Harm Reduction: A Misnomer
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Harm Reduction: A Misnomer Nicholas B. King1 Accepted: 15 October 2020 © The Author(s) 2020
Abstract ‘Harm reduction’ programs are usually justified on the utilitarian grounds that they aim to reduce the net harms of a behavior. In this paper, I contend that (1) the historical genesis of harm reduction programs, and the crucial moral imperative that distinguishes these programs from other interventions and policies, are not utilitarian; (2) the practical implementation of harm reduction programs is not, and probably cannot be, utilitarian; and (3) the continued justification of harm reduction on utilitarian grounds is untenable and may itself cause harm. Promoting harm reduction programs as utilitarian in the public arena disregards their deeper prioritarian impulses. ‘Harm reduction’ is a misnomer, and the name should be abandoned sooner rather than later. Keywords Harm reduction · Philosophy · Ethics · Utilitarianism · Justice
Introduction Given the foregrounding of the words ‘harm’ (which implies an explicit assessment of harms and an implicit assessment of benefits) and ‘reduction’ (which implies a demonstrated decrease in harms), it is unsurprising that ‘harm reduction’ is generally considered a utilitarian approach to public health. Unsurprising, but wrong. In this paper, I contend that (1) the historical genesis of harm reduction programs, and the crucial moral imperative that distinguishes these programs from other interventions and policies, are not utilitarian; (2) the practical implementation of harm reduction programs is not, and probably cannot be, fully utilitarian; and (3) the continued justification of harm reduction on utilitarian grounds is untenable and may itself cause harm. Harm reduction programs are not utilitarian, they are rarely implemented in a spirit of utilitarianism, they should not be promoted or defended as such, and the extension of ‘harm reduction’ into new arenas under the banner
* Nicholas B. King [email protected] 1
Biomedical Ethics Unit, McGill University, Montreal, Canada
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of utilitarianism is misguided. For most of the programs that bear the name, ‘harm reduction’ is a potentially damaging misnomer. Defining Harm Reduction Programs as Utilitarian Precise definitions of ‘harm reduction’ are hard to come by, and the term has been subject to robust debate. Programs bearing the name encompass a variety of actors, practices, and goals [4, 11], and attempts to define the term draw on multiple histories and claim compatibility with several philosophical positions. For example, Newcombe argues that harm reduction “has its main roots in the scientific public health model, with deeper roots in humanitarianism and libertarianism” [17], while the Harm Reduction International website contends that “harm reduction is grounded in justice and human rights.” Nevertheless, these are minority positions, and harm reduction is almost universally defined by two contrasts. The first, as Holland notes, is practical: The key is to distin
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