and people usually have a hard time thinking of examples, let alone volunteering them of their own accord. So thank you, Jessica. It's been a pleasure having you on the show.

Thank you so much.

Thank you for having me. You can talk to me. This concludes another episode of Rationally Speaking. Join us next time for more explorations on the borderlands between reason and nonsense.