At least in the context of Western values, it is hard to defend coercive behaviors per se. Nonetheless, there are many examples of coercive behaviors that are generally accepted. Indeed, political scientists general acknowledge that the governmental monopoly on the use of force is a fundamental feature of civil order. The ability of the authorities to threaten the use of force seems essential. There are innumerable examples, both in and out of medicine, in which coercion is accepted. The courts routinely tell people who are thought to have a mental illness that they can either take their prescribed medicine or be involuntarily committed to a hospital. In this case, the courts are still consistent with Mill's viewpoint. But when parents are told that if they want their children to attend public schools, the children must have certain vaccinations, this appears to go beyond Mill's limits on coercion.
The viewpoint that coercion is sometimes justified is referred to as paternalism. Here the authority, be it the state or the medical professional, justifies the use of threats and force based on the best interests of the individual. Although few ethicists have expressly focused on justifying paternalism per se, there has been considerable discussion of the circumstances under which paternalism might be acceptable.
Feinberg (1971) distinguished between weak paternalism and strong paternalism. The former depends for its legitimacy on an individual's compromised ability to decide, based on, for example, the influence of psychotropic drugs, some forms of mental illness, severe acute pain, or acute neurological injuries. Strong paternalism, by contrast, justifies actions that are simply intended to benefit a competent rational individual who is, in the view of the paternalist, making the wrong decision. Strong paternalism may take the form of either restricting what is disclosed to an individual or simply overriding the person's autonomous choices.
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