Abstract
Harm reduction has been advocated to address a diverse range of public health concerns. The moral justification of harm reduction is usually presumed to be consequentialist because the goal of harm reduction is to reduce the harmful health consequences of risky behaviors, such as substance use. Harm reduction is contrasted with an abstinence model whose goal is to eradicate or reduce the prevalence of such behaviors. The abstinence model is often thought to be justified by ‘deontological’ considerations: it is claimed that many risky behaviors are morally unacceptable, and therefore that we have a moral obligation to recommend abstinence. Because harm reduction is associated with a consequentialist justification and the abstinence model is associated with a deontological justification, the potential for a deontological justification of harm reduction has been overlooked. This paper addresses this gap. It argues that the moral duty to protect autonomy and dignity that has been advocated in other areas of medical ethics also justifies the public health policy of harm reduction. It offers two examples—the provision of supervised injection sites and the Housing First policy to address homelessness—to illustrate the argument.
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Notes
In an unpublished manuscript, “‘Harm Reduction’ is Neither,” Nick King also argues against a consequentialist justification of harm reduction. He claims that harm reduction policies in fact operate to benefit the least well off and therefore that a justification that employs principles of justice may be promising. There may be interesting overlaps between a deontological approach and a justice approach that I won’t be able to pursue here.
Collins et al. [2], p. 7.
Ibid., pp. 23–24.
Mercer [15], p. 87.
MacCoun [9].
A document of the World Medical Association. See https://www.wma.net/policies-post/wma-declaration-of-helsinki-ethical-principles-for-medical-research-involving-human-subjects/ Accessed February 6, 2020. My emphasis.
The Belmont Report (United States Department of Health and Human Services). See https://www.hhs.gov/ohrp/regulations-and-policy/belmont-report/read-the-belmont-report/index.html Accessed February 6, 2020.
Killmister [7], p. 161.
Killmister [7], pp. 161–162.
Ibid. I am grateful to an anonymous referee for pointing out that evaluation of the evidence in these contexts is a complex matter and that it should not be assumed that evidence is always equivocal or that evidence-based policymaking is a flawed enterprise.
Ibid.
Killmister [7], p. 161.
https://www.camh.ca/en/camh-news-and-stories/a-housing-first-success-story. Accessed February 6, 2020.
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I am grateful to the editors, Shannon Dea and Daniel Weinstock, and to two anonymous referees whose constructive comments helped to clarify the paper.
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Stoljar, N. Disgust or Dignity? The Moral Basis of Harm Reduction. Health Care Anal 28, 343–351 (2020). https://doi.org/10.1007/s10728-020-00412-y
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DOI: https://doi.org/10.1007/s10728-020-00412-y