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Reducing the Burden of Injury: Advancing Prevention and Treatment
A related development is recognition of the need to embrace different perspectives on the weighing of risks. A developing literature on risk analysis has described the factors that affect people's judgments about what risks are acceptable (e.g., whether they are voluntarily assumed) and how different types of risks are compared with one another, and has helped to highlight the ways in which the benefits and burdens of risk-taking behavior are differentially distributed (Fischhoff et al., 1981). Those contributions have enriched our understanding of the ethical dimensions of preventive interventions and have located the injury field in the larger landscape of risk regulation.
Controversies in the Field
Because the injury field is mission driven and action oriented, some controversies concerning the ethics and politics of prevention tend to recur. A continuing challenge for participants in the public debate, and particularly for leaders of the field, is to develop rhetorical strategies for promoting public consensus on controversial issues.
Regulation and Freedom
Injury prevention interventions often aim at protecting people from the consequences of their own risk taking. In some instances, critics may characterize these interventions as "paternalistic" because they curtail people's freedom "for their own good," rather than to protect other people. The most clear-cut examples are mandatory motorcycle helmet laws and other regulations requiring that people use safety precautions to protect themselves. More ambiguous examples include prohibiting manufacturers from selling products thought to be too risky (e.g., three-wheel all-terrain vehicles [ATVs]) or requiring manufacturers to protect adult consumers from their own negligence (e.g., machine guards) when doing so increases the product's cost or reduces its utility.
The argument that an intervention is impermissibly paternalistic can be contested on a variety of grounds. First, it might be argued that the intervention is designed to offset irremediable deficits in information that prevent people from appreciating the risks they face or otherwise making informed risk-benefit judgments. Everyone would agree that such information deficits, if proven, provide an ethically appropriate basis for regulation. The disagreement arises when the government restricts peoples' choices (by banning three-wheel ATVs for use by adults or requiring adult car occupants to wear safety belts) on the ground that people sometimes do not make "rational" choices based on the information at hand. Libertarian critics would find this argument unpersuasive because it substitutes the government's values and preferences for the individual's. Proponents might also defend supposedly paternalistic regulation by arguing that the person