SARS-CoV-2 safer infection sites: moral entitlement, pragmatic harm reduction strategy or ethical outrage?

The pandemic of SARS-CoV-2 has led to unprecedented changes to society, causing unique problems that call for extraordinary solutions. We consider one such extraordinary proposal: ‘safer infection sites’ that would offer individuals the opportunity to be intentionally infected with SARS-CoV-2, isolate, and receive medical care until they are no longer infectious. Safer infection could have value for various groups of workers and students. Health professionals place themselves at risk of infection daily and extend this risk to their family members and community. Similarly, other essential workers who face workplace exposure must continue their work, even if have high-risk household members and live in fear of infecting. When schools are kept closed because of the fear that they will be sites of significant transmission, children and their families are harmed in multiple ways and college students who are living on campus, whether or not they are attending classes in person, are contributing to high rates of transmission and experiencing high rates of exposure. We consider whether offering safer infection sites to these groups could be ethically defensible and identify the empirical unknowns that would need to resolve before reaching definitive conclusions. This article is not an endorsement of intentional infection with the coronavirus, but rather is meant to spark conversation on the ethics of out-of-the-box proposals. Perhaps most meaningfully, our paper explores the value of control and peace of mind for those among us most impacted by the pandemic: those essential workers risking the most to keep us safe.

Download Full-text

Erratum for “Misoprostol in women's hands: a harm reduction strategy for unsafe abortion" Contraception 2013 Feb; 87(2): 128–130

Contraception ◽

10.1016/j.contraception.2015.08.011 ◽

2016 ◽

Vol 93 (1) ◽

pp. 87

Author(s):

Alyson Hyman ◽

Kelly Blanchard ◽

Francine Coeytaux ◽

Daniel Grossman ◽

Alexandra Teixeira

Keyword(s):

Harm Reduction ◽

Unsafe Abortion ◽

Reduction Strategy ◽

Harm Reduction Strategy

Download Full-text

Public Health Implications of Smokeless Tobacco Use as a Harm Reduction Strategy

American Journal of Public Health ◽

10.2105/ajph.2005.075499 ◽

2006 ◽

Vol 96 (11) ◽

pp. 1934-1939 ◽

Cited By ~ 38

Author(s):

David A. Savitz ◽

Roger E. Meyer ◽

Jason M. Tanzer ◽

Sidney S. Mirvish ◽

Freddi Lewin

Keyword(s):

Public Health ◽

Harm Reduction ◽

Tobacco Use ◽

Smokeless Tobacco ◽

Reduction Strategy ◽

Health Implications ◽

Harm Reduction Strategy ◽

Smokeless Tobacco Use

Download Full-text

Performance-Enhancing Substances in Sports

10.1093/oso/9780190130640.003.0019 ◽

2021 ◽

pp. 266-275

Author(s):

Kaveri Prakash

Keyword(s):

Harm Reduction ◽

Level Playing Field ◽

New Approach ◽

Reduction Strategy ◽

Playing Field ◽

Ethical Frameworks ◽

Harm Reduction Strategy ◽

Practice Of Medicine ◽

Performance Enhancing Substances ◽

Performance Enhancing

Given that the current strategies focusing on deterrence and punishment are increasingly ineffective worldwide, is there a radically different approach to ensuring a level playing field? This essay explores the growing discourse on alternate approaches to controlling the use of performance enhancing substances (PES) in sports and reflects on the fact that social and cultural behaviour patterns, plus a lack of ethics in the practice of medicine are the issues that need to be tackled urgently in this eagerness to ensure a level playing field in sports. Kaveri Prakash cautiously argues for adopting a relatively new approach, under wide discussion, centring on a harm reduction strategy, that would allow performance enhancing substances to be administered under supervision. However, this will only be successful if regulatory and ethical frameworks in related areas are strengthened and current practices are systematically reviewed and either discarded or reformed. Moreover, India needs to pay serious attention to its sporting population, on and off the field, in order to gauge its response to regulation.

Download Full-text

The Ethics of Tobacco Harm Reduction: An Analysis of E-Cigarette Availability From the Perspectives of Utilitarianism, Bioethics, and Public Health Ethics

Nicotine & Tobacco Research ◽

10.1093/ntr/ntaa198 ◽

2020 ◽

Cited By ~ 1

Author(s):

Rebecca Thomas ◽

Lisa S Parker ◽

Saul Shiffman

Keyword(s):

Public Health ◽

Harm Reduction ◽

Biomedical Ethics ◽

Public Health Ethics ◽

Individual Autonomy ◽

Tobacco Harm Reduction ◽

Reduction Strategy ◽

Ethics Framework ◽

Health Ethics ◽

Harm Reduction Strategy

Abstract Much evidence suggests e-cigarettes are substantially less harmful than combustible cigarettes. Assuming this is true, we analyze the ethical case for a policy of e-cigarette availability (ECA) as a tobacco harm reduction strategy. ECA involves making e-cigarettes available to allow smokers to switch to them, and informing smokers of the lower risks of e-cigarettes vis-à-vis smoking. After suggesting that utilitarian/consequentialist considerations do not provide an adequate ethical analysis, we analyze ECA using two other ethical frameworks. First, ECA is supported by a public health ethics framework. ECA is a population-level intervention consistent with respecting individual autonomy by using the least restrictive means to accomplish public health goals, and it supports equity and justice. Second, ECA is supported by four principles that form a biomedical ethics framework. By reducing smokers’ health risks and not harming them, ECA fulfills principles of beneficence and non-maleficence. Because ECA allows smokers to make informed health decisions for themselves, it fulfills the principle requiring respect for persons and their autonomy. Here, we consider whether nicotine addiction and thus ECA undermine autonomy, and also discuss the ethical warrant for special protections for youth. Finally, ECA can also advance justice by providing a harm reduction alternative for disadvantaged groups that disproportionately bear the devastating consequences of smoking. Policies of differential taxation of cigarettes and e-cigarettes can facilitate adoption of less harmful alternatives by those economically disadvantaged. We conclude that public health and biomedical ethics frameworks are mutually reinforcing and supportive of ECA as a tobacco harm reduction strategy. Implications Making e-cigarettes and information about them available is supported as ethical from multiple ethical perspectives.

Download Full-text