Assessing the Morality of Harm Reduction Interventions in Substance Use Treatment

Addiction impairs human agency; causes medical, behavioral, and social sequelae; and can result in reduced imputability for addiction-related behavior. Harm reduction refers to a variety of interventions implemented to mitigate the harmful sequelae associated with an individual's ongoing substance use. Whereas there is evidence that harm reduction interventions can reduce addiction-related sequelae and potentially save lives, a discussion of the morality of harm reduction raises issues of consequentialism, virtue ethics, cooperation with evil, double effect, counseling the lesser of two evils, tolerance, gradualism, the principle of totality, and scandal. To illustrate the moral considerations relevant to harm reduction, we discuss the case of the medically supervised injecting service that was proposed by the Sisters of Charity Health Service in 1999 in collaboration with the government of New South Wales at St. Vincent's Hospital in the Darlinghurst suburb of Sydney, Australia. We present the previously unpublished conclusions of the Congregation for the Doctrine of the Faith's (CDF) evaluation of that program. The CDF adjudicated that a medically supervised injecting service constitutes "extremely proximate material cooperation" with substance use and its foreseeable adverse effects, and therefore ruled against administering such a program at a Catholic hospital. This decision raises the issue that specific harm reduction interventions can be associated with varying degrees of cooperation with addiction. Drawing from Catholic tradition, we provide guidance that can inform the provision of morally permissible harm reduction interventions.