An Ethical Study on Autonomy and Paternalism in Preventive Medicine

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Recently the Health Promotion Law, which prescribes that all people have a duty to administrate their own health, has been enforced in Japan, whereby the life expectancy at birth for females is over 82 years. This paper is intended as a critical investigation of widespread discourses on the obligation to achieve good health for the people's own sake. In the beginning, we review the evolution of classical public health to the new public health movement. While classical public health addressed the improvement of the environment such as installing sewerage systems for infection prevention, the new public health movement since the mid 1970s has largely been concerned with our lifestyles. With some epidemiological surveys, both researchers and policy makers reached agreement on the tenet that reforming 'unhealthy' lifestyles is more effective and economical than curative health care practices. Thus, they insist that people have an obligation to promote their own health and prevent disease by self-discipline, and that medical intervention in people's lifestyle is justified. Here we outline the essential features of today's discourse on the duty to promote health as follows : healthism, a quasi-religious and moral characteristic of modern medicine, giving extraordinary meaning to diseases and illnesses by metaphors, the medicalization of our everyday life, and an excessive emphasis on personal responsibility for disease or illness as rhetoric to justify cutbacks in required health and social programs. As will be seen, we examine these claims of preventive medicine in detail. In conclusion, we cannot accept the idea of the obligation to promote health for people. On the contrary, it rather seems that the government is obliged to preserve the environment, to assure daily commodities' safety such as food, water, housing and so forth, and to improve health care services without paternalistic coercion.