Thursday, 18 September 2014

Self Harm: The Philosophical, Ethical and Policy Issues

My primary research interests are in ethics and philosophy of psychiatry. For the past ten years I have worked as a lecturer and researcher in bioethics at the Centre for Ethics in Medicine, University of Bristol.
Self Harm
by Kerry Gutridge

During the past four years, my research has focused on the ethical, legal, philosophical and policy issues of self harm. In particular, I have been concerned with the ethical questions which arise when doctors or nurses allow patients to self harm in psychiatric hospitals. I first encountered this issue when it was reported in the British press that patients were being allowed to self cut in some NHS hospitals. For example, one inpatient was allowed to keep a piece of glass in a locked draw in her room and use it to cut her knees. This idea is of course controversial. Many people find the idea of allowing patients to self harm in medical institutions at best counter intuitive and at worst sickening and morally wrong. However, I argue that in certain circumstances patients should be allowed to self harm.

My book Self Harm: The Philosophical, Ethical and Policy Issues (available to download from Amazon) is part of an ongoing project of scholarship drawing on the research I began with my PhD. In the book I argue that allowing self harm is permissible in the short term if there is a low probability of serious physical damage or death and the patient can engage with therapeutic strategies designed to manage their distress in alternative ways in the future.
The research described in the book had an empirical component. I conducted qualitative interviews and focus groups with patients, doctors and nurses. In the interviews we explored people’s motivations and intentions when they self harm and possible consequences of allowing people to injure themselves in hospital. This was the first study conducted of its kind. This empirical work was integrated with analysis of relevant moral and philosophical questions raised by harm minimisation. Part of my argument looked at the way in which patient’s autonomy may be enhanced by combining harm minimisation with therapeutic engagement.

More information about my research can be found at my website. The website, co-edited with the philosopher A. M. Calladine, already hosts a number of articles by contributors such as Neil Levy, Katrina Sifferd and Nancy Nyquist Potter. We are expecting a post from Lisa Bortolotti in the near future. Topics range from issues in neuroethics such as consciousness and responsibility to the ethical issues of coercive treatment. The website is intended as a forum for debate between academics, students and the general public. It also functions as an educational resource for students studying bioethics, featuring videos and podcasts on psychiatry and ethics. If you would like to contribute to the site please contact me using the contacts page on the website.


  1. Do you look into parallels with tribal scarring or piercings? Has there been any look into the shaping self harm into a goal orientated model, which is essentially what tattoos, piercings and tribal scarring are?

    1. Thank you for your comment. I do briefly consider the relationship between self-harm and body modification but only to draw a distinction based on the beliefs and desires which motivate the action. If you are interested in body modification and ethics you might want to read Schramme, Thomas. "Should We Prevent Non-Therapeutic Mutilation and Extreme Body Modification?". Bioethics 22, no. 1 (2008): 8-15.

  2. Hey, I'm a philosophy MA student and I'M interested on writing about the ethics of self harming as my dissertation. I'm not sure exactly what I want to specifically look into (maybe something broad like is it ever morally justified or something a bit more specific like whether it should be permitted in hospitals). It's not a wide topic so I was wondering if you had any advice on areas would be good to focus on or any recommended reading? Thanks!


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