The harm threshold and Mill's harm principle.

Theoretical medicine and bioethics Pub Date : 2024-02-01 Epub Date: 2023-11-18 DOI:10.1007/s11017-023-09652-0
Maggie Taylor
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Abstract

The Harm Threshold (HT) holds that the state may interfere in medical decisions parents make on their children's behalf only when those decisions are likely to cause serious harm to the child. Such a high bar for intervention seems incompatible with both parental obligations and the state's role in protecting children's well-being. In this paper, I assess the theoretical underpinnings for the HT, focusing on John Stuart Mill's Harm Principle as its most plausible conceptual foundation. I offer (i) a novel, text-based argument showing that Mill's Harm Principle does not give justificatory force to the HT; and (ii) a positive account of some considerations which, beyond significant harm, would comprise an intervention principle normatively grounded in Mill's ethical theory. I find that substantive recommendations derived from Mill's socio-political texts are less laissez-faire than they have been interpreted by HT proponents. Justification for state intervention owes not to the severity of a harm, but to whether that harm arises from the failure to satisfy one's duty. Thus, a pediatric intervention principle derived from Mill ought not to be oriented around the degree of harm caused by a parent's healthcare decision, but rather, the kind of harm-specifically, whether the harm arises from violation of parental obligation. These findings challenge the interpretation of Mill adopted by HT proponents, eliminating a critical source of justification for a protected domain of parental liberty and reorienting the debate to focus on parental duties.

伤害阈值与密尔的伤害原则。
伤害阈值(HT)认为,只有当父母代表孩子做出的医疗决定可能对孩子造成严重伤害时,国家才可以干预这些决定。如此高的干预门槛似乎与父母的义务和国家在保护儿童福祉方面的角色不相容。在本文中,我评估了HT的理论基础,重点关注约翰·斯图尔特·穆勒的伤害原则,认为这是其最合理的概念基础。我提出(I)一种新颖的、基于文本的论证,表明密尔的伤害原则并没有为HT提供正当的力量;(ii)对一些考虑因素的积极描述,除了重大伤害之外,这些考虑因素将构成以密尔伦理理论为规范基础的干预原则。我发现,从密尔的社会政治文本中得出的实质性建议,并不像传统经济学支持者所解释的那样自由放任。国家干预的正当性不在于伤害的严重程度,而在于这种伤害是否源于未能履行自己的义务。因此,从密尔衍生出来的儿科干预原则不应该以父母的医疗决定造成的伤害程度为导向,而应该以伤害的种类为导向——具体来说,就是伤害是否因违反父母义务而产生。这些发现挑战了HT支持者所采用的密尔的解释,消除了保护父母自由领域的一个关键理由,并将辩论的焦点重新定位在父母的责任上。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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