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Notes
1 Advocates of such a system have called this a “fee-for-service” view of healthcare, in which doctors and pharmacists are procurers, rather than advisors. Under this view, prescription requirements should not exist. Under these views, which the authors are right to oppose, the FDA’s primary duty is in “merely providing “information” to inform autonomous decision-making” (10).
2 Soft paternalism fits this format in that (if you want X you should Y) indicates that something “is to be so” given antecedent conditions (wanting X, i.e., wanting to quit smoking). Hard paternalism fits this format in that redirection of ends entails an explicit statement that “something ought to be so.” The authors rightly note that advice we might expect from strangers, or from self-interested agents such as private companies and carries with it less “salience” and “legitimacy” such that these “to be so” relations fail to obtain.
3 When issued, soft paternalistic “to be so” advisements are legitimated by helping the agents under advisement achieve their own ends. So, advising that e-cigarettes should be considered as a more effective tool for smoking cessation would only be justified if it showed that the end would be better achieved had the communication been issued. However, counterexamples to the “hardening hypothesis” have shown that e-cigarette proliferation may hamper population-level smoking cessation. Therefore, this communicative action would likely be hurtful both to the populous (by contributing to the proliferation of smoking) and to the FDA (by weakening its paternalistic warrant).