Introduction
John Stewart Mill’s Principle of Liberty (“The Harm Principle”) has been considered by some as the guiding ethical principle for thinking about public health policy and interventions. The Harm Principle finds its clearest and most succinct articulation in Mill’s 1859 book On Liberty, where he writes: “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” (Mill, 2007). This quote (along with Mill’s work more generally) has traditionally been invoked in support of broad conceptions of liberty and personal autonomy whose only prohibition is direct and traceable harm to others.
Bracketing the question of what “harm” consists of (a philosophical quagmire in its own right), the Harm Principle, taken at face value, could lead one to think that very many public health interventions are impermissible because they interfere with seemingly non-harmful actions or behaviors. How ought we think about the relationship between public health and individual liberty, then? Is it possible to reconcile individual liberty with public health interventions? What if they are coercive (e.g., a vaccine mandate)? Do public health policymakers owe individuals complete discretion when it comes to self-harming behavior (e.g., drinking soda or maintaining a poor diet), or is some paternalism acceptable (and if so, under what conditions)?
To begin to answer these questions, we must clarify why we care about maintaining public health in the first place, or why we care about protecting individual liberty, as well as consider alternative values that may compete for our moral priority (e.g., utility).
Assigned Readings
Thesis: Powers et al. believe that Mill’s ethical framework for state intervention is more nuanced and complex than the traditional interpretation of the Harm Principle would suggest. They argue that Mill recognized three different types of liberties: (1) liberties that are immune from interference, (2) liberties that warrant a presumption in favor of liberty, and (3) liberties that do not deserve the presumption in favor of them when it comes to balancing them with public health interests. The first two types of liberties fall under the Harm Principle, but the third falls under the “The Doctrine of Free Trade.” The authors argue that not all liberties are on a moral par; state coercion or interference is more or less justified depending on what type of individual liberty at stake
Thesis: Selgelid argues that equality, liberty, and utility are all legitimate and worthy values which should be weighed in the context of public health interventions. In their view, strict loyalism to any one of these values at the expense of the other two comes at serious moral cost, and so the solution is a ‘moderate pluralism’ which aims to balance their interests when tradeoffs are necessary and seek creative solutions which eliminate the need for those tradeoffs wherever possible. Moreover, the tradeoffs should always adhere to the principle of proportionality, which stipulates that tradeoffs can be settled when the scales are sufficiently lopsided in favor of one value over the other.
Discussion Questions
- What are some public health dilemmas where individual liberties would fall under the Principle of Liberty? What about dilemmas that would fall under the Doctrine of Free Trade?
- What are some kinds or categories of liberty you think ought to be immune from interference or enjoy a presumption in favor of liberty?
- Selgelid’s pluralist triangle of equality, liberty, and utility assumes that equal weight in principle belongs to all three, and that differences in scale should resolve tradeoff disputes (I.e., severe liberty costs should trump marginal utility gains, and vice versa). Is it right to assume that these three values matter equally in principle?
- How might these conceptual tools apply in some of the following public health case/dilemmas: mandating vaccines, quarantine (TB, Ebola, COVID, etc.), heavy taxation of sugary beverages or obesity causing foods, seatbelt laws, limiting individuals’ access to “low value care” medical interventions, bio-defense (government acts to defend a state’s population against future biological attack), research on war prisoners (e.g., for bio-defense or weapons), use of stigmatization in public health interventions (e.g., to reduce smoking, obesity).
Additional Assorted Readings
Jennings, B. “Public Health and Liberty: Beyond the Millian Paradigm.” Public Health Ethics 2, no. 2 (July 1, 2009): 123–34. https://doi.org/10.1093/phe/php009.
Jennings, B. “Relational Liberty Revisited: Membership, Solidarity and a Public Health Ethics of Place.” Public Health Ethics 8, no. 1 (April 1, 2015): 7–17. https://doi.org/10.1093/phe/phu045.
Mill, John Stuart, and Stefan Collini. On Liberty and Other Writings. Cambridge Texts in the History of Political Thought. Cambridge [England]; New York: Cambridge University Press, 1989.
Sutrop, Margit. “Changing Ethical Frameworks: From Individual Rights to the Common Good?” Cambridge Quarterly of Healthcare Ethics 20, no. 4 (October 2011): 533–45. https://doi.org/10.1017/S0963180111000272.