Harm Reduction and Benefits
- posted by Jim Leitzel @ 4:31 PM

Yesterday I noted the reluctance to adopt harm reduction measures
(such as needle exchanges and methadone maintenance) in the case
of currently illicit drugs, when analogous measures would be all but
universally applauded in other areas. (I mentioned the case of safer
football helmets, which could increase total football-related harm by
inducing more folks to play football.) Why this asymmetric treatment?

Presumably much of the answer has to do with perceptions of the
benefits of the activities themselves. Even people who loathe football
do not expect that everyone share their preferences, and they don't
take a dim view of those who recreate on the gridiron. But decisions to
pursue pleasure through the use of illicit drugs do not receive the
same license, obviously. (The use of nicotine and alcohol falls
somewhere in between in terms of social warrant, I would suggest.) It is
as though the consumption of an illicit substance has no benefits, though
millions of consumers evidently disagree.

The terms "harm reduction" or "harm minimization" themselves involve
the same implicit assumption. Economists talk about maximizing net
benefits, but not (typically) about minimizing harms. These different
objectives only are equivalent if the activity involves no benefits.
"Harm reduction" is a term more at home in the field of public health.
Diseases generally are taken to be wholly negative phenomena, and for
those diseases that cannot be prevented or cured, minimizing their
attendant harms is a sensible strategy.

The public debate over vice (and not just illicit drugs) often invokes,
implicitly, the notion of no benefits from vice consumption. When was
the last time you heard someone say, "you know, we really need to have
a bit more pornography available"? The debates about legalizing
prostitution mentioned in Vice Squad a couple days ago are framed
in terms of controlling the harms of prostitution, not of maximizing
net benefits.

[Public health and economic approaches to vice also differ in that
economists make much of the distinction between internal and external
harms (and benefits), but I will save that thought for another time.]

Why are football-related decisions by adults accorded respect, when
drug-related decisions (by non-addicted adults) are typically viewed
as suspect? Presumably because of some reluctance to view decisions
surrounding the traditional vices (psychoactive drugs, illicit sex, and
wagering) as fully rational. (The standard neoclassical economist
doesn't share this reluctance, and hence typically would be unwilling to
support regulations aimed solely at reducing harms to the users
themselves.) But even if you stipulate that self-control problems are
often associated with vice-related decisions, and hence that some
consumers are not fully rational (at least in the traditional sense), that
situation is still insufficient to justify a vice prohibition backed by criminal
penalties. The role of regulation, as I have argued before, should
be to aid those who suffer from self-control problems, but without
unduly inconveniencing those whose decisions to engage in vice are
fully rational. Prohibition (at least if accompanied by meaningful
enforcement) is too imposing upon rational adults.

Labels: harm reduction