Ladders and Stairs: How the Intervention Ladder Focuses Blame on Individuals and Obscures Systemic Failings and Interventions

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.