Ladders and Stairs: How the Intervention Ladder Focuses Blame on
Individuals and Obscures Systemic Failings and Interventions
Abstract
Introduced in 2007 by the Nuffield Council on Bioethics, the
intervention ladder has become a widely used tool in bioethics and
public health policy. By ordering potential interventions from least to
most intrusive, the intervention ladder seeks to balance efficacy of
interventions with the cost to individual liberty. While the ladder
serves as a useful tool for evaluating potential interventions, it also
has unintended side-effects. In particular, by orienting itself around
how interventions impact individual liberty, the ladder obscures
potential interventions that operate on a systemic rather than
individual level. As such, I argue that the ladder needs to be broadened
into stairs. That is, the ladder needs to be broadened to accommodate
multiple parties simultaneously. Whereas a ladder can only accommodate
one party at a time, stairs allow for multiple parties to exist at the
same level and to pass each other freely.