Risk compensation, harm reduction, and morality

Last updated on: May 18, 2015 at 8:27 am by Jane the Actuary

Risk compensation, harm reduction, and morality 2015-05-18T08:27:55-06:00 Jane the Actuary

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I was thinking about these concepts in connection with a couple things that came in view over the last couple days.

“Harm reduction” refers to the concept that we should allow various sorts of risky behavior, and behavior traditionally considered immoral by public consensus, on the belief that it’s less risky than the alternative. So far as I am familiar with the term, it had its origins in needle-swapping and similar programs for drug addicts, intended to protect them from AIDS even if the didn’t quit using. Legalizing pot is, of course, another big example of harm reduction, on a societal level, as proponents cite the desire to eliminate the harm to communities affected by gangs, drug-selling, and the incarceration of young men.

“Risk compensation” is the idea that risk is “sticky,” so that reducing certain harms is like playing whack-a-mole — the classic (anecdotal) example is coming across SUVs on the side of the road during snowstorms, since their drivers felt more protected by their vehicles and took more risks in driving. This wikipedia article provides further examples: some studies showed children with safety equipment taking more risks than those without, but studies with ski helmet-wearers were inconclusive as to whether helmet-wearing tended to be associated with riskier behavior.

And whether one signs on to harm reduction goals or worries about risk compensation, for any given risk or activity? Morality has a lot to do with it.

I’m thinking about this now because of two recent examples:

First, National Review has an article about e-cigarettes, “What’s Driving the War on E-Cigarettes?” The article details the ways in which e-cigarettes have been maligned as toxic by the CDC, Democratic politicians, and large numbers of people who line up on the “progressive” side of the political spectrum. Despite the great potential that e-cigarettes have as a harm-reduction method, allowing people who are unable to quite smoking outright to substantially reduce their risk of major health damage, progressives want to place limits on their availability, on the locations where they can be used, and want to regulate them as tightly as cigarettes. Concepts of harm reduction are thrown out the window in favor of concerns about risk compensation: that teens will begin to use them, that existing smokers will use them more than they “need to,” because they perceive them as harmless.

Or is it really that? One suspects that progressives and the Socially Enlightened, for all their words about not legislating morality, believe that cigarette smoking, and, more importantly, cigarette manufacture, is simply an immoral activity that shouldn’t be allowed to continue under any circumstances.

And here’s another harm reduction/risk compensation issue, coming this time from a discussion in the comments: contraception. I don’t have the slightest bit of evidence to back this up, but it seems fairly intuitively the case that there’s risk compensation going on with teen and unmarried pregnancies — that is, despite the plentiful availability of contraception, teen pregnancies (though they’ve declined considerably from their peak) are much higher than you’d expected given contraception effectiveness rates because, feeling protected by contraception, teens (and unmarried adults) are having more sex than they otherwise would.

(The same, I’ve read, is true of abortion: every aborted child does not reflect a reduction in the total population, because the availability of abortion has changed behavior and increased pregnancy rates over what they otherwise would have been.)

Actually, I do have one bit of evidence, though I don’t know what to make of it: in various studies, providing at-risk women with emergency contraception didn’t reduce pregnancy rates. I’d seen a reference to this somewhere along the way and assumed it was because having emergency contraception makes these women more likely to have sex without contraception than they otherwise would have done — though the actual study I found online says that the problem is that women aren’t actually using the pills; instead they just sit in their dresser drawers.

And, at the same time, progressives who wouldn’t for a minute stand for accepting concepts of “harm reduction” when it comes to teen smoking, are more than happy to promote sex ed and ready provision of contraception for teens under the label “harm reduction.”

Of course, it seems a bit silly to speak of sex, and teen sex in particular, with these abstract risk concepts, because it is, in the end, a moral issue — though, in the end, promoters of the “harm reduction” approach tend to see it as decidedly not a moral issue at all, and have no moral objection to teen sex. And, of course, for most Americans, and even many Christians, the promise of the contraceptive pill, offering the expectation, if not the reality, of sure-fire sex without pregnancy, radically transformed opinions on sexual morality.

But that’s what I’ve got for you before starting my Monday. What do you think?

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