AAP 2026 CONFERENCE

"A clinician suggests to a person who physically injures themselves without suicidal intent to use red ink instead to simulate the injury without causing physical harm."

Debates about harm reduction in non-suicidal self-harm (NSSH) usually focus on questions of safety, proportionality, and autonomy from a third-person perspective concerned with outcomes and professional responsibilities. Harm reduction, in this context, refers to interventions aimed at reducing physical harm without necessarily requiring immediate cessation of NSSH.
I argue that this approach is incomplete because it overlooks the communicative dimension of harm reduction interventions. The ethical significance of these interventions depends not only on clinical intentions, but also on how they are framed, offered, and interpreted by the person receiving care. Ethical evaluation requires attention to both third-person justification and first-person experience. An intervention may be clinically appropriate and voluntary, yet still be experienced as dismissive, corrective, or validating depending on how it is framed and received within the clinical encounter. This gap between professional justification and personal meaning is ethically important because harm can arise not only through physical outcomes, but also through the meanings conveyed and interpreted in care relationships."