RT Journal Article SR Electronic T1 Sometimes, not always, not never: a response to Pickard and Pearce JF Journal of Medical Ethics JO J Med Ethics FD BMJ Publishing Group Ltd and Institute of Medical Ethics SP medethics-2017-104343 DO 10.1136/medethics-2017-104343 A1 Patrick J Sullivan YR 2017 UL http://jme.bmj.com/content/early/2017/09/14/medethics-2017-104343.abstract AB This paper provides a response to Hanna Pickard and Stephen Pearce’s paper ‘Balancing costs and benefits: a clinical perspective does not support a harm minimisation approach for self-injury outside of community settings.’ This paper responded to my article ‘Should healthcare professionals sometimes allow harm? The case of self-injury.’ There is much in the paper that I would agree with, but I feel it is important to respond to a number of the criticisms of my paper in order to clarify my position and to facilitate ongoing debate in relation to this important issue.