Mini-SymposiumA balanced intervention ladder: promoting autonomy through public health action
Section snippets
Public health ethics and the intervention ladder
The 2007 Nuffield Council on Bioethics report Public health: ethical issues1 is a foundational document in the field of public health ethics. It was the subject of the opening editorial in the first issue of the journal Public Health Ethics2 and continues to be widely cited in that and cognate journals. Many of these authors take issue with elements of the report, as we do here, but it remains a key point of reference even for its critics. The Nuffield report developed a framework for
Theories of freedom and autonomy
The Intervention Ladder embodies a conception of freedom that can be termed negative, liberal, or libertarian and which equates autonomy with non-interference. On this conception, any intervention designed to promote public health necessarily comes at a cost to individual autonomy; and, consequently, stands in need of justification. This non-interference conception of autonomy means that the burden of proof is placed on public health advocates to demonstrate that the welfare benefits of any
Positive freedom and autonomy
Negative neo-liberal and republican conceptions of freedom contrast with ‘positive’ conceptions, according to which freedom requires not merely the absence of constraints but also sufficient power and resources—material, social and psychological—to pursue one's own ends effectively.12 Positive accounts of freedom regard non-interference—even resilient non-interference—as insufficient; by these accounts, freedom requires skills and substantive opportunities that do not exist de novo, but must be
A balanced intervention ladder
The richer perspectives on autonomy that we have reviewed in this paper are well known in contemporary ethics and moral psychology, and have been discussed in public health ethics.6, 23 If they are to have any influence on public discussion and on policy, however, they will need to be formulated in a manner as appealing as the original Intervention Ladder. This is readily done by a ‘balanced’ version of the ladder, in which inaction represents zero and actions may have either positive or
Acknowledgements
We would like to thank Pierrick Bourrat for comments on the draft and assistance with preparation of the manuscript.
Ethical approval
None sought.
Funding
None declared.
Competing interests
None declared.
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