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Paternalism is defined as an action that infringes a person’s liberty and is performed without their consent, but is intended to improve a person’s welfare. As such, many public health policies are criticized as being paternalistic because they attempt to influence citizens’ behaviours to prevent disease or injury. Therefore, public health advocates ought to be aware of what justifies paternalism. Arguments based on the harm principle are the strongest defense of paternalistic policies in Western culture, but reinforcing an individual’s integrity and improving social welfare may also be considered sufficient reasons. In practice, what is considered sufficient reason for paternalism depends upon the culture of the affected society. Collectivist cultures are willing to accept a paternalistic policy in exchange for a better quality of life for their whole community, but individualist cultures are very averse to such a trade. This article provides examples of how these principles arise in the debate over implementing anti-obesity legislation. Advocates must recognize paternalism and know when it is acceptable in order to defend public health policy from that common criticism.

Disasters that produce an overwhelming number of casualties demand that healthcare resources be rationed. Given the gravity of these decisions, it is imperative that they be guided by acceptable principles of distributive justice. Utilitarianism governs current disaster triage protocols because the efficient use of resources prevents the greatest amount of disability and mortality in the population. However, this conflicts with maximin egalitarianism, which demands that the most severely injured patients be prioritized even if it is not an efficient use of resources. Utilitarian triage also conflicts with the egalitarian principle of equal chances, which states that all people should be given an opportunity to be given treatment since all persons value their lives equally. Utilitarianism protects the needs of the entire population, and so demands that an individual patient's right to autonomy and a fiduciary relationship with their physician must be sacrificed. Like other policies in a democratic society, the legitimacy of disaster triage protocols comes from support by the majority. For this reason, choosing the values that guide disaster triage requires open and transparent communal disaster planning that reflects the values of all members of society. Rather than prioritizing one principle over another, it is likely that the most just approach to allocating resources in disaster triage may be to apply a mixture of distributive justice principles.introduction Some natural disasters and conflicts cause an overwhelming surge of severely injured casualties. These circumstance require more lifesaving care than the available medical services can provide, creating a bottleneck in which some patients cannot be saved. [1][2][3][4][5] The fact that some patients will die because there are not enough resources to save all severely injured people is what differentiates disaster triage from normal emergency department triage. [1][2][3]6,7 These conditions make triage a decision of which patients will receive curative treatment and which will be categorized as expectant, expected to succumb to their injuries, and be given only palliative care. 1,2,5 How can one make such a tragic choice justly? The most commonly used and accepted disaster triage algorithms, START and SALT, direct care towards patients that need it to survive, but also prioritizes patients that have the best prognosis. 1,8 Under these guidelines, patients less likely to survive or needing disproportionate resources are categorized as expectant. 1,8,9 This article will explain why this utilitarian approach to disaster triage is justified, as well as how utilitarianism conflicts with egalitarian principles of distributive justice, and patient autonomy and the patient-physician fiduciary relationship. Here it is argued that community participation in disaster planning and compromise between values is necessary to resolve these ethical dilemmas.utilitarianism provides a justification for withholding lifesaving careUtilitarianism can be summarized as valu...