Autonomy and the harm principle

Tags: ethics 

That the only purpose for which power can be rightfully exercised over any member of a civilized community, against his will, is to prevent harm to others. His own good, either physical or moral, is not a sufficient warrant ... Over himself, over his body and mind, the individual is sovereign. 

John Stewart Mill

Mill is arguing that the only legitimate reason for the government to interfere in an individual's life is to prevent that individual from harming others. Mill believed that individuals are sovereign over their own bodies and minds, and that they have the right to make their own decisions, even if those decisions are wrong or harmful to themselves. He argues that the only way to ensure that people are free to live their own lives is to protect their individual liberty.

Autonomy is the right of individuals to make their own decisions free from external coercion or interference. The harm principle is a moral principle that states that people should be free to act however they wish unless their actions cause harm to others.

Autonomy and the harm principle are closely related in that they both value individual liberty. Autonomy is the ability to exercise one's own freedom, while the harm principle is a restriction on that freedom to prevent harm to others.

One way to think about the relationship between autonomy and the harm principle is that autonomy is the default position. We assume that individuals have the right to make their own decisions, even if we disagree with those decisions. The harm principle is a justification for overriding autonomy when necessary to prevent harm.

For example, we generally believe that adults have the right to smoke cigarettes, even though smoking is harmful to the smoker's health. However, we may also believe that it is justified to restrict smoking in public places to protect the health of non-smokers. In this case, the harm principle overrides the smoker's autonomy.

Another way to think about the relationship between autonomy and the harm principle is that they are both important values that sometimes need to be balanced against each other. There is no easy answer to the question of how to weigh these two values in specific cases.

For example, consider the debate over vaccination mandates. Some people believe that individuals should have the right to choose whether or not to vaccinate themselves and their children, even if this means putting others at risk. Others believe that the government should mandate vaccination in order to protect public health. In this case, there is a conflict between the individual's right to autonomy and the collective interest in preventing harm.

Ultimately, the relationship between autonomy and the harm principle is complex. It is a matter of balancing two important values in specific cases.

Here are some other examples of how autonomy and the harm principle interact:

• Freedom of speech: The harm principle is often used to justify restrictions on freedom of speech, such as laws against hate speech and incitement to violence.

• Medical ethics: The harm principle is used to guide decision-making in medical ethics, such as when to override a patient's refusal of treatment.

• Public safety: The harm principle is used to justify laws and regulations that protect public safety, such as traffic laws and building codes.

"Liberty consists in the freedom to do everything which injures no one else; hence the exercise of the natural rights of each man has no limits except those which assure to the other members of the society the enjoyment of the same rights. These limits can only be determined by law." Frances declaration of rights

Spider-Man, a single male in his early 20s, presents to the GP clinic with a headache. He has been having headaches for several weeks, and they have been getting worse. He describes the headaches as pounding and throbbing, and they are often accompanied by nausea and vomiting.  Spider-Man tells the GP that he began experiencing the headaches after he was hit in the head by a falling object while fighting Green Goblin, a supervillain. The GP suspects that Spider-Man has a concussion, but is worried about serious head injuries and recommends that he go to the A&E department for further assessment.

Spider-Man declines to go to the A&E department, citing two reasons. First, he needs to get back to work and prevent Green Goblin from destroying the local practice waiting room. Second, he believes that he will be able to manage his concussion at home with over-the-counter pain relievers and rest.

Questions 

• What are the clinical issues here?

• What are the ethical issues and how do they relate to autonomy

• What would you do?

More cases 

• Case 1: A patient with diabetes refuses to take their insulin because they are afraid of the side effects. The patient's blood sugar levels are dangerously high, and the doctor is concerned about the risk of complications. The doctor discusses the risks and benefits of insulin with the patient, but the patient is still adamant about not taking it.

• Case 2: A patient with chronic back pain is seeing a chiropractor instead of a doctor. The chiropractor is recommending a series of expensive and unproven treatments. The doctor is concerned that the patient is not receiving the best possible care, and that they are wasting their time and money.

• Case 3: A patient with a history of alcohol abuse is asking for a prescription for a benzodiazepine. Benzodiazepines are addictive, and the doctor is concerned that the patient will relapse if they are prescribed the medication. However, the patient is insistent, and they threaten to go to another doctor if they don't get the prescription.

• Case 4: A patient with depression is refusing to take their medication. The patient is experiencing suicidal thoughts, and the doctor is concerned about the patient's safety. The doctor tries to talk the patient into taking their medication, but the patient refuses.

Varelius, J. (2006). The value of autonomy in medical ethics. Medicine, Health Care, and Philosophy, 9(3), 377-388. https://doi.org/10.1007/s11019-006-9000-z

Harm principle. (2023, October 02). In Wikipedia. https://en.wikipedia.org/wiki/Harm_principle