Health Care Analysis最新文献

When thinking about the harms of drug addiction, there is a tendency to focus on the harms of drug consumption. But not all harms associated with drug addiction are caused by drug consumption. There is at least another dimension of harm worth considering: what I call the linguistic harm of drug addiction. Starting with an analysis of 'drug addict' as it appears in the media, I argue that 'drug addict' is inconsistently applied to people with drug addiction and that this inconsistency reveals two important features of the term. First, being called a 'drug addict' is worse than being described as 'having a drug problem'. Second, being called a drug addict exacerbates the challenges experienced by people with drug addiction. Referencing the 'addict' narrative, I detail how calling someone a drug addict can add to the marginalization of people with drug addiction and argue that to eliminate the linguistic harm of drug addiction, we ought to reduce it first. Using the analysis of 'drug addict' from the first half of the paper, I propose a novel harm reduction strategy that benefits people with drug addiction but calls on people who do not use drugs.

The target of my discussion is intuitions lay people have about justice in the context of drug policy-intuitions that take on a more or less moral-desert-based shape. I argue that even if we think desert is the right measure of how we ought to treat people, we ought still be in favour of Harm Reduction measures for people who use drugs. Harm Reduction measures are controversial with members of the public, and much of the opposition seems to come from something like an appeal to a desert conception of justice-the notion that a just state of affairs is one in which everybody gets what they deserve, no more, no less. A recent study, for example, found that 'moral outrage' predicts a preference for prevalence reduction (criminal sanction, etc.) over Harm Reduction. The thinking seems to be that, since drug use is wrong, letting people who use drugs suffer and/or die as a consequence of their use is just. Aiding their health and safety, while perhaps compassionate, is unjust. I argue that there is a bad desert fit between using drugs and suffering avoidable harm even if using drugs is morally wrong. Many of the possible harms of drug use are socially/policy driven, and much problematic drug use is context dependent, not cleanly attributable to the decisions of the person who uses drugs. This means that even if drug use is wrong, people who use drugs deserve Harm Reduction policies, at minimum.

The World Professional Association for Transgender Health's Standards of Care (WPATH SOC), now in its seventh edition, is a frequently cited, internationally recognized, evidence-based document that details a comprehensive framework for gender-related care of trans people. However, the WPATH SOC still relies heavily in some cases on gatekeeping practices, dubbed "triadic therapy," or a process where a trans patient is encouraged to seek out psychotherapy, and hormone therapy, and only then be able to engage in surgical options for transitioning. I use G. Alan Marlatt's harm reduction framework to argue that the triadic process creates its own set of harms that trans people have to contend with, especially insofar as it focuses on resolving gender dysphoria in a demanding, moralizing, and top-down way as opposed to enriching trans lives by reducing harms that prevent us from flourishing. Using Marlatt's criterion that harm reduction ought to be bottom-up, low threshold, and not moralizing, I develop a list of suggestions for what ought to be centrally considered in treating trans patients.

In this paper, I will argue that some prominent objections to parental licensing rely on dubious claims about the existence of a very stringent, if not indefeasible, right to parent, which would be violated by licensing. I claim that attaching such stringency to the right only makes sense if we make a number of idealising assumptions. Otherwise, it is deeply implausible. Instead, I argue that we should evaluate parental licensing policies in much the same way we would harm reduction policies. By adopting this critical perspective, we can see that there are powerful, but quite different, reasons to be cautious about parental licensing relating to our ability to minimize the harmful effects of mass-parenting in a world of minimal surveillance and intervention.

At first glance, it seems difficult to object to any program that merits the label "harm reduction." If harm is bad, as everyone recognizes, then surely reducing it is good. What's the problem? The problem, we submit, is twofold. First, there's more to "harm reduction," as that term is typically used, than simply the reduction of harm. Some of the wariness about harm-reduction programs may result from the nebulous "more." Thus, part of our task is to provide a clear definition of harm reduction. Next, we turn to a second problem: a worry about complicity. Those who object to harm reduction programs fear that participation in such programs would make them complicit in activities they deem immoral. In this paper we argue that this fear is largely unwarranted. We use supervised injection sites (SISs)-safe spaces for the use of risky drugs-as our paradigmatic case of harm reduction. These SISs are generally offered in the hope of reducing harm to both the drug user and the public. For this reason, our analysis focuses on complicity in harm. We draw upon the work of Gregory Mellema as our framework. Mellema offers three ways one can be complicit in harm caused by another: by enabling, facilitating or condoning it. We argue that one who operates an SIS is not complicit in any of these ways, while also laying out the conditions that must be met if one is to argue that harm reduction entails complicity in non-consequentialist wrongdoing.

Talk of harm reduction has expanded horizontally, to apply to an ever-widening range of policy domains, and vertically, becoming part of official legal and political discourse. This expansion calls for philosophical theorization. What is the best way in which to characterize harm reduction? Does it represent a distinctive ethical position? How is it best morally justified, and what are its moral limits? I distinguish two varieties of harm reduction. One of them, technocratic harm reduction, is premised on the fact of non-enforceability of prohibitionist policies. The second, deliberative harm reduction, is premised on the fact of reasonable disagreement, grounded in the fact that reasonable persons disagree about a range of controversial behaviours. I argue that deliberative harm reduction better accounts for some of harm reduction's most attractive features, and provides a plausible way of accounting for harm reductions's justificatory grounds and limits.

The justification for harm reduction as an approach to drug use and addiction is seen by many to be consequentialist in form and it has been claimed that as a deontologist Kant would reject harm reduction. I argue this is wrong on both counts. A more nuanced understanding of harm reduction and Kant shows them compatible. Kant's own remarks about intoxication reinforce this. Moreover, there is a Kantian argument that harm reduction is not only morally permissible but more consistent with the Kantian duty of respect for autonomy than mandatory abstinence approaches.

One of harm reduction's most salient features is its pragmatism. Harm reduction purports to distinguish itself from dominant prohibitionist and abstinence-based policy paradigms by being grounded in what is realistic, in contrast with the moralism or puritanism of prohibition and abstention. This is reflected in the meme "harm reduction works", popular both in institutional and grassroots settings. The idea that harm reduction is realistic and effective has meant different things among the main actors who seek to shape harm reduction policy. Drawing on scholarly literature about harm reduction, as well as examples from recent harm reduction advocacy efforts in relation to drug policy in Canada, this paper argues that harm reduction distinguishes itself through a unique "way of knowing". Grassroots harm reduction advocates, particularly as they argue through human rights frameworks, do more than simply make claims for the provision of particular services-like needle exchange, safe consumption sites, safe supply and the like-on the basis that these are realistic paths toward the health and well-being of people who use drugs. Rather, as they marshal lived experience in support of these policy changes through peer-driven initiatives in contexts of prohibition, they make particular claims about what constitute valid, methodologically rigorous evidence bases for action in contexts where policies to date have been driven by ideology and have developed in ways that have excluded and marginalized those most affected from policymaking. In doing so, they advocate for the centrality of people who use drugs not only in policy-making processes, but in evidence production itself.

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.