Mill's Harm Research Articles

Justification for coercion in a public health crisis: not just a matter of individual harm.

The COVID pandemic was an exceptional public health situation - which brought with it unprecedented restrictions across the global populace. But what was it about this pandemic which caused us to implement such drastic restrictions on liberty? Much of the ethical debate on restrictive measures such as lockdowns and vaccine requirements focused on the potential harm that individuals cause to other individuals by the risk of infection. I will suggest that this may come from a reliance on J.S. Mill's harm principle as providing the ultimate justification for coercion - i.e., the well-accepted principle that state coercion is justified in order to prevent the imposition of unacceptable risk of harm to others. Though there have been attempts, in the wider public health ethics literature, to use the harm principle as a basis for restricting contribution to collective harms, I will suggest that these attempts cannot rely on the harm principle alone. I will then turn to the ways in which an individual-based line of reasoning does not capture a distinctive sort of harm posed by the COVID pandemic (and others like it): the potential failure of healthcare systems. I will draw out three ways in which a focus on the harm that an individual poses to another individual fails to capture the full scope of harm wrought by the collapse of healthcare systems. First, it can't adequately capture the cumulative and "looping effects" of the harm caused by strained healthcare systems. Second, it fails to capture the widespread ripple effects the failure of a central societal institution can have on other institutions. And third, the failure of a healthcare system can impose "psychic costs", affecting the moral character of all members of society, reducing trust in institutions, and potentially posing an existential threat to the fabric of society. Finally, I will sketch some implications of the recognition of this distinctive sort of harm for the justification of coercive public health measures.

Harm to What Others? J. S. Mill's Ambivalence Regarding Third-Party Harm

abstract: John Stuart Mill's harm principle holds that an individual's freedom can only be restricted to prevent harm to others. However, there is an important ambiguity between a strong version, which limits legitimate interference to self-defense and therefore prohibits society from protecting third parties (those who are not its members), and a narrow version, which grants any society universal jurisdiction to prevent nonconsensual harms, no matter who is harmed. Mill sometimes appeals to the strong harm principle to preclude interference, but elsewhere endorses measures (including humanitarian foreign intervention and animal cruelty laws) to protect third parties, suggesting that he subscribes only to the weak harm principle. This ambiguity regarding who it is that society has standing to protect has important implications for the scope of individual freedom.

The harm threshold and Mill’s harm principle

The Harm Threshold (HT) holds that the state may interfere in medical decisions parents make on their children’s behalf only when those decisions are likely to cause serious harm to the child. Such a high bar for intervention seems incompatible with both parental obligations and the state’s role in protecting children’s well-being. In this paper, I assess the theoretical underpinnings for the HT, focusing on John Stuart Mill’s Harm Principle as its most plausible conceptual foundation. I offer (i) a novel, text-based argument showing that Mill’s Harm Principle does not give justificatory force to the HT; and (ii) a positive account of some considerations which, beyond significant harm, would comprise an intervention principle normatively grounded in Mill’s ethical theory. I find that substantive recommendations derived from Mill’s socio-political texts are less laissez-faire than they have been interpreted by HT proponents. Justification for state intervention owes not to the severity of a harm, but to whether that harm arises from the failure to satisfy one’s duty. Thus, a pediatric intervention principle derived from Mill ought not to be oriented around the degree of harm caused by a parent’s healthcare decision, but rather, the kind of harm—specifically, whether the harm arises from violation of parental obligation. These findings challenge the interpretation of Mill adopted by HT proponents, eliminating a critical source of justification for a protected domain of parental liberty and reorienting the debate to focus on parental duties.

J.S. Mill's Puzzling Position on Prostitution and his Harm Principle

AbstractJ.S. Mill argues against licensing or forced medical examinations of prostitutes even if these would reduce harm, for two reasons: the state should not legitimize immoral conduct; and coercing prostitutes would violate Mill's harm principle as they do not risk causing non-consensual harm to others, their clients do. There is nothing puzzling about Mill opposing coercive restrictions on self-regarding immoral conduct while also opposing state support of that conduct. But why does Mill oppose restrictions on prostitutes’ liberty if those restrictions could prevent harm to third parties? Mill's position is not puzzling once we recognize that his harm principle is not a harm-prevention principle that warrants restrictions on liberty to prevent harm no matter who caused it (as David Lyons famously argued) but instead warrants restrictions on liberty only of individuals who are the morally relevant cause of that harm. Mill's discussion of prostitution shows he prioritizes both individuality and moral progress over harm reduction.

The citizen choice architect in an ultra-processed world

AbstractTwo concepts shaped and continue to shape the discussion on the limits of a liberal and democratic state. First, Mill's harm principle, according to which the fundamental justification for a state exercising power over individuals is to prevent harm being done to others. Second, the distinction between the public sphere, where liberal democracies can intervene, and the private sphere, where individuals are, in principle, free to do as they like. I argue that both concepts have to be revisited in the context of today's ‘ultra-processed’ world, in which sophisticated technologies and highly engineered products reach deep into the private sphere, exploiting human psychology and jeopardizing citizens’ health and welfare in the interest of maximizing profit. In this ultra-processed world, where the distinction between the public and the private spheres is blurred, systemic interventions such as regulation and taxation, often criticized as paternalistic, are necessary to minimize harm. However, they must be complemented by interventions informed by behavioural science that modify and guide individual behaviours. Beyond the soft paternalism of nudging, people can be empowered to self-nudge – a non-paternalistic approach that enables them to design and structure their own decision environments and choice architectures as they see fit.

A Neo-Republican Critique of AI ethics

The AI Ethics literature, aimed to responsibly develop AI systems, widely agrees on the fact that society is in dire need for effective accountability mechanisms with regards to AI systems. Particularly, machine learning (ML) systems cause reason for concern due to their opaque and self-learning characteristics. Nevertheless, what such accountability mechanisms should look like remains either largely unspecified (e.g., ‘stakeholder input’) or ineffective (e.g., ‘ethical guidelines’). In this paper, I argue that the difficulty to formulate and develop effective accountability mechanisms lies partly in the predominant focus on Mill's harm's principle, rooted in the conception of freedom as non-interference. A strong focus on harm overcasts other moral wrongs, such as potentially problematic power dynamics between those who shape the system and those affected by it. I propose that the neo-republican conception of freedom as non-domination provides a suitable framework to inform responsible ML development. Domination, understood by neo-republicans, is a moral wrong as it undermines the potential for human flourishing. In order to mitigate domination, neo-republicans plead for accountability mechanisms that minimize arbitrary relations of power. Neo-republicanism should hence inform responsible ML development as it provides substantive and concrete grounds when accountability mechanisms are effective (i.e. when they are non-dominating).

The legitimacy of criminalizing drugs: Applying the ‘harm principle’ of John Stuart Mill to contemporary decision-making

The article assesses the legitimacy of criminalizing drugs on the basis of relevant liberty-limiting principles. Where appropriate, empirical findings about drugs, drug use and drug policies are used to make the assessment. John Stuart Mill's harm principle is the pivotal element of this exploration and Joel Feinberg's framework of the moral limits of criminal law is used as a heuristic. First, the article considers whether legal moralism or legal paternalism provide arguments convincing enough to justify the criminalizing of drugs. Second, it explores whether individual conduct that does not harm others but causes harm to society by accumulation provides sufficient justification. The article concludes that drug use falls within the jurisdiction of individual choice that Mill identifies in his principle of liberty and the ‘accumulative harm’ perspective does not carry enough weight to justify their prohibition, and therefore society is not morally authorized to criminalize drugs.

John Stuart Mill's Harm Principle and Free Speech: Expanding the Notion of Harm

AbstractThis article advocates employing John Stuart Mill's harm principle to set the boundary for unregulated free speech, and his Greatest Happiness Principle to regulate speech outside that boundary because it threatens unconsented-to harm. Supplementing the harm principle with an offense principle is unnecessary and undesirable if our conception of harm integrates recent empirical evidence unavailable to Mill. For example, current research uncovers the tangible harms individuals suffer directly from bigoted speech, as well as the indirect harms generated by the systemic oppression and epistemic injustice that bigoted speech constructs and reinforces. Using Mill's ethical framework with an updated notion of harm, we can conclude that social coercion is not justified to restrict any harmless speech, no matter how offensive. Yet certain forms of speech, such as bigoted insults, are both harmful and fail to express a genuine opinion, and so do not deserve free speech protection.

A sufficiency threshold is not a harm principle: A better alternative to best interests for overriding parental decisions.

Douglas Diekema influentially argues that interference with parental decisions is not in fact guided by the child's best interests, but rather by a more permissive standard, which he calls the harm principle. This article first seeks to clarify this alternative position and defend it against certain existing criticisms, before offering a new criticism and alternative. This 'harm principle' has been criticized for (i) lack of adequate moral grounding, and (ii) being as indeterminate as the best interest standard that it seeks to replace. I argue that these are not serious problems. I take Diekema's negative point to be right-our actual standard for intervention is not literally the best interests of the child-but I disagree with his proposed replacement. First, Diekema's proposed harm threshold should be more carefully distinguished from Mill's harm principle. Second, there is no reason to assume that the standard for permissible intervention coincides with the threshold for harm (or serious harm). Thus, I propose that the best alternative to the best interests standard is not a harm principle, but rather a sufficiency threshold between adequate (or 'good enough') and inadequate (or 'substandard') parenting.

Clinician Perspectives on Ethics and COVID-19: Minding the Gap in Sexual and Reproductive Health.

Clinician Perspectives on Ethics and COVID-19: Minding the Gap in Sexual and Reproductive Health.

Conceptual challenges to the harm threshold

Children are presumptively regarded as incompetent to make their own medical decisions, and the responsibility for making such decisions typically falls to parents. Parental authority is not unlimited, however, and ethical guidelines identifying appropriate bounds on this authority are needed. One proposal currently gaining support is the harm threshold (HT), which asserts that the state may only legitimately intervene in parental decision-making when serious and preventable harm to children is likely. This paper considers two questions: in virtue of what underlying principle or property does the HT gain its purported justification?; and does this underlying principle or property ground the HT as its proponents conceive of it? I identify two separate grounds represented in the literature: (a) J.S. Mill's Harm Principle; and (b) the liberty interests of parents. I find that the HT is not sufficiently grounded in either of these, revealing a substantial conceptual difficulty for its advocates.

The subversion of Mill and the ultimate aim of nursing.

This is lightly edited and referenced version of a presentation given at the 20th International Philosophy of Nursing conference in Quebec on 23rd August 2016. Philosophical texts are not given the same prominence in nurse education as their more valued younger sibling, primary research evidence, but they can influence practice through guidelines, codes and espoused values. John Stuart Mill's harm principle, found in On Liberty, is not a universal law, and only a thoroughgoing libertarian would defend it as such, though it, or its remnants, can be seen can be seen in policy documents. But its influence is weakening. Smoking bans in enclosed spaces were initially justified with other-regarding considerations, but judgements from unsuccessful legal challenges from patients in UK psychiatric hospitals rely on preventing harm to the smoker, even when smoking outside, which does not harm others. In the wake of legislation, no-smoking policies enacted by hospitals are becoming more aggressive, banning smoking both inside and outside, and extending the use of power gained through employment to prevent nurses assisting patients enjoy a lawful habit. Mill's dictum has been subverted, and this speaks to the fundamental purpose of nursing. Should nurses collude and willingly exert their power for their version of the good of the patient? Or should they instead reaffirm values that support and facilitate life choices made by autonomous people? The paper supports the latter option, and this has wider application for nursing which can be illuminated, if not settled, by revisiting Mill and his famous dictum.

On the philosophical foundations of medical ethics: Aristotle, Kant, JS Mill and Rawls

Summary This article aims to trace back some of the theoretical foundations of medical ethics that stem from the philosophies of Aristotle , Immanuel Kant, John Stuart Mill and John Rawls. The four philosophers had in mind rational and autonomous human beings who are able to decide their destiny, who pave for themselves the path for their own happiness. It is argued that their philosophies have influenced the field of medical ethics as they crafted some very important principles of the field. I discuss the concept of autonomy according to Kant and JS Mill, Kant's concepts of dignity, benevolence and beneficence , Mill's Harm Principle (nonmaleficence), the concept of justice according to Aristotle, Mill and Rawls, and Aristotle's concept of responsibility.

Finding the Harm in Hate Speech: An Argument against Censorship

AbstractThe liberal justification for censorship equates the harm in hate speech with the sort of tangible injury that would justify state intervention under J.S. Mill's harm principle. Recently, Jeremy Waldron has suggested that the real harm perpetuated by hate speech is less tangible, taking it to be a variety of moral pollution which undermines both the public good of inclusiveness and the minority's assurance of personal dignity. This paper scrutinizes Waldron's conception of the harm in hate speech, arguing that it lacks the specificity and gravity Mill's principle requires in order to justify censorship. The paper also questions the categorical distinction between hate speech and speech that is “merely offensive,” arguing that Waldron's reasons for censoring the one also apply to the other. The result is a censorship regime that liberals ought not to accept.

The use of data mining by private health insurance companies and customers' privacy.

This article examines privacy threats arising from the use of data mining by private Australian health insurance companies. Qualitative interviews were conducted with key experts, and Australian governmental and nongovernmental websites relevant to private health insurance were searched. Using Rationale, a critical thinking tool, the themes and considerations elicited through this empirical approach were developed into an argument about the use of data mining by private health insurance companies. The argument is followed by an ethical analysis guided by classical philosophical theories-utilitarianism, Mill's harm principle, Kant's deontological theory, and Helen Nissenbaum's contextual integrity framework. Both the argument and the ethical analysis find the use of data mining by private health insurance companies in Australia to be unethical. Although private health insurance companies in Australia cannot use data mining for risk rating to cherry-pick customers and cannot use customers' personal information for unintended purposes, this article nonetheless concludes that the secondary use of customers' personal information and the absence of customers' consent still suggest that the use of data mining by private health insurance companies is wrong.

In defence of mandatory bicycle helmet legislation: response to Hooper and Spicer

We invoke a triple rationale to rebut Hooper and Spicer's argument against mandatory helmet laws. First, we use the laws of physics and empirical studies to show how bicycle helmets...

A Response to H.L.A. Hart Embodiment of Mill's Harm Principle that All Laws are Not an Expression of Morality but a Way to Prevent Harm (Law, Liberty and Morality, 1963, Part of the Hart - Devlin Debate)

John Finnis believes that morality is what led to the common good. In this context, he believes that seven underived basic goods exist in all culture: life, knowledge, practical reasonableness, play, aesthetic experience, sociability and religion. These basic goods are, according to Finnis, what we should seek. Aquinas morality was abstract but Finnis gives us goal, a direction to follow. He gives us nine principles of practical reasonableness. The first principle of practical reasonableness follows directly in correlation with Aquinas’ first principle of moral action: Good is to be done and pursued, and evil avoided”. Finnis’ principles of practical reasonableness are what can call a guide to help people seek the seven basic goods and therefore seek morality. Finnis theory is really pragmatic since, to recognize the immoral thing, you only have to ask yourself if this very thing can help you to seek one or more of the seven basic goods.But this leads us to wonder if the seven basic good does not consist in only one and only very basic good which is actually pleasure and brings his way of recognizing the immorality closer to Bentham’s one.

A normative approach to the criminalisation of cartel activity

Although cartel behaviour is almost universally (and rightly) condemned, it is not clear why cartel participants deserve the full wrath of the criminal law and its associated punishment. To fill this void, I develop a normative (or principled) justification for the criminalisation of conduct characteristic of ‘hard core’ cartels. The paper opens with a brief consideration of the rhetoric commonly used to denounce cartel activity, eg that it ‘steals from’ or ‘robs’ consumers. To put the discussion in context, a brief definition of ‘hard core’ cartel behaviour is provided and the harms associated with this activity are identified. These are: welfare losses in the form of appropriation (from consumer to producer) of consumer surplus, the creation of deadweight loss to the economy, the creation of productive inefficiency (hindering innovation of both products and processes), and the creation of so-called X-inefficiency. As not all activities which cause harm ought to be criminalised, a theory as to why certain harms in a liberal society can be criminalised is developed. It is based on JS Mill's harm to others principle (as refined by Feinberg) and on a choice of social institutions using Rawls's ‘veil of ignorance.’ The theory is centred on the value of individual choice in securing one's own well-being, with the market as an indispensable instrument for this. But as applied to the harm associated with cartel conduct, this theory shows that none of the earlier mentioned problems associated with this activity provide sufficient justification for criminalisation. However, as the harm from hard core cartel activity strikes at an important institution which permits an individual's ability to secure their own well-being in a liberal society, criminalisation of hard core cartel behaviour can have its normative justification on this basis.

A plea for precaution with public health: the xenotransplantation example

In this paper we argue that while individual private interests such as autonomy and the need for a medical procedure or treatment are important in the provision and delivery of health care and the utilization of biotechnologies, these concepts need to be balanced with other interests such that in certain situations they do not take priority. We use as an example a particular developing biotechnology, xenotransplantation, to suggest that interest in the health of the public is such that this biotechnology should not be permitted to move to the clinical trial stage because of the particular risk of harm it poses to the potential xeno-recipient, their close contacts and the wider population. This is despite the interest of those in need of a transplant in allowing such clinical trials to proceed. We derive support for our position from John Stuart Mill's harm principle.

Beyond the ‘nanny state’: Stewardship and public health

SUMMARYBackgroundSome public health measures restrict personal freedom more than others, and deciding what type of measure will be appropriate and effective has long been a problem for policy makers. Existing bioethical frameworks are often not well suited to address the problems of public health.MethodsThe Nuffield Council on Bioethics set up an expert working party to examine the ethical issues surrounding public health in January 2006. Following evidence gathering and a public consultation exercise, the Council published its conclusions and recommendations in the report ‘Public health: ethical issues’ in November 2007.ResultsA spectrum of views exists on the relationship between the state's authority and the individual. The Council set out a proposal to capture the best of the libertarian and paternalistic approaches, in what it calls the ‘stewardship model’. This model suggests guiding principles for making decisions about public health policies, and highlights some key principles including Mill's harm principle, caring for the vulnerable, autonomy and consent. An ‘intervention ladder’ is also proposed, which provides a way of thinking about the acceptability of different public health measures. The report then applies these principles to a number of case studies: infectious diseases, obesity, alcohol and tobacco, and fluoridation of water supplies.ConclusionsThe idea of a ‘nanny state’ is often rejected, but the state has a duty to look after the health of everyone, and sometimes that means guiding or restricting people's choices. On the other hand, the state must consider a number of principles when designing public health programmes, and justification is required if any of these principles are to be infringed.