Access the full text.
Sign up today, get DeepDyve free for 14 days.
Public HealtH etHics VOluMe 16 • issue 1 • 2023 • 64–76 64 Paternalism in Historical c ontext: Helmet and s eatbelt l egislation in the uK Janet Weston , London School of Hygiene and Tropical Medicine, London, UK *Corresponding author: Janet Weston, Centre for History in Public Health, LSHTM, 15-17 Tavistock Place, London WC1H 9SH, UK; Email: email@example.com Paternalism is a frequent source of anxiety and scholarly enquiry within public health. This article examines debate in the UK from the 1950s to the early 1980s about two quintessentially paternalistic laws: those mak- ing it compulsory to use a motorcycle helmet, and a car seatbelt. This kind of historical analysis, looking at change over time and the circumstances that prevent or enable such change, draws attention to two signif- icant features: the contingent nature of that which is perceived as paternalistic and therefore objectionable, and the wide range of arguments that can be marshalled for and against. It suggests that paternalism became a particularly disruptive accusation in the UK of the 1970s in relation to seatbelts, thanks to the population that would be affected and the wider socio-political context. It also suggests that arguments about the social cost of death and injury on the roads, along with overt acceptance that some element of paternalism could be acceptable, proved influential—as was the sense of inevitability that 10 years of regular debate helped to create. Paternalism and its place in public health is conten- or seatbelt) is minimal, and the gains in terms of reduced tious. Put simply, paternalism is commonly understood chances of death or serious injury are substantial, creat- as an infringement of a person’s freedom or autonomy, ing a morally tolerable trade-off (Nuffield Council on for that person’s own good. To call something paternal- Bioethics 2007). istic is now usually a criticism, and one oen le ft velled To contribute to understandings of paternalism as at public health interventions. In response, there have a point of contention within public health, this arti- been many suggestions of ways to rebut or reconceptual- cle examines debate in the UK from the 1950s to the ise such a criticism. These have included calls to rethink early 1980s about helmet and seatbelt laws. It focuses our understandings of autonomy or self-determina- on parliamentary discussion rather than the more tion, to refute the belief that paternalism is necessarily behind-the-scenes processes of policy development unacceptable, to destabilise some of the assumptions and delivery, which deserve separate attention. It uses that underpin current debate, or to challenge the cen- Hansard, the official record of parliamentary debate in tral role of paternalism within public health evalua- Westminster, supplemented by government archives tions (Brännmark 2018; Carter et al., 2015; Coggon and media coverage. This kind of historical analysis, 2020; Gostin and Gostin 2009; Holland 2009; Nys 2008; looking at change (or lack thereof ) over time and the Wilson 2011). circumstances that enable or prevent such change, Laws that penalise people who fail to wear a helmet directs attention towards two significant features of the when riding a motorcycle or a seatbelt in a car are oen ft public debate: the contingent nature of that which is cited as quintessential examples of paternalism, whether perceived as paternalistic and therefore objectionable, in public health specifically or public policy more gener - and the range of arguments (with variable impact) that ally (Coons and Weber 2013; Coggon, Syrett, and Viens can be marshalled for and against seemingly paternal- 2017; Flanigan 2017; Brännmark 2018). Such laws are istic measures. It suggests that paternalism became not currently seen as controversial in the UK, although a particularly disruptive accusation in the UK in the helmet laws have been fiercely contested and in some 1970s, when political instability coincided with ris- cases repealed in the USA (Jones and Bayer 2007). ing popular individualism, reconfigurations of the Helmet and seatbelt laws are usually said to be ethically role of the state, and greater emphasis on individual acceptable because the infringement of individual free- responsibility and education rather than compulsion. dom (to choose freely whether or not to use the helmet It also suggests that framing such laws as both (and https://doi.org/10.1093/phe/phad001 Online publication date: 13 March 2023 © The Author(s) 2023. Published by Oxford University Press. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. PateRNalisM iN Hist ORical c ONteX t • 65 sometimes simultaneously) ‘not paternalistic’ and ‘jus- habitual use, but even aer in ft tensive advertising only tifiably paternalistic’ was helpful in rendering them 30 per cent of drivers were doing so by the early 1970s. acceptable. Following the announcement of a formal consultation Historians of road safety have characterised the in 1973, the question of compulsory use immediately period from the end of the nineteenth century through became extremely controversial and was ultimately left to the dawn of the 1970s as one during which laws and to a free vote in Parliament the same way as abortion regulations favoured private motorists, at the expense and the death penalty, framed as a matter of personal of pedestrians and other road-users (Luckin and Sheen morality that transcended party politics. Between 1973 2009; Pooley 2021). Describing the opponents of road and 1981, under both Labour and Conservative gov- safety laws over these decades as ‘unreconstructed liber- ernments, no fewer than ten attempts were made to tarians’ (Luckin 2010, 373), existing historical accounts pass a seatbelt law in the UK. Over these years, most gladly note their reduced number and influence by the of the UK’s European neighbours joined Australia in 1960s, and attribute their decline to a combination of passing such a law. Failure to wear a belt finally became factors: technological innovation and mounting evi- an oen ff ce in the UK 1983 thanks to the Transport dence surrounding collisions and safety; dramatically Act 1981 and Motor Vehicles (Wearing of Seatbelts) rising numbers of road users jostling for space; canny Regulations 1982. media management from safety advocates; and grow- Analysis in the 1980s attributed the arrival of a ing public pressure to deal with high rates of death and UK seatbelt law to the absence of industry opposi- injury. Motorists, in this account, were finally compelled tion along with support from a range of professional to yield by the late 1960s, and consensus over road safety groups (Leichter 1986). Little has been said, though, could replace conflict. about why a seatbelt law–unlike a helmet law–became The history of helmet and seatbelt laws and the so morally loaded and generated such insistent oppo- debate over paternalism disrupts this picture, where sition in the first place. I argue here that the contrast- conflict in the 1970s replaced prior consensus. A sum- ing trajectories of the two measures reflected not only mary of successful and unsuccessful attempts to intro- the different constituencies that would be affected by duce helmet and seatbelts laws in the UK is given in them, but also the different socio-political context in Figures 1 and 2. Primary legislation empowering the which they were first proposed: by the 1970s, accu- transport secretary to make motorcycle helmets com- sations of paternalism could be particularly damag- pulsory was passed in 1962, and this power was taken ing. This led to regular discussions about the rights up in 1973: motorcyclists failing to wear helmets would and wrongs of a seatbelt law throughout the decade, incur a fine, and failure to pay could mean imprison- during which two defences against the accusation of ment. The same year saw the first public step towards paternalism were raised: firstly, that the proposal was a seatbelt law. Car manufacturers had been required to not paternalistic at all, and secondly, that it was, but t n fi ew vehicles with front seatbelts since 1965, in the was nonetheless justified. Both strands of argument hope that the constant presence of a belt would lead to proved influential. Date MeasureStage/ProposalHouse OutcomeGovernment Additional clause proposed, to 30 minute debate; proposal May-56 Road Traffic Bill Commons Conservative make helmets compulsory. withdrawn. Clause included for debate following pressure in Standing Committee Additional clause proposed, to from George Strauss (Lab) and Jul-62 Road Traffic Bill Commons Conservative make helmets compulsory. Grevill Hall (Lab); accepted after some debate in the Commons and without debate in Lords. Motor cycles Introducing regulations to make Prayer unsuccessfully moved to (Wearing of helmets compulsory, under the Feb-73 Commons annul the regulations; debate Conservative Helmets) powers given to the Transport initiated via a motion to take note. Regulations Secretary in 1962. Figure 1. Successful and unsuccessful attempts to make motorcycle helmets compulsory. 66 • West ON Date MeasureStage/ProposalHouse OutcomeGovernment Additional clause proposed at Report One hour discussion; Dec-73 Lords Conservative stage, to make seat belts compulsory. additional clause agreed. Almost all who mentioned the seat belt clause spoke in Road Traffic Bill Second Reading, including new clause favour; Bill sent to Jan-74 from the Lords to make seat belts Commons Conservative Committee. Progress then compulsory. interrupted by general election. Second Reading, including seat belt Labour May-74 LordsLittle discussion of seat belts. clause. (minority) Committee stage: proposal to remove 66 vote in favour of keeping Labour Jun-74 Lords seat belt clause. the clause; 55 against. (minority) Committee stage: proposal to remove 79 vote in favour of removing Labour Jun-74 Lords seat belt clause. the clause, 71 against. (minority) Road Traffic Bill Very little time for debate: most supporters of a seat belt law prefered not to try to Committee stage: proposal to Labour Jul-74 Commons rush it through without a full reintroduce seat belt clause. (minority) debate. 69 vote against reintroducing the clause; 3 in favour. Lengthy speeches in opposition from both Labour Road Traffic (Seat and Conservative; adjourned Nov-74 Second Reading. Commons Labour Belts) Bill at 9pm and not revisited before the end of the parliamentary session. Over 5 hours of debate, ending with 249 voting in favour, 139 against. Broadly: Labour members were mostly in favour, but both Road Traffic (Seat Mar-76 Second Reading; with free vote. Commons Conservatives and Liberals Labour Belts) Bill were divided. Made very slow progress and failed to complete Report stage before end of parliamentary session. Road Traffic (Seat Over 5 hours of debate, Apr-77 Private Peer's Bill: Second Reading. Lords Labour Belts) Bill defeated 55-53. Road Traffic (Seat Private Peer's Bill, Second Reading (for Just under 2 hours of debate, May-77 Lords Labour Belts) Bill no.2 compulsion on motorways only). defeated, 86-62. Proposal to adjourn debate, Road Traffic (Seat Seeking approval for an Order to make as a way to pause the Order: Jul-78 Belts) (Northern seat belts compulsory in Northern Lords Labour 114 voted in favour of Ireland) Order Ireland. adjournment and 74 against. Over 5 hours of debate; 244 Road Traffic (Seat in favour, 147 against. Mar-79 Second Reading; with free vote. Commons Labour Belts) Bill Progress interrupted by the general election in May. Four hours of debate; 139 in favour, 48 against. Proceeded through Committee; discussion of amendments at Road Traffic (Seat Private Member's Bill: Second Reading, Jul-79 Commons Report stage begun in Conservative Belts) Bill with free vote. February 1980; no further progress by the end of the parliamentary session in November. Wrecking amendment Road Traffic (Seat Dec-80 Private Peer's Bill: Second Reading. Lords proposed but 72 vote against Conservative Belts) Bill it, 36 in favour. New clause proposed at committee 2.5 hour debate: agreed with Jun-81 Lords Conservative stage, to make seat belts compulsory. 132 in favour, 92 against. Transport Bill Proposal to disagree with the Lords' amendment on seat Jul-81 Second Reading, free vote. Commons Conservative belts: 144 in favour, 221 against. Introducing regulations to make seat Proposed regulations to Motor Vehicles belts compulsory, under the powers come into force on 31 Jul-82 (Wearing of Seat Lords Conservative given to the Transport Secretary in the January 1983. 2.5 hour Belts) Regulations recent Transport Bill. debate; agreed 95-13. Figure 2. Successful and unsuccessful attempts to make car seatbelts compulsory. PateRNalisM iN Hist ORical c ONteX t • 67 were particularly harmful, and that motorcyclists were Helmets and a cceptable less than fully competent to make their own decisions. Paternalism ‘Motor-cycling accidents take the cream of our youth,’ said one member of the House of Lords; another pointed Motorcycle helmets had begun to prove their worth out that ‘these young people, these boys and girls, who by the early 1940s (Cairns, 1941), and their design rush about our roads’ were exactly those ‘who have was developed and improved aer ft the Second World everything we want for the future,’ especially ‘[i]f war War as the number of motorcyclists rose. The idea of a came again.’ One Conservative MP also argued that a helmet law was first floated in the early 1950s and met ‘great deal of money is invested in young men, in their with ambivalence. Amidst uncertainty about the qual- education,’ and this was lost when they died prematurely ity of existing helmets, politicians felt that information on the roads. e Th perceived value to the nation of bold and encouragement was more ‘in accord with the way young motorcyclists meant that their life and wellbeing we try to do things in this country’ –continuing a long could be situated as something of exceptional impor- tradition of characterising anything akin to policing tance, worthy of special measures. health as ‘”foreign” to English political mores’, despite an Even more significantly for arguments about pater - equally long history of such policing (Carroll 2002, 491). nalism, their youth meant that motorcyclists could be Persistent concern about low-quality helmets and the presented as less than fully competent to make their own number of motorcyclists killed and injured prompted in decisions. ‘Many of these youngsters are not sufficiently 1956 a first attempt to pass a law that would have pro- responsible to recognise the great pain and suffering vided for a minimum helmet standard as well as com- which they cause to relatives and others,’ Conservative pulsory use. e Th short debate acknowledged the ‘really MP Gerald Nabarro had said in 1956. The government controversial matter,’ about paternalism: whether ‘a man therefore had a duty to step in and ‘provide protection has a right to kill himself ’ by not wearing a helmet if for these persons who have not sufficient common sense he so chose, or whether the government had a respon- to protect themselves.’ Arch-libertarian Ronald Bell sibility to ‘protect the fool from his own folly.’ Several MP made this even more explicit in the debate over seat- speakers including the transport secretary were not con- belts some years later, arguing that that the ‘safety helmet vinced that compulsion was appropriate, but all could legislation – not that I approved of it – overwhelmingly agree on the need for improving helmet standards and applies to very young people, and a proscription in advocating for their use. respect of children has always been accepted by soci- Six years later, with around 30 per cent of motorcy- ety.’ Here, all motorcyclists (who had to be at least 16 clists still not wearing helmets and over 1,500 fatalities years old, or 17 from 1971) became ‘young people’ who and 26,000 serious injuries per annum, some were con- became ‘children.’ Along similar lines, Conservative MP vinced that persuasion was not enough. Under pres- Gresham Cooke likened the government’s position in sure from a handful of Labour Members of Parliament relation to motorcyclists to that of parents towards their (MPs), the Conservative transport secretary agreed to children, with one ‘entitled’ to tell the other what to do. support the inclusion of permissive powers within his It may be ‘grandmotherly’ to do so, admitted Labour Road Traffic Bill of 1962, allowing for helmets to become MP Frederick Bellenger, but what was wrong with that? compulsory in future. This received cross-party support, ‘Aer ft all, a grandmother knows quite a number of things and only two MPs objected. Motoring associations from long experience.’ Motorcyclists could be posi- muttered that it was ‘taking a sledge-hammer to crack tioned as inexperienced and immature: compulsion was a walnut,’ given the relatively high rates of helmet-wear- therefore simply the right thing to do. ing (The Times 1962), and some MPs reported receiving letters of protest from motorcyclists, but the measure passed without further comment or complaint. It was probably relevant to this that few MPs (and a Paternalism becomes c ontentious minority of voters) were motorcyclists. Commentators Regulations to penalise motorcyclists for failing to wear acknowledged that motorcyclists might not like com- helmets then took some years to materialise. It was pulsion, but many others—such as their families—cer- recognised as unpopular amongst motorcyclists them- tainly would. As well as being a minority, motorcyclists selves, and road safety efforts focused elsewhere during were characterised as particularly daring and mostly the 1960s. The decision to introduce helmet regula- very young. This enabled two distinctive arguments in tions was announced by the Conservative transport favour of compulsion: that these deaths and injuries 68 • West ON secretary John Peyton in February 1973, aer 2 y ft ears decade in the UK has oen b ft een characterised as one of preparation concerning the standard of helmet to be of chaos, crisis and decline. Amidst inflation, recession, required. Some degree of controversy was anticipated: and hostile industrial relations, the presence of fragile a handful of motoring organisations had indicated their and minority governments plus increasing political opposition to such ‘an undemocratic interference with extremism were seen to mark the end of the post-war the liberty of motor cyclists.’ No press conference was consensus (Robinson et al. 2017). This included pro- scheduled; a straightforward announcement would ‘stir found rifts within the Conservative party itself. As one up enough hornets,’ observed one civil servant, ‘without MP had observed back in 1962, the debate over helmets also exposing the Minister to being openly buzzed at by ‘illustrates a fissure in the Conservative Party. There is the captive Press representatives of the motor cyclists.’ the liberalistic Whiggish side, the freedom of the indi- In the event, the helmet regulations attracted little vidual and so on, and the paternalistic, benevolent press attention, but the muted debate of the 1950s and authoritarian on the other side.’ This fissure was very 1960s flared up in Parliament with surprising vigour. much evident in 1973: Peyton, the transport secretary, Although the power to make regulations already existed was persuaded of the need for a seatbelt law, but his and little could be done to block them, Conservative MP counterpart in the Home Office, Reginald Maudling, Enoch Powell signalled his vehement disapproval, ‘con- was resolutely opposed. The ‘liberalistic’ side of the vinced that a genuinely new and important principle’ party was given particularly loud voice by Ronald Bell, of limiting people’s choices purely for their own good Enoch Powell and others who railed against helmet reg- was at stake. He had supporters: as The Times reported, ulations and were increasingly prepared to oppose their protests from ‘[l]egislative purists’ from both main polit- own party. ical parties ‘battered the Government mercilessly’ when All this meant that the first attempt to pass a seatbelt the Regulations were debated (Noyes 1973). A small but law, initiated in 1973 in the House of Lords, generated vocal group of about thirteen MPs, including William a profoundly noncommittal reaction from the govern- Hamling of the Labour party along with Ronald Bell and ment. It was interrupted by a sudden general election Enoch Powell, frequent allies on the (far) right of the in February 1974, and when it was reintroduced under Conservatives, loudly condemned this ‘gross infringe- the new minority Labour government, those opposed ment of personal liberty.’ to compulsory seatbelts had begun to marshal their Beyond Parliament, some motorcyclists certainly troops. Rising controversy meant that the provision agreed that this was a highly unwelcome interference was removed from the Road Traffic Bill, and the parlia- in their freedom. Fred Hill accrued numerous fines for mentary session ended before its reintroduction could failing to wear a helmet which he refused on principle to be fully debated. Between 1974 and 1979, numerous pay, winning the admiration of Ronald Bell (Bell 1981; unsuccessful attempts under Labour secured its place as The Times 1973b). Sikh motorcyclists also protested, a highly controversial, morally loaded step. petitioned, and refused to pay fines to draw attention to As well as party political instability, this heightened their request for an exemption for those who wore tur- sense of controversy reflects the fact that a seatbelt law bans as part of their religious practice—an exemption ran counter to broader socio-political trends. The 1960s finally granted three years later (Bebber 2017). Although had seen various steps towards reconfiguring the proper the government had been aware of the desire for this role of the state in relation to individual behaviour, with exemption from the outset, the question of religious issues like abortion, homosexuality and attempted sui- objections was not raised by MPs opposing compulsory cide increasingly viewed as a matter of private rather helmets on the basis of personal freedom. There is no than public morality. This was always only partial, sign that Bell or Powell, united in their opposition to with the decriminalisation of cannabis, for example, immigration and the Race Relations Act 1965, gave any debated on similar grounds but rejected (Seddon 2020). support to Sikh activists. Nevertheless, the language of individual freedom was e f Th urore over helmets may have dampened gov- very much in the air, in political manifestos and every- ernment enthusiasm for a seatbelt law. Perhaps more day conversation as well as calls for drug law reform. significantly, the government itself was divided. The os Th e who opposed a seatbelt law tapped into growing Conservative party had come to power in 1970, con- tendencies towards popular individualism, in which trary to most expectations at the time, and by 1973 there many people were ‘increasingly insistent… about defin- was something of a ‘sense of impending apocalypse in ing and claiming their individual rights, identities and Britain’s political class’ (Pemberton 2009, 586). This perspectives,’ expressing ‘desires for greater personal PateRNalisM iN Hist ORical c ONteX t • 69 autonomy and self-determination’ (Robinson et al. 2017, energetic disagreement: was this a paternalistic measure 302). Paternalistic legislation could be presented as a that limited a person’s choice for their own good? And retrograde step, founded on the outdated ‘concept that if it were, was it nonetheless justifiable? The primary the gentlemen in Whitehall... know best.’ objection was very simply that it was paternalistic and A seatbelt law also ran counter to new trends within therefore unacceptable. Lord Monson, a crossbench peer public health, in which health was becoming the respon- and president of the anti-statist Society for Individual sibility of rational, autonomous individuals who should Freedom (SiF), made this case clearly and consistently weigh up expert advice and behave accordingly (Clark throughout the 1970s: ‘I believe it introduces an addi- 2019; Mold et al., 2019). This kind of individual respon- tional undesirable element of paternalism, or perhaps sibility, with potential to reduce the cost of the struggling one should say “maternalism”, into the law.’ This ran National Health Service (NHS), rested on health promo- counter to the philosophies of both conservative and tion and choice not compulsion: the ‘fabled gentleman liberal traditions alike, in his view, both of which held in Whitehall’ may have useful information to share, but that ‘an individual should be free to make his or her own should not have the final say. Similar trends were pres- mistakes, if indeed mistakes they be, so long as nobody ent in relation to occupational health legislation, which else is harmed in the process.’ Others who were simi- shifted in the 1970s to place responsibility for safety on larly convinced that it was unacceptable ‘big brotherism,’ employers and workers, relying on self-regulation, vol- ‘nannying,’ ‘nursery legislation,’ ‘totalitarian,’ or ‘Fascist/ untarism and persuasion (Sirrs 2016). Primary legisla- Communist’ included correspondents in the medical tion for motorcycle helmets predated the full force of and mainstream press as well as an assortment of MPs these developments; the prospects for a seatbelt law in and peers, mostly (but not all) Conservative. the 1970s were much more challenging. Although the issue did not elicit any responses from Undoubtedly, the degree of controversy also had civil liberties organisations or campaigners, these accu- something to do with the number of people that would sations still demanded a reply. Many of those in favour be aeff cted. A last-minute attempt to reintroduce a of a seatbelt law argued that it was not such a clear-cut seatbelt clause in July 1974 met with the complaint case of paternalism aer a ft ll. This drew on three points: that this ‘will, I suppose, aeff ct half the population,’ firstly, that a seatbelt law did not ae ff ct a person’s free- and therefore demanded a full debate not a snap deci- dom to chose; secondly, that ‘individual freedom’ was sion. Commentators frequently referred to their own perhaps not being removed aer a ft ll; and thirdly (and and their family’s experiences of collisions and use of most commonly), that the wearing of seatbelts was not seatbelts, signalling their personal investment in the something that only ae ff cted the wearer, but had a sig- issue (as well as the rise of the anecdote within political nificant impact on others too. rhetoric, as a way of claiming authentic connection to In relation to the question of choice, some argued ‘ordinary people’ (Robinson et al., 2017)). Parliamentary that freedom of choice would remain: anyone was free votes usually showed that about 60 per cent were in to choose to walk instead of using a car. The president favour of a seatbelt law, but once the idea had become of the Royal College of Surgeons presented the choice controversial, this was not enough. As one astute com- somewhat differently in 1978, observing that ‘anyone mentator observed in 1977, it could only succeed with would be at liberty to ignore or circumvent such laws if government support as part of a larger bill. As a stand- he so wished’ (Murley et al., 1978). In an effort to legiti- alone measure, it was doomed to face the full range of mise this element of choice, Labour transport secretary parliamentary obstacles and delaying tactics. William Rodgers proposed an ‘opt out’ clause for those who objected on principle to being forced to wear a seat- belt—but the idea of being able to opt out of obeying the law was not well received by colleagues concerned with Refuting a ccusations of criminal justice. These discussions had little impact: Paternalism the choice to break the law was not one that law-makers could realistically acknowledge, nor was the choice not One such delaying tactic was extremely lengthy parlia- to travel by car seen as a meaningful one. mentary debate, in which the arguments for and against In relation to the removal of ‘individual freedom,’ were repeated time and again. Alongside various subsid- some argued that drivers and passengers were not freely iary arguments that waxed and waned over the years to deciding whether to wear a seatbelt in the first place. do with safety, comfort, design and enforcement, there Echoing academic distinctions between ‘weak/so’ ft were two points that consistently prompted the most 70 • West ON and ‘strong/hard’ paternalism (Childress et al., 2002; environment within which I may enjoy another element Feinberg 1971), in which ‘weak/so’ p ft aternalism inter - of freedom.’ Jack Ashley put it bluntly, ‘e b Th asic free- venes in decisions that are not entirely voluntary, such dom is life.’ William Molloy spoke more vehemently, arguments cited the vicissitudes of the human mind and drawing on his experience of poverty—or his ‘personal the complexity of social life: passengers did not want freedom to be out of work’ and ‘nearly starved’—to crit- to oen ff d drivers by donning a belt, and drivers did not icise the valorisation of freedom from state interference. want to worry their passengers; the vast majority were ‘Many people in the valleys of Wales [in the 1930s] were misinformed about risks and benefits, and absolutely destitute,’ he recalled, ‘but they were in a free land. I have everyone was liable to forget. All these circumstances been a little sickened by the argument about personal would, it was argued, impede a person’s ability to choose freedom.’ Freedom here was associated with broader freely. Conservative MP Toby Jessel, who advocated programmes of welfare and social support, but any energetically in favour of a seatbelt law following the extension of such programmes—even if only concep- death of his young daughter in a car collision, held that tually—was a hard sell in the context of the 1970s, as people were either lazy or mistaken, with ‘incomplete the welfare state foundered and underwent significant knowledge’ about the dangers on the roads. Labour change (Lowe 1994). MP Jack Ashley agreed that most people were sure that By far the most frequent and consistent argument accidents only happened to others and therefore mis- against accusations of paternalism was that wearing judged the true value of a seatbelt. Decisions were a seatbelt did not only ae ff ct the wearer, but also the ill-informed, when they were consciously made at all, wider community. A 1973 article in the Lancet pointed and so there was no true ‘freedom’ being exercised. This out the potential impact of seatbelt-wearing on ‘the argument, much like any endorsement of the choice to hospitals to which the beltless victims are taken’ and, disobey the law, was not taken up very oen o ft r pursued in emotive terms, on children witnessing unbelted par- very far. ents maimed or killed. ‘Can one really say that on those Others tried to distinguish between different kinds of occasions no-one else is involved?’ (McKie 1973). The freedom. ‘“Freedom” is a much hackneyed expression,’ pain and suffering of the families of those injured or observed Labour peer Lord Wells-Pestell. ‘We have to killed was certainly not overlooked, but the price paid bear in mind that there can be no freedom at all in any by emergency responders and medical professionals was society unless there are laws, unless there are restric- a particular talking point. ‘What worries me,’ said David tions’ which inevitably limit what individuals can do. Stoddart in the Commons, ‘is the gory job that nurses, Conservative peer Lord Mowbray argued that measures doctors, firemen and policemen have when clearing up like seatbelt laws enabled safer driving with fewer deaths aer a ft n accident.’ The work of medical and emergency and injuries, meaning that a more important freedom personnel was frequently described in vivid terms, (to move around by car) was protected. Jessel argued emphasising their ‘considerable anguish and pain’ as several times that freedom was ‘not one, indivisible con- well as the cost of their time and expertise. cept.’ He sought to distinguish between ‘great freedoms e cos Th ts to others of failing to wear a seatbelt became of speech, conscience and religion’ on one hand, and a regular refrain. There was surely ‘an obligation on freedoms that we ‘may not want’ on the other’—such as each of us to reduce unnecessary calls on the limited the freedom to ignore a seatbelt and to be gravely injured resources’ of emergency and medical services, proposed or killed as a result. The latter were minor freedoms, in Conservative peer Lord Montagu of Beaulieu, which 36 42 his view, ‘worth sacrificing for health and safety.’ might include accepting legislation. e Th ‘burden’ on Building on these interrogations of ‘freedom’ was a the ‘already grossly over-strained’ NHS was oft-cited— view expressed only from the Labour benches, that the unsurprisingly, given the severe financial pressures and protection of life and health was necessary for the indi- reorganisations to which it was being subjected during vidual freedom that was being defended so passionately. the 1970s. Countless correspondents in newspapers In essence, this countered calls for negative rights (to be and journals agreed that road injuries were not simply free from government interference) with an argument ‘the affair of nobody but the victim: the family and the for positive rights (to live under conditions that enable health services cannot be left out of the account’ (Clarke life and health). MP Bruce George argued that ‘the 1977; Personal Liberty versus Common Sense 1980; creation of the Welfare State, public health legislation, Seat-Belt Legislation’ 1979; The Times 1976; Weston and health and safety at work legislation and transport legis- Paynton 1977). Others highlighted the knock-on effect lation’ may restrict freedom in one sense, but created ‘an for scheduled medical procedures, when clinicians had PateRNalisM iN Hist ORical c ONteX t • 71 to respond to emergencies. ‘Dying on the roads is not about the ‘danger’ of emphasising the community costs a private matter,’ the voiceover of an influential televi- of unwise personal decisions: ‘it is not such a giant step sion documentary affirmed. ‘It ties up huge resources before communities... start wondering if they any lon- not just in rescue teams, but of the health services and ger want to foot the bill for avoidable mishaps’ (Primary the police, the courts and the coroners, the repairers and Prevention: The next Stage 1973). What might this mean insurers, and the social services’ (e B Th iggest Epidemic for the future of public health? This point was picked of All Time 1981). up in Parliament. Conservative MP Nicholas Ridley e ide Th a of social cost was extended in numerous objected that presenting a seatbelt law as a way of saving directions. It included the idea that an unbelted driver NHS costs was ‘a repulsive argument,’ since it breached was more likely to lose control of their car and cause the fundamental agreement about shared costs and ben- 46 54 additional collisions; that the body of an unbelted efits that underpinned the NHS. Some did propose passenger might harm others within the car (Stewart et that a better solution would be for the unbelted to pay al., 1976); the loss of ‘productive work and skill’ when extra towards health and social services; insurance serious injuries and deaths prevented people from companies, with the support of the courts, had already ‘mak[ing] a full contribution to society,’ and the cost of begun to reduce compensation payments when those providing social care and financial aid to the injured and injured had not been wearing a belt (The Times 1973a). their dependants. With the emergence of health eco- More broadly, opponents of a seatbelt law protested nomics as a specialist field and the arrival of economic that seatbelts could not be meaningfully distinguished advisers within a wider range of government areas, from any other choice that people made: every single including transport, some of these social costs could be choice had some kind of indirect impact on others. If counted. Labour peer Lord Davies of Leek produced in causing harm to oneself by not wearing a seatbelt should 1973 a dramatic figure of £115 million for the annual be criminalised, Enoch Powell argued, then ‘there is no cost ‘to the taxpayer’ of responding to injuries caused aspect of life, inside or outside the home, where punish- by ‘people not wearing a belt;’ the following year his able oen ff ces could not be created on the grounds that colleague Lord Wells-Pestell made a much more modest they reduced the risk of self-injury.’ References to the claim, that ‘there is ample evidence that the loss of about awful or absurd prospect of government bans on moun- £40 million a year, including lost production by those taineering, pot-holing, cigarettes, alcohol or over-eating killed and in health service costs, is experienced by the were frequent. community’ as a result of deaths and injuries that might have been prevented by seatbelts. By 1976, the figure regularly cited had risen to £60 million, rising again to a ccepting Paternalism £100 million in 1979–1980. A more concise, but no less regular, perspective was This focus on the impact of road collisions upon that a seatbelt law certainly was paternalistic but others oen s ft haded into framing people with disabili- nonetheless acceptable. ‘I take the point that the coun- ties, particularly men, as an emotional burden on their try does not like to be nannied too much,’ said one families and a financial burden on their communities. Conservative peer, ‘but there are points where you ‘What about the wife who might have to suffer for the ought to nanny people for their own good.’ ‘When rest of her life in looking aer a h ft usband who is inca- people are inadequate,’ Labour MP Ronald Atkins pacitated, mentally or physically?’ asked MP George said, ‘they need to be protected against themselves.’ Strauss. ‘What about the children who can no longer be Some framed this as a duty or responsibility, adopt- dependent on their father?’ This was echoed by Labour ing the language of a duty to protect freedom that was MP George Foulkes, with reference to a wife providing used by their opponents. ‘It is our firm duty to carry lifelong care to a ‘crippled husband,’ and Lord Somers in this Bill,’ insisted the Bishop of London in the House the House of Lords, who at least included husbands as of Lords; it is ‘our collective duty to humanity,’ agreed potential carers of their wives as well. Labour MP Neil Labour MP George Robertson, ‘to make sure that the Carmichael put it in ‘brutal’ terms, as he acknowledged: Bill succeeds.’ Racing car driving Jackie Stewart, an he [sic] who failed to wear a belt ‘may be a burden on the enthusiastic campaigner in favour of a seatbelt law, rest of us for the remainder of his life.’ similarly held that it was ‘our social responsibility’ to es Th e efforts to foreground the community cost of ensure that as few people as possible were harmed on not wearing a seatbelt met with different kinds of resis- the roads (Stewart et al., 1976). tance and concern. An editorial in the Lancet wondered 72 • West ON e m Th ost common line of argument, familiar today, airbags. However, his tenure saw the third consecutive was that it was a small loss of freedom in exchange for parliamentary vote in favour of a seatbelt law in less than a large gain. In this analysis, life and health were more 2 years, and he faced pressure from the Prime Minister’s important than the freedom at stake. An editorial in office to (be seen to) take action on road safety and to Lancet took this position in 1977, dryly commenting that respond to the ‘major and continuing burden on the a seatbelt was ‘a mild restraint on individual liberty but a health and social services (including social security) at singularly effective restraint on violent forward motion’ a time when we are trying to contain expenditure.’ A (Seat Belts and J.S. Mill 1977). Editorials and correspon- seatbelt law had the great advantage of requiring virtu- dents elsewhere agreed that the ‘savings in life, limb and ally no outlay. Although it remained sufficiently morally money are so huge and the tiny reduction in personal contentious to be the subject of a free vote, a major- liberty is so small that really it must make sense’ (Avery ity in both houses voted in favour. As part of a major 1978; Crawley 1976; The Times 1976). Many from all Transport Bill, its safe passage onto the statute books parties in the Lords and Commons agreed. For the was secured. most dedicated opponents of a seatbelt law, the key Historical attention to the debates surrounding point was just the opposite: the principle of protecting helmet and seatbelt laws shows that these quintes- individual freedom was always more important. sential examples of paternalism in public health were This absolutist defence of individual freedom cer - recognised as such when first proposed, and that this tainly had its adherents beyond Whitehall, but the free- became a problem in the 1970s. Hostility towards pol- dom not to wear a seatbelt failed to resonate with most icies perceived as paternalistic is variable, ae ff cted not civil liberties organisations. By the mid-1970s, there was only by whose welfare and freedom is involved, but also significant support for a seatbelt law. Medical, safety and the broader socio-political context. That which pro- motoring organisations were consistently almost unan- voked little concern in relation to young motorcyclists imously in favour, and surveys indicated that between in the 1960s became much more controversial a decade 60 and 75 per cent of the public were prepared to accept later, when it might ae ff ct a significant majority of vot- it too (Durie 1976; Willard 1976). As legislative attempt ers. Such controversy was fuelled by political rifts and followed legislative attempt, media coverage began to upheaval, as well as the seatbelt law’s uneasy fit within depict mandatory seatbelts as inevitable and to criticise broader social trends. Opposition to the seatbelt law government prevarication (Benson 1979; Daily Mirror reflected and responded to the popular individualism of 1976; McLoughlin 1978; Seat Belts: The Overwhelming the decade, in which individual choice and freedom was Evidence 1977). As early as 1974, Punch magazine increasingly celebrated. mocked those who opposed it as old-fashioned and Supporters of a seatbelt law adopted many elements unrealistic. ‘People do not seem to appreciate that it is an of current debate around paternalism and public health, Englishman’s inalienable right to get in his own motor albeit oen ft in simple (and sometimes internally incon- car, skid on his own bald tyres, fly through his own sistent) terms. They argued that it was not paternalistic windscreen, and leave his own remains spread all over because an element of choice remained; because greater his own bonnet,’ an editorial quipped, and ‘the quicker freedoms were protected; and because the decision not we realise this, the quicker we shall get India back.’ ‘Do to wear a belt could have significant impacts on others, you really regard the right to go through a windscreen as particularly through the costs to health and social ser- the last bastion of freedom?’ asked a booklet produced vices. Although some expressed concern that this idea by the Royal Society for the Prevention of Accidents. could disturb the principles underpinning the NHS, it By 1981, those who still said yes to this question finally nonetheless seemed to be one of the most persuasive lost the battle. arguments, and remains a common refrain. In 2015, to mention just one example of recent debate over paternal- ism and public health, parliamentary debate concerning a tax on sugary drinks included numerous references to c onclusions the cost to the NHS of the nation’s poor diet. Compulsory seatbelt wearing came into effect in 1983. Supporters of a seatbelt law also argued that it was Ironically, the transport secretary at the time, Norman paternalistic but was nonetheless acceptable, because Fowler, was a staunch opponent of such a paternalis- the government should tell people what to do at times, tic measure and investigated every possible alterna- and because it would lead to large health benefits in tive, from audio reminders to belt up, to investment in exchange for a small loss of freedom. This final point PateRNalisM iN Hist ORical c ONteX t • 73 achieved widespread acceptance, in Parliament and col 491, col 493-4; Hansard HC Deb 17 July 1962 vol elsewhere, and remains the usual justification for seat- 663 col 258, cols 263-4, col 280. belt mandates (Giubilini and Savulescu 2019; Nuffield 9 Hansard HC Deb 17 July 1962 vol 663 col 275. Council on Bioethics 2007). The argument that govern- 10 Hansard HC Deb 31 May 1956 vol 553 col 494. ments have a duty or responsibility to deliver policies 11 Hansard HC Deb 20 July 1979 vol 970 col 2264. that reduce disease, disability and premature death, even 12 Hansard HC Deb 17 July 1962 vol 663 col 275. if they are paternalistic, is also still made (Gostin and 13 Hansard HC Deb 17 July 1962 vol 663 col 276. Gostin 2009)—albeit perhaps with less vigour in the 14 TNA MT 92/257. context of parliamentary debate. 15 TNA MT 98/788; MT 92/521; MT 92/522; MT Although the debate varied little over the 1970s, one 92/588. anonymous civil servant was probably correct when they 16 Response from National Association of Cycle and wondered whether ‘this is the kind of issue that benefits Motor Cycle Traders, September 1971, in TNA MT from continued public discussion, however unpropitious 92/522. the circumstances.’ The 1970s may have been unpropi- 17 Memorandum dated 30 November 1971, in TNA tious, but such discussion gradually made the prospect MT 92/522. of a UK seatbelt law more familiar and its supporters 18 Letter to John Peyton dated 17 April 1972, in TNA more vocal, while seatbelt laws came into effect around MT 92/588. Europe and much of the English-speaking world. By the 19 Hansard HC Deb 5 April 1973 vol 854 col 745. early 1980s, this constant debate as well as the presence 20 Notes from April 1973 in TNA MT 92/588. of seatbelt laws elsewhere meant that a sense of inevita- 21 Hansard HC Deb 17 July 1962 vol 663 col 275. bility prevailed. Hostility towards the paternalism of a 22 Memorandum dated 25 May 1971, in TNA HO seatbelt law was more the product of the era than the pre- cise nature of the intervention; had primary legislation 310/241. to make motorcycle helmets compulsory been proposed 23 Brief for Legislation Committee dated 28 March in the 1970s instead of the 1960s, it seems likely that it 1977, in TNA MT 92/633. would have faced a similarly turbulent time. 24 Hansard HL Deb 11 June 1974 vol 352 col 369. 25 Hansard HL Deb 26 April 1977 vol 382 col 468. 26 Hansard HC Deb 23 July 1974 vol 877 col 2114. Funding 27 Brief for Legislation Committee dated 28 March 1977, in TNA MT 92/633. This work was supported by the Wellcome Trust (grant 28 Hansard HL Deb 17 December 1973 vol 348 col 106. number 222203/Z/20/Z). See also HL Deb 15 December 1980 vol 415 col 946; HL Deb 26 April 1977 vol 382 cols 468-470; HL Deb 11 June 1974 vol 352 cols 366–369; HC Deb 1 March Notes 1976 vol 906 col 949. 1 Discussion paper from November 1965, in The 29 Hansard HL Deb 17 December 1973, vol 348 cols National Archives, London (hereaer TN ft A), MT 106-7; HL Deb 11 June 1974 vol 352 col. 366, 369; HL 98/563; Royal Society for the Prevention of Accidents Deb 25 June 1974 vol 352 col 1344; HC Deb 1 March National Road Safety Committee meeting minutes 1976 vol 906 col 993; HC Deb 20 July 1979 vol 970 14 December 1972, in TNA MT 92/556. col 2212 and 2215; HL Deb 15 December 1980 vol 2 Consultation responses are in TNA MT 98/778. 415 col 943, 947; see also newspaper clippings in 3 Hansard HL Deb 28 January 1953 vol 180 col 38. See TNA MT 102/375. also Hansard HC Deb 27 October 1952 vol 505 cols 30 Hansard HL Deb 17 December 1973 vol 348 col 108; 155-6, WA. HC Deb 28 July 1981 vol 9 col 1039. 4 Hansard HC Deb 31 May 1956 vol 553 col 491. 31 TNA CAB 129/204/10 and CAB 129/204/12; mem- 5 Accident data available in TNA MT 92/206. orandum dated 25 October 1978 in TNA PREM 6 Hansard HC Deb 17 July 1962 vol 663 col 265. 16/2282. 7 Hansard HC Deb 17 July 1962 vol 663 col 257, 262. 32 Hansard HC Deb 1 March 1976 vol 906 col 957. 8 Hansard HL Deb 28 January 1953 vol 180 col 34; col 33 Hansard HC Deb 1 March 1976 vol 906 col 947-8. 31. See also Hansard HC Deb 31 May 1956 vol 553 34 Hansard HC Deb 11 June 1974 vol 352 col 375-6 74 • West ON 35 Hansard HL Deb 28 April 1977 vol 382 col 435. 58 Hansard HC Deb 22 March 1979 vol 964 col 1766. 36 Hansard HC Deb 1 March 1976 vol 906 col 957; also See also HC Deb 30 January 1974 vol 868 col 515; HL HC Deb 22 March 1979 vol 964 col 1762. Deb 11 June 1974 vol 352 col 378. 37 Hansard HC Deb 20 July 1979 vol 970 col 2247; see 59 Hansard HL Deb 15 December 1980 vol 415 col 918; also HC Deb 30 January 1974 vol 868 col 515. HC Deb 22 March 1979 vol 964 col 1743. 38 Hansard HC Deb 1 March 1976 vol 906 col 946-7; see 60 Hansard HL Deb 11 June 1981 vol 421 col 347; HL also HC Deb 22 March 1979 vol 964 col 1731. Deb 26 April 1977 vol 382 cols 456, 488, 512; HC 39 Hansard HC Deb 1 March 1976 vol 906 col 1006-7; Deb 1 March 1976 vol 906 col 962; HC Deb 22 March see also HC Deb 20 July 1979 vol 970 col 2237; HL 1979 vol 964 col 1731-2. Deb 26 April 1977 vol 382 col 450. 61 See also, for example, Hansard HC Deb 20 July 40 Hansard HC Deb 30 January 1974 vol 868 col 515. 1979 vol 970 col 2261; HC Deb 28 July 1981 vol 9 col 41 Hansard HC Deb 1 March 1976 vol 906 col 988. See 1056. also cols 955 and 1028 in the same debate. 62 Punch magazine, 27 November 1974, clipping in 42 Hansard HL Deb 15 November 1973 vol 346 col 862. TNA MT 92/578/1. 43 Hansard HC Deb 1 March 1976 vol 976; see also cols 63 RoSPA leaflet entitled ‘Seatbelt Sense’, p.5, copy in 906 and 961; HC Deb 20 July 1979 vol 970 col 2237, TNA MT 191/131. 2252, 2284; HL Deb 15 December 1980 vol 415 cols 64 Meeting note dated 22 June 1979, in TNA MT 912-3, 926. 191/131. 44 For example, Roger Stott in Hansard HC Deb 28 July 65 Memorandum from Sir Kenneth Berrill dated 1 1981 vol 9 col 1054. June 1979, in TNA PREM 19/3576; Letter from 10 45 See, for example, Hansard HC Deb 21 November Downing Street to the Ministry of Transport dated 3 1974 vol 881 col 1645 and HL Deb 17 December June 1979, in TNA PREM 19/3576. 1973 vol 348 col 109-110. 66 Hansard HC Deb 30 November 2015 vol 603 cols 46 Hansard HL Deb 11 June 1981 vol 421 col 339. See 1WH-48WH; Hansard HC Deb 18 April 2017 vol also HC Deb 1 March 1976 vol 906 col 931; HL Deb 624 cols 572, 598, 602. 24 May 1977 vol 383 col 1209 and col 1218; HC Deb 67 Hansard HC Deb 21 December 2010 vol 520 col 22 March 1979 vol 964 col 1759; HC Deb 20 July 1344; HL Deb 20 November 2013 vol 749 cols 408-9, 1979 vol 970 col 2217. for example. 47 Hansard HL Deb 15 December 1980 vol 415 col 507. 68 Memorandum dated 3 May 1977 in TNA MT 92/634. See also HC Deb 22 March 1979 vol 964 col 1741; HL Deb 15 December 1980 vol 415 col 913; HC Deb 1 a cknowledgements March 1976 vol 906 col 1024. 48 Hansard HL Deb 17 December 1973 vol 348 col 102. With thanks to my always helpful readers at LSHTM: 49 Hansard HL Deb 11 June 1974 vol 352 col 377. Agnes Arnold-Forster, Virginia Berridge, Hayley 50 Hansard HC Deb 1 March 1976 vol 906 col 928; reit- Brown, Hannah J Elizabeth, Alice Gambell, Martin erated in HC Deb 22 March 1979 vol 964 col 1791; Gorsky, Susanne Macgregor, Becky Martin, Alex Mold. HC Deb 20 July 1979 vol 970 col 2218; HL Deb 15 Manuscript received: November 2022 December 1980 vol 415 col 913. 51 Hansard HL Deb 11 June 1981 vol 421 col 343. See also HL Deb 25 June 1974 vol 352 col 1358. References 52 Hansard HC Deb 20 July 1979 vol 970 col 2218; HL Deb 25 June 1974 vol 352 col 1358. Avery, J. G. (1978). Car Seat-Belt Legislation: Third 53 Hansard HC Deb 20 July 1979 vol 970 col 2204. Time Lucky? British Medical Journal, 2, 1364. 54 Hansard HC Deb 25 June 1976 vol 913 col 2094. Bebber, B. (2017). Model Migrants? Sikh Activism 55 Hansard HL Deb 17 December 1973 vol 348 col 107. and Race Relations Organisations in Britain. 56 Letter to John Peyton dated 17 April 1972, in TNA Contemporary British History, 31, 568–592. MT 92/588. Bell, R. (1981). Crash Helmet Compulsion. The Times , 3 September, page 15. 57 Hansard HL Deb 17 December 1973 vol 348 col 117 PateRNalisM iN Hist ORical c ONteX t • 75 Benson, D. (1979). e B Th lunders. Daily Express , 24 July, Jones, M. M. and Ronald, B. (2007). Paternalism & Its pages 14–15. Discontents: Motorcycle Helmet Laws, Libertarian Brännmark, J. (2018). On the Epistemic Legitimacy of Values, and Public Health. American Journal of Government Paternalism. Public Health Ethics, 11, Public Health, 97, 208–217. 27–34. Leichter, H. (1986). Saving Lives and Protecting Liberty: Cairns, H. (1941). Head Injuries in Motor-cyclists: The A Comparative Study of the Seat-Belt Debate. Journal Importance of the Crash Helmet. British Medical of Health Politics, Policy and Law, 11, 323–344. Journal, 2, 465–471. Lowe, R. (1994). Lessons from the Past: The Rise and Carroll, P. E. (2002). Medical Police and the History of Fall of the Classic Welfare State in Britain, 1945-76. Public Health. Medical History, 46, 461–494. In Oakley, A. and Williams, A.S. (eds), e P Th olitics Carter, S. M., Entwistle, V. A. and Little, M. (2015). of the Welfare State. London: UCL Press, pp. 37–53. Relational Conceptions of Paternalism: A Way to Luckin, B. (2010). A Kind of Consensus on the Roads? Rebut Nanny-State Accusations and Evaluate Public Drink Driving Policy in Britain 1945–1970. Twentieth Health Interventions. Public Health, 129, 1021–1029. Century British History, 21, 350–374. Childress, J. F., Faden, R. R., Gaare, R. D., Gostin, L. Luckin, B. and Sheen, D. (2009). Defining Early O., Kahn, J., Bonnie, R. J., Kass, N. E., Mastroianni, Modern Automobility. Cultural and Social History, A. C., Moreno, J. D. and Nieburg, P. (2002). Public 6, 211–230. Health Ethics: Mapping the Terrain. Journal of Law, McKie, D. (1973). Talking Politics. The Lancet , 301, Medicine & Ethics, 30, 170–178. 1173–1174. Clark, P. (2019). “Problems of Today and Tomorrow”: McLoughlin, J. (1978). Seat Belt Law Almost Certain. Prevention and the National Health Service in the e Th Guardian , 30 October, page 4. 1970s. Social History of Medicine, 33, 981–1000. Mold, A., Clark P., Millward G., and Payling D. (2019). Clarke, P. (1977). Correspondence: Seat Belts. The Placing the Public in Public Health in Post-War Lancet, 309, 1155. Britain, 1948–2012. Cham: Palgrave Macmillan. Coggon, J. (2020). Smoke Free? Public Health Policy, Murley, R., Newton, P. E. and Allen, J. (1978). Car Seat- Coercive Paternalism, and the Ethics of Long-Game Belt Legislation: Third Time Lucky? British Medical Regulation. Journal of Law and Society, 47, 121–148. Journal, 2, 1492. Coggon, J., Syrett K., and Viens A.M. (2017). Public Noyes, H. (1973). Mr Speed Crashes into Helmet Health Law: Ethics, Governance, and Regulation. Trouble. The Times , 6 April, page 5. Abingdon: Routledge. Nuffield Council on Bioethics. (2007). Public Health: Coons, C., and Weber M., eds. (2013). Paternalism: Ethical Issues. London: Nuffield Council on Bioethics. Theory and Practice . Cambridge: Cambridge Nys, T. R. V. (2008). Paternalism in Public Health Care. University Press. Public Health Ethics, 1, 64–72. Crawley, R. (1976). Freedom and Safety. Observer, 17 Parliament: Seat-Belt Legislation. (1979). British Medical November, clipping in TNA MT 102/378. Journal, 1, 276. (1976) Belt up Hold Up, Daily Mirror, 2 December, clip- Pemberton, H. (2009). Strange Days Indeed: British ping in TNA MT 102/378. Politics in the 1970s. Contemporary British History, Durie, A. C. (1976). Compulsory Seat Belts. Times, 23 23, 583–595. February, page 13. Personal Liberty Versus Common Sense. (1980). The Feinberg, J. (1971). Legal Paternalism. Canadian Journal Lancet, 316, 567–568. of Philosophy, 1, 105–124. Pooley, C. (2021). Walking Spaces: Changing Pedestrian Flanigan, J. (2017). Seat Belt Mandates and Paternalism. Practices in Britain since c. 1850. Journal of Transport Journal of Moral Philosophy, 14, 291–314. History, 42, 227–246. Giubilini, A. and Julian, S. (2019). Vaccination, Risks, Primary Prevention: The Next Stage. (1973). The Lancet , and Freedom: The Seat Belt Analogy. Public Health 302, 82–83. Ethics, 12, 237–249. Robinson, E., Schofield, C., Sutcliffe-Braithwaite, F. and Gostin, L. O. and Gostin, K. G. (2009). A Broader o Th mlinson, N. (2017). Telling Stories about Post- Liberty: J.S. Mill, Paternalism and the Public’s Health. War Britain: Popular Individualism and the “Crisis” Public Health, 123, 214–221. of the 1970s. Twentieth Century British History, 28, Holland, S. (2009). Public Health Paternalism—A 268–304. Response to Nys. Public Health Ethics, 2, 285–293. Seat Belts and J.S. Mill. (1977). The Lancet , 309, 1140. 76 • West ON Seat Belts: The Overwhelming Evidence. (1977). British e T Th imes. (1962). Helmets to Be Compulsory , 13 July, Medical Journal, 1, 593–594. page 5. Seddon, T. (2020). Immoral in Principle, Unworkable in e T Th imes. (1973a). Seat Belt Not Worn: Girl’s Damages Practice: Cannabis Law Reform, the Beatles and the to Be Cut, 13 February, page 15. Wootton Report. British Journal of Criminology, 60, e T Th imes. (1973b). Sikhs Protest at New Helmet Ruling, 1567–1584. 1 March, page 5. Sirrs, C. (2016). Accidents and Apathy: The Construction e T Th imes. (1976). Worth A Law To Save Lives, 1 March, of the “Robens Philosophy” of Occupational Safety page 13. and Health Regulation in Britain, 1961–1974. Social Weston, P. A. M. and Paynton, D. J. (1977). Compulsory History of Medicine, 29, 66–88. Wearing of Safety Belts. British Medical Journal, 2, 955. Stewart, J., Strong, D. G. and Havard, J. D. J. (1976). Willard, T. (1976). Three Out of Four Call for “Belt up” Compulsory Wearing of Seat Belts. The Times , 28 Law. Birmingham Evening Mail, 13 December, clip- February, page 13. ping in TNA MT 102/378. e Th Biggest Epidemic of All Time. (1981). Man Alive. Wilson, J. (2011). Why It’s Time to Stop Worrying About BBC2, available from: https://vimeo.com/35067658 Paternalism in Health Policy. Public Health Ethics, 4, [accessed 20 September 2022]. 269–279.
Public Health Ethics – Oxford University Press
Published: Mar 13, 2023
Access the full text.
Sign up today, get DeepDyve free for 14 days.