Mirror of Justice

A blog dedicated to the development of Catholic legal theory.
Affiliated with the Program on Church, State & Society at Notre Dame Law School.

Saturday, February 13, 2010

Thoughts on the Needle Exchange Program adopted by the Diocese of Albany


I should like to thank Bob Hockett for his bringing to our attention the Washington Post article published earlier today on the Albany Diocese’s needle exchange program. In short, the thrust of the argument appears to be: it is a choice between the lesser of two evils. Is it really? Is there any guarantee that once the addict leaves the distribution center or centers administered by the Diocese he or she will use it once and then return it prior to the time the next “fix” is required? It is apparent that there will be no supervision by Safe Point in how the new needle is used and for how long by the addict of illegal drugs. Moreover, there appears to be no recognition that at some point, all hypodermic syringes are new—even the used one being returned for an exchange was new at one time. There is some agreement with the program as Susan’s comment to Bob’s posting suggests: she states that the Diocese has made the correct decision. I cannot endorse this view; furthermore, I am troubled that some in the Diocese believe that the United States Conference of Catholic Bishops ought to now reconsider its position against needle exchanges. Since reason is an underlying principle of the law and, therefore, legal theory—including that which employs the label Catholic—, let us test the various propositions put forth in the Post article with reason. Jonathan’s comments to Rob’s posting help us begin this task.

First of all, let us consider the contention that, while illegal drug use is bad, the spread of deadly disease is worse. Let us test the soundness of this proposition. I begin with the distinction that this statement makes that blood-borne diseases are deemed a greater evil than drug addiction and the addictions essential surrounding issues. It is false. Illegal drug use is no lesser an evil because without appropriate medical treatment, the spiral of the addict will progress downward until the day that the addict’s body can no longer sustain the chemical abuse, and he or she dies from an overdose or other complications. There is no good ending to untreated drug abuse with serious and illegal drugs that require injection by hypodermic syringes. The addict is constantly hanging over a pit of destruction started by himself or herself and then sustained, as Jonathan points out, by drug lords who have little interest in anything but more profit. By providing a needle exchange program, any institution is at a minimum turning a blind eye to the profit driven motivations that prey on human life without mercy and the destruction of life that this chemical dependency generates. Are there alternatives? Of course there are. Treatment programs, job counseling programs, and other projects that could be substituted for needle exchange programs help the addict far more than assistance that will only sustain the addict’s dependency but do nothing about it. By providing a needle exchange program, the addict’s life remains over the pit of destruction without any hope of rescue other than trying to reduce infections from blood-borne diseases. But as I have already mentioned, there is no guarantee how the new needle is used once the addict departs with it. How “public health authorities” referred to by the Post article can assert that needle exchange programs can “even lead drug abusers to treatment and recovery” makes no appeal based on reason. If the destructive habit is being sustained by “well intentioned programs,” how can the addict turn to the path of treatment and recovery? The craving that is an inevitable part of drug dependency will not vanish with new needles. I fail to see the logic in the arguments offered by the proponents of needle exchange as presented and only recognize an unsupportable claim. The addict remains enslaved to a self-destructive habit which robs him or her of human dignity and life. There is no charity or solidarity or mercy extended to this victim of chemical dependency, only abandonment is offered so that the dependency increases while the drug lords grow richer. Somehow this fact which ought to be inescapable escapes those who support needle exchange programs.

The Diocese then asserts that the Safe Point program “is based upon the church’s [sic] standard moral principles.” In theory, it may be possible to argue in the proper contexts “double effect” or “choosing the lesser of two evils” or, for some moralists, “proportionalism” or “consequentialism.” But these justifications do not apply here. [The latter two, i.e., proportionalism and consequentialism, are plagued with their own problems which I won’t go into today since they have not been raised by any of the moralists quoted in the Post article.] Why? I suggest these elements of “the church’s [sic] standard moral principles” cannot overlook the spectrum of the constitutive elements of both evils, i.e., drug addiction and infectious disease that is generated by drug abuse. In the final analysis, they are both evil in their own right, and it would be unsound to suggest that one is less problematic than the other. While they may intersect the life of the same person, one is not disproportionate to the other.

In the preparation of its article, the Post consulted with a variety of individuals in demonstrating the spectrum of views that favor and that object to needle exchange programs administered by the Church’s corporal works of mercy. I begin with the remarks attributed to Dr Edward Peters, who is both a canonist and a civil law lawyer. He has addressed the Albany Diocese exchange program at his own website, and I believe his in depth reflections need to be studied carefully because he is on to something vital regarding these issues and the debate surrounding them.

The Post then turns to three priests, yes, all are Jesuits, and yes, I am familiar with them and their work. My comments in no way reflect a lack of fraternal concern of or respect for them; however, on the issue of supporting needle exchange programs by relying on their versions of Catholic moral principles, I must state my disagreement and explain why. Unfortunately for Fr. Bretzke, a professor of moral theology at Boston College, the Post merely states that by relying on the “lesser evil” argument, the Diocese of Albany is relying, in part, on a Thomistic principle. But as I have stated earlier, the issues involved here are much more involved than giving “safe” needles versus risking infection from blood-borne diseases and assuming that one evil is lesser than the other. Let us understand the distinction clearly: the rational agent must conclude that he or she is not simply giving an addict a clean needle so that the addict will be free from a contaminated needle. As already stated, there is no guarantee that the new needle will be used only once and only by the addict to whom it is given. No one, including the addict, can predict if this needle will not be used again by the addict or anyone else. The hope that this will not happen is misplaced. In addition, the purported “lesser evil” is a complex one with many tentacles that ensnare the unwary and the unthinking. There is no promise of treatment and cure with a needle exchange program without something more being offered to assist the addict; the inexorable potential is that the chemical dependency without further intervention will therefore be sustained indefinitely. The other thing that will be sustained is the boldness of the dealers whose desire it is to keep the addict addicted. And with their business uninterrupted, will they not look for new markets to sell their poison? These are surely elements of the “Safe Point” program that lurk in the side wings but have not been addressed by the needle exchange proponents. Fr. Bretzke further states if: “you cannot reasonably expect a person to avoid the moral evil itself [i.e., illegal drug use], you can counsel them or mitigate the potential damage of their action and can even help them in doing that.” If the concern he expresses is only mitigation through needle exchange, his conclusion is wrong. If the needle exchange program were substituted with counseling and medical treatment that assists the addict in overcoming the chemical dependency, then yes, Fr. Bretzke would be on the correct track because the addict would then be given assistance to overcome the moral evil of illegal drug dependency.

The aspiration that “Safe Point” will decrease or eliminate infections of blood-borne diseases by the addict who exchanges the needle or by other addicts is wishful thinking but little else. Blood-borne diseases of any kind are an enormous problem, and deaths caused by such diseases are avoidable. Dependency on illegal, potent drugs is also an enormous problem, and it, too, causes deaths. So, is death by drug dependency or death by blood-borne diseases any different? No. But can we as a society and Church that cares about people through our exercise of Christian charity avoid both? To borrow from a high-level public official, “yes, we can!” And we can do so if we recognize that both are evils that can be avoided and, at the same time, acknowledge that one is not the lesser evil than the other.

Rev. Fuller, a well-known Boston physician, is quoted as saying, “If we know programs are scientifically validated to save lives, then condemning them can be more scandalous than the possibility of being seen to condone drug use.” I suggest that this “if” is a pretty big one. Let us be clear about the distinction he makes: does the program that is “scientifically validated” ensure that no needle from a needle exchange program is ever used more than once? He does not mention this. I wonder if there is an assumption that no needle is used more than once. It may be that the needle is used by the exchanging addict only once, but does the “scientifically validated” program take stock of the possibility, perhaps probability, that someone else may use the needle, since it is “almost new,” before it is exchanged? I wonder. Fr. Fuller does speak about a possibility elsewhere, but it is only in the context that there is a possibility that needle exchange programs may condone the use of drug use. No, the scandal is more than “possibly condoning drug use.” The scandal is that it, at a minimum, constitutes material cooperation with a distinct, but not lesser evil. I am prepared, along with Dr. Peters, to demonstrate that a needle exchange program is, in fact, formal cooperation with evil that can be and must be avoided. A needle exchange program’s officials cannot overlook the fact that drug addicts are destroying their lives while drug dealers and distributors and manufacturers of controlled substances increase their profits and are then encouraged to look for new markets. To provide needles in an exchange program and overlook these undeniable realities of drug addiction is a scandal of enormous magnitude that is independent of scandals of denying addicts clean needles in the hope of avoiding life-threatening blood-borne illnesses.

The Post also quotes Fr. James Keenan, also another professor of moral theology at Boston College. The article mentions that he “successfully pushed...a nondenominational association of scholars, to pass a resolution in support of needle-exchange programs.” I wonder what the resolution states and the reasoning used to justify it? Did those voting in favor of it consider the points I have addressed demonstrating the problems inherent in the justifications given for the Albany Diocese’s program? I agree with Fr. Keenan that the Church and her corporal works of mercy must be about love of neighbor, the common good, human dignity, and responding to human suffering. But, as I have demonstrated, mercy, love of neighbor, the common good, human dignity, and responding to human suffering are not well served when problems are intensified rather than remedied for those addicts whom the Church is attempting to help. I must unfortunately disagree with Fr. Keenan’s assertion that the Albany Catholic Charities “just gave us the answer.” They gave no answer but have, I believe, made a serious problem worse for the intravenous illegal drug user.

Let me conclude this lengthy posting with a reference to Dr. Germaine Grisez’s discussion in the Post article. There is far more involved with needle exchanges that just needle exchanges. I hope to have demonstrated that. Dr. Grisez states that the Church has a care-taker role in the betterment of the human person and should not be involved in needle exchange programs. By way of illustrating my point, let us say that the Albany Diocese were not involved in a needle exchange program but a project designed to help alcoholics. If the Diocese’s Catholic Charities offered counseling and medical treatment for the alcoholics, I think most would agree that this would be a meritorious project supported by the Church’s moral teachings and social doctrine. But what if, instead, the Diocese took a different tack and set up cocktail lounges that catered to alcoholics and operated under the project name “Safe Pint.” What would be the reaction then? You would be correct in labeling this project indefensible. So, too, is the needle exchange program.

“Safe Point” is not something to celebrate. It is not something to promote. It is not something to rationalize as the lesser of two evils. It is, ultimately, something to lament because of what it is and what it does to human life. Complicating the lament that makes it a tragedy is the fact that the Diocese of Albany, through its Catholic Charities, had and still has alternatives that do not require the cooperation—formal or material—with drug dependency. Sadly, and for the time being, the Diocese has not chosen the better and moral path. Let us pray that it will be corrected, and soon because human life, human dignity, the common good, and alleviating human suffering remain at risk.

RJA sj


Araujo, Robert | Permalink

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"It may be that the needle is used by the exchanging addict only once, but does the “scientifically validated” program take stock of the possibility, perhaps probability, that someone else may use the needle, since it is “almost new,” before it is exchanged?"

Fr. Araujo--

I think what the proponents are getting at here is that, in the aggregate, the needle exchange program does (or can) greatly reduce the risk of transmission of serious disease. The program, it seems, does not guarantee that in individual cases a new needle will not be re-used. It may, however, in enough cases to cut down on the overall risk to the addicts. Furthermore, even if a new needle is only "almost new," is it not possible that with a lessened number of past users, this too cuts down on the overall level of risk? Broadly speaking, if the program cuts down on the average number of users per needle, this lessened risk could be what the proponents are getting at. This argument is similar to the concept of STDs (except the needle is substituted for the sexual partner): a person who has had two sexual partners may not be risk-free, but on average such a person is less risky than an individual who has had twenty sexual partners.

I think the question of overall risk is probably what the studies look at. Of course, this does not answer the ethical objections.

Posted by: Don Altobello | Feb 14, 2010 8:29:48 AM

I think some insight into these programs would help you put things into better context. Here is some information I think would be helpful:

1)Drug addiction is neither transmissible nor necessarily fatal without treatment. Syringe exchange programs protect not only drug users from blood borne diseases but their sexual partners and their sexual partners as well. 75% of HIV cases in the United States have had injection drugs as part of their sequence of transmission. Many drug users live long, functional lives despite their addiction. This is not an endorsement of drug use, merely pointing out that deciding between HIV and drug overdose death is a false dichotomy, at best.

2)Injection drug users are difficult to access, from a human services point of view. Syringe exchange programs give an opportunity for trained professionals to talk to users about their use and to help navigate them into treatment when they are ready. Most programs have formal linkages with treatment providers to help expedite the transition into treatment. This is an opportunity that would not happen otherwise.

3)Most importantly, the arguments about what people are doing with the needles and whether there is an assurance that they're not being shared is utterly irrelevent. These programs are very well demonstrated to reduce the transmission of blood borne diseases. Whether some of the syringes from the program are shared does not matter because those injections would have been with a dirty needle anyways. The bottom line is the one that matters, and the bottom line shows that these programs save lives and are incredibly cost effective at doing so. If you like, I will gldaly provide you with the peer reviewed scientific literature that attests to this.

4)Lastly, these programs do not encourage drug use. The aggregate of studies indicates that these programs have no effect on drug use in the worst case to a reasonable reduction of drug use due to treatement access in the best case. So it is difficult to see the harm that you imply from ignoring profit seeking drug peddlers.

In one thing, we are agreed. There is far more involved with needle exchange programs than needle exchange. There is an increase in access to services, a higher quality of life, a reduced risk of disease, and a compassionate face for somebody who is otherwise spurned from "civilized life". Please do not turn a blind eye to the overwhelming evidence that these programs are effective and necessary.

Posted by: Phil | Feb 16, 2010 10:32:47 AM