Disgust or Dignity? The Moral Basis of Harm Reduction
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Disgust or Dignity? The Moral Basis of Harm Reduction Natalie Stoljar1 Accepted: 12 October 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
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. Keywords Harm reduction · Medical ethics · Relational autonomy · Dignity
Introduction Harm reduction policies have been advocated to address a diverse range of public health concerns, from substance use to risky sexual behavior to homelessness [2]. The harm reduction approach seeks to ameliorate the harmful consequences of engaging in the behavior and hence it is thought that the moral justification of harm reduction is consequentialist. In contrast, abstinence or ‘prevalence reduction’ models are claimed to have a deontological justification because the relevant behaviors are often treated as morally questionable or deserving of ‘moral outrage’ [9]. It has * Natalie Stoljar [email protected] 1
Department of Philosophy and Institute for Health and Social Policy, McGill University, 855 Sherbrooke St, W., Montreal, QC H3A 2T7, Canada
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been argued that there is a moral duty to promote abstinence and that public policy should send a clear message supporting this moral duty. Because the harm reduction model is associated with a consequentialist justification and the abstinence model is associated a deontological justification, the potential for a deontological or dutybased justification of harm reduction has been overlooked.1 This paper addresses this gap. I argue that the values of individual autonomy and dignity—core values in other areas of medical ethics—should play an important role in public health ethics generally and the justification of harm reduction in particular. Harm reduction policies are an important example of how the general moral duties to promote aut
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