Stewardship, Paternalism and Public Health: Further Thoughts

In November 2007, the Nuffield Council on Bioethics published the report Public Health: Ethical Issues. While the report has been welcomed by a wide range of stakeholders, there has also been some criticism. First, it has been suggested that it is not clear why, in developing its 'stewardship model', the Council felt the need to go beyond the liberal position developed by John Stuart Mill—what is it that the stewardship model adds? Second, it is suggested that the Report is confused about the concept of paternalism. Third, it is argued that the discussion of the concept of stewardship is lacking in detail and substance. We clarify the Working Party's thinking regarding these three areas, which demonstrates the robustness of the framework set out in the report.