Department of Philosophy and Institute for Health and Social Policy, McGill University, 855 Sherbrooke St, W., Montreal, QC, H3A 2T7, Canada.
Health Care Anal. 2020 Dec;28(4):343-351. doi: 10.1007/s10728-020-00412-y. Epub 2020 Oct 24.
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.
减少伤害策略已被倡导用于解决各种公共卫生问题。减少伤害策略的道德正当性通常被假定为后果主义，因为减少伤害策略的目标是减少危险行为（如药物使用）对健康的有害后果。减少伤害策略与禁欲模式形成对比，后者的目标是消除或减少此类行为的流行。禁欲模式通常被认为是由“道义论”考虑来证明其合理性的：有人声称，许多危险行为在道德上是不可接受的，因此我们有道德义务建议禁欲。由于减少伤害策略与后果主义的理由有关，而禁欲模式与道义论的理由有关，因此减少伤害策略的道义论理由的可能性被忽视了。本文旨在弥补这一空白。它认为，在其他医学伦理领域所倡导的保护自主性和尊严的道德义务也证明了减少伤害的公共卫生政策是合理的。它提供了两个例子——提供监督注射场所和解决无家可归问题的“首先住房”政策——来说明这一论点。
