Through the eye of the needle exchange…
I imagine this story will gin up some controversy–or perhaps not?
In short, Catholic Charities of Albany, N.Y., in the diocese of Bishop Howard Hubbard, who has a reputation as a social justice liberal, has launched a new program to provide free syringes to intravenous drug users. Catholic Charities studied the program for five years before agreeing to work on it. “Project Safe Point” will be funded by $170,000 in grants from New York State.
Religion News Service has the best write-up I’ve seen:
Albany Bishop Howard Hubbard approved the needle program, according to the diocese. In a statement, the diocese acknowledged that it may appear to be complicit in drug use, but argued that providing disease-free needles is the lesser of two evils.
“To guide us, the church provides us with the principles of licit cooperation in evil and the counseling of the lesser evil. The sponsorship of Catholic Charities in Project Safe Point, then, is based upon the Church’s standard moral principles,” the diocesan statement reads.
While a number of secular social service agencies—including 17 in New York—maintain syringe-exchange programs, the project is thought to be a first for a Catholic Charities agency. A request for information from Catholic Charities USA, the national headquarters for 1,700 Catholic Charities institutions and agencies nationwide, was not answered immediately.
Medical studies have documented that needle-exchange programs effectively reduce the spread of blood-borne diseases such as HIV/AIDS and hepatitis C. According to New York State Health Department studies cited by the diocese, in 1990, 50 percent of new AIDS cases were caused by drug use. By 2004, after the introduction of needle-exchange programs, just 7 percent of new AIDS cases were linked to intravenous drug use.
The story goes on to note, however, that the Albany policy seems to contradict a 1990 statement on AIDS from the U.S. conference of bishops (re-printed in 1997) which says: “Although some argue that distribution of sterile needles should be promoted, we question this approach for both moral and practical reasons.”
It appears some of those practical reasons may have been superseded. But the moral reasons? Calling all ethicists (and moralists).
I don’t think that needle exchange programs promote iv drug use. We have had such programs in our community for some time and they are a public health exercise. There are groups from community health centers that will go into apartments to clean out for needles.
The way they work, at least in one area, is that you get clean needles in exchange for the dirty ones that are brought in. What the program does is help in keeping dirty needles from harming anyone else.
Needle exchange programs are part of the harm reduction movement in addiction treatment. If the drug use is chronic and serious, you should do everything you can from reducing the harm that can occur as a result of such activities. Clean needles is one option, but so is suggesting other types of drug of choice.
The bottom line, however, is that these actions as useful as they are, are no substitute for systemic, political change for millions of impoverished and marginalized (as much as I don’t like that term) people.
Jesse Jackson said it well, “We have to start putting hope in our young people’s brains and stop jamming dope in their veins”.
Both of these actions can happen at the same time!!!
Excellent comments. Working for 20+ years in mental health/substance abuse, these approaches work – they take into consideration the best of recent and current studies; the best in psychological analysis; the best in working with human nature and human beings.
If you believe in human life; if you believe in the quality of life – then, this method works – the needle itself is not evil; it is not a means to evil. It is neutral and is used to achieve human life.
Excellent diocesan application of the “old” principle of double effect.
I’ve been scratching my head about this one myself. Not only does it appear to contradict USCCB statements as noted above, but as Ed Peters notes in his Canon Law blog, in 1999 the CDF ordered an Australian Catholic hospital to stop providing an injection room for heroin addicts stating that the room constituted “an extremely proximate material cooperation in the grave evil of drug abuse.” The point is that the CDF forbade a hospital from engaging in mere proximate material cooperation in drug abuse so it would seem to be even harder to justify Albany’s practice which looks arguably more like formal participation in drug abuse and therefore even more serious than what the Australian hospital was forbidden to do.
Likewise in Caritas in Veritate, we’re encouraged to minister to the needs of others in manner that respects the truths of the faith, “In a culture without truth, this is the fatal risk facing love. It falls prey to contingent subjective emotions and opinions, the word “love” is abused and distorted, to the point where it comes to mean the opposite.” While I have no doubt that Albany’s policy is motivated by love, I am concerned that it is a love that, uninformed by the truths of the faith–not to mention the lack of clear public health data supporting the practice–runs the risk of not being love at all, but rather a destructive codependency rooted in a questionable pragmatism masquerading as love.
As moral theologian Fr. Tadeus Pacholczyk argues, approaches like the one that Albany is taking are not only morally questionable but not necessarily supported by public health data as being effective.
It is hard, for me at least, to reconcile Albany’s policy with both the available empirical and theological data. It would no doubt be helpful if the commission responsible for this policy would show its math so that people concerned about the moral and public health repercussions of their decision could be enlightened. That said, without illuminating such a solid moral foundation for the decision, it is difficult for me to imagine that the CDF would support Albany’s policy if it were ever challenged at that level.
G
In light of Bill’s assertions above (posted while I was typing), here’s the link to the Pacholczyk article. http://www.catholiceducation.org/articles/medical_ethics/me0122.htm
My sense, Bill, also as a mental health provider for over 20 years, is that the mental health field (and even moreso the drug and alcohol abuse field) often has a difficult time telling the difference between what is fashionable and what is empirically effective. For instance, have you read the most recent studies questioning the efficacy of SSRI’s in treating depression? Basically, they don’t work (except for the most serious depression). This after 20 years of “science says that depression is caused by seratonin depletion and can be easily corrected by SSRI’s” Just another example a fashionable idea gaining dominance in the absence of hard data.
I just don’t think the science is there to support the policy, but that’s all irrelevant unless the moral justifications are strong enough to overcome the data I cited above. It may be, but until the committee shows their math, there’s no way to know.
G
There are studies that show that individuals who participate in needle exchange programs are far more likely to seek treatment for their underlying addiction. Why this is might be hard to determine, but certainly one reason could be that such individuals develop a trust relationship with program workers that makes them more amenable to further intervention.
Gregory Popcak, I understand the moral qualms but your claims about the empirical evidence being lacking is not backed up by the studies cited in the RNS piece nor in the article you linked to. The math has been shown. So what now?
It seems to be quite well known that needles infected by drug users are a major potential vector for the spread of AIDS and hepatitis. Needle exchanges seem to cut down on this. And since infected addicts can infect non-addicts, we have another consideration that goes beyond the addicts themselves.
Against this, there is an idea that by sponsoring a needle exchange, the Church might look like it is condoning or participating in the promotion of drug abuse.
It seems clear to me that a consistent pro-life position would say that the Church should support needle exchanges. Let the uncharitable think what they want.
I wonder if we could use the principle of double effect to justify this program. Something along the lines of the following?
* The intention in providing clean needles is to prevent the ailments that result from dirty needles, such as infection and spreading contagious diseases. There may be other good intended outcomes as well, such as sparing the patient the pain of withdrawal (I’ll defer to the experts here as to whether that would come into play).
* The unintended effects are that potentially harmful substances are introduced into the user’s body; and that an addiction is enabled.
* Preventing an infection is morally equivalent, and containing a contagious disease is morally weightier, than enabling an addiction (which many health professionals would also classify as a disease).
I would also stipulate that such a program would need to exist as one component under an umbrella of treatment and support for the addict; the overall goal of the program would be to wean the patient from the addiction.
Thoughts?
Does the argument (fact, I’d say) that addiction is a disease also account for something, as some have indicated above? In other words, this is not necessarily akin to offering condoms to prevent HIV as having sex, protected or not, is something we can (ostensibly) control. (Sex workers aside.) Same with abortion. The classic case here that I always cite are the German church’s pregnancy counseling centers that convinced thousands of women not to have an abortion. But because the center had to issue a certificate saying a woman had been counseled, and because that certificate was necessary to procure a legal abortion, the CDF ruled that it was material cooperation with evil. I see the point in the abstract but not at all in the real world. And even the abstract is a bit too fuzzy for me. Still, abortion and condoms don’t seem analagous here. Or are they?
David Gibson,
No, sadly, the “math has not been shown.”
If you re-read my post, you’ll see that my math comment refers to the “moral math” that justifies the position. Social scientists can (and do)disagree about the public health data on the efficacy of needle sharing programs just as they do on the efficacy of condom distribution for HIV-AIDS prevention. But that something is scientifically arguably effective (like, say, IVF) doesn’t make it morally licit or appropriate for the Church to engage in. My point was that there appears to be a strong moral argument against the policy and the science doesn’t even necessarily justify attempting to make a contrary moral argument in the first place. But even if it does, it needs to be a doozy of a moral argument to address pretty obvious objections that this policy at least superficially represents formal cooperation in the evil of addiction.
I would argue that since the Diocese of Albany apparently believes that it has discovered a moral argument that trumps apparent precedent, they have an obligation to enlighten the faithful on their decision making process and, since it is obviously controversial and potentially the source of scandal, there would appear to be an obligation to submit it for some sort of review.
Perhaps the Diocese has done this. I don’t know. Do you? That’s the math I’m talking about.
And to clarify, I make no claims about being an expert in moral theology. I know the basics. But I do know a few professional moral theologians who work with me on various issues, and having discussed the situation casually, they’re telling me the argument–as presented in the article you linked–may not pass the smell test. You can’t ever choose evil–lesser or no–that good may result. If we could choose evil that good may result, then there would be no moral argument against torture. I presume, perhaps mistakenly, that we both agree that torture may not be committed that good may result. Same applies here.
Likewise, double-effect (choosing a good in which an evil may unintentionally result) wouldn’t seem to apply because there is no reasonably good, direct, “other intention” one may have in giving an addict a needle. I mean, if you gave a diabetic addict a needle for insulin and they used it for heroin, you’d be covered by double-effect but not if you give an addict a needle for the express purpose of abusing drugs. That does not appear to be double effect. That appears to be formal cooperation in the sin of addiction.
The question I’m asking, is “What is the novel interpretation of double-effect or other principle in play that permits this innovation?” I’m not saying it doesn’t exist–that’s beyond my pay grade (as a friend of yours is fond of noting). I’m saying the responsible thing to do is to show the reasoning so that the faithful can benefit from the wisdom of the decision.
Does that help clear up your confusion, David Gibson?
G
Greg, no, I am still confused at your confusing comments.
You repeatedly cited the problem with “data” and “math” as complicating the moral calculation (and indeed the 1990 bishops’ letter also said the evidence wasn’t there at that time). You wrote:
Later you wrote:
Again, you cited no data–”math,” in your words.
But in fact the diocese and Catholic Charities did supply that data/math. You seem to be ignoring the facts that are printed here on the screen for whatever reason.
I think the question here is, since the data/math are there showing a certain effectiveness of these programs, what are we to make of the moral/ethical arguments now? Or is there data/math that counters the studies cited?
If you could address that I think you would clear up your confused comments from earlier. If you can’t no sweat.
Greg – if you will examine the past couple of years of research and quantifiable evidence from SAMSHA, all the study and experience data you need to justify this type of outreach is there.
You cited SSRI’s and depression. That is one recent study….most studies would agree with your statements in general – but, 20-25% of all depression cases do need both medication and counseling (SSRI’s continue to show better empirical evidence of improvement, less side effects, and better/longer term use by patients). In any study, over a long period of time, roughly 30% of depressed people will get better (with no treatment). 30% will probably get better if they received counseling. Fact – all improve if they use both counseling and medication combined and follow the treatment plan that is evidence based.
What is left out from those who get better on their own is the length of time; the damage to relationships, work, families, health in general.
Yes, we are way too quick to administer SSRI’s by PCPs with no follow up, treatment continuity, etc. But, that does not mean we knee-jerk and say that SSRI’s are only for the most seriously depressed.
How is a needle exchange supporting the evil of drug addiction in any way? The addicts are exchanging infected needles for clean needles. This significantly closes off an avenue for the spread of disease, both to the addicts and the larger population. The addicts may be more likely to remain addicted because they are now more likely not to die of certain other illnesses. And it’s not as if banning needle exchanges would cause needles to go away. I am not seeing the moral downside at all.
Would the better comparison be, forgive the association, to St. Damian of Molokai cleaning the wounds of the lepers? In effect this is like trying to keep someone with a disease as healthy as possible–and prevent them from infecting others–until such time as they can get other help or indeed a cure.
Yes, it would.
Addicts may have character problems, but addiction is a disease. Diseases need to be socially managed and that’s part of what needle exchanges are all about.
If IV drug users were a risk only to themselves the morality of needle exchange programs might be more debatable. But IV drug abusers have sex and procreate and are a clear risk to their partners and children. Here is the most thorough discussion I found of the potential benefits of these programs:
http://www.avert.org/needle-exchange.htm
I don’t even feel there’s a need to argue this one. It’s a no brainer.
It’s a cooperation with evil problem. For two different views, see Anthony Fisher’s and my articles in Cooperation, Complicity , and Conscience, ed. Helen Watt.
I’ve found the probative value of sentences that begin, “studies show” to be virtually nil. Is there anything that some study somewhere hasn’t “shown”?
Moreover, I’m troubled by the implications of needle exchange. It seems to be saying the addict is less than human, that his addiction is greater than he is.
“Dude, you’re a goner, so take these clean needles and don’t infect anyone more important than you, ok? There, now run along.”
Sorry, your approach takes us back to seeing all addiction, etc. as human weakness and/or sin. It is the polar opposite of an enlightened understanding that most addictions are medical diseases just like cancer.
Your approach takes us back to the tired and old “Just Say No” approach of Mrs. Reagan….we need to understand that these are diseases; we need a different approach than criminalization (see other blog about the number of incarcerated folks in the US – majority are African-American for some type of drug sentence); we need to have courts use treatment and tracking systems that provide systemic support……needle exchange is just one example.
If you understand that this is a medical disease, then you avoid the “material cooperation with evil” problem unless you are going to leap and say that cancer and other diseases are evil. Would hope that we had moved past the Middle Ages.
kit seems to me that serious addiction is a special sort of moral problem. If addiction is a sin and proximate co-operation in sin is an evil, then giving an addict a needle is a sin also.
But is using a drug a sin for such addicts? Sin assumes the capacity to choose evil. But can an addict who is so inexorably drawn to the drug be acting by chpoce when confronted with a drug? A sin requires a choice, and it seems that addicts have no choice. So they are not sinning. (Or are they?)
If they have np choice, then perhaps it is moral to supply a needle to avoid a greater evil, the addict’s eventual death. Granted there will be some lesser physical evil if he shoots the drug again. But Cstholoc moral theolgy often allows a lesser evil to be done for the sake of a later good — as when a gangrenous leg is cut off to save a person’s life.
(Again, the Church is inconsistent about the principle that evil may not be done to achieve good.)
I don’t see drug abuse as evil. If it isn’t evil to drink wine it is not evil to inject yourself with heroin. I see it as an extremely poor choice because the expected outcome of using most recreational and more than a few prscription drugs is so negative — and at least for some drugs, the consequences of their use would be no worse for many than the use of alcohol, but for society’s disproportionately harsh response to such drugs. So I categorically reject all efforts to view this within the moral framework of double effect or whatever other Catholic doctrine on sin might apply.
Most needle exchange programs are set up to do more than just exchange needles — for instance, to test for diseases, to offer methadone, to try to find treatment. Certainly, they are far more compassionate than throwing someone in jail for a few years without treatment.
Is saying studies show of nil probarive value or merely an argument coming friom a don’t let facts bother me perspective?
I agree with David -it’a a no brainer, except for ideologists.
My issue of “The Evangelist,” the weekly newspaper of the Albany diocese just arrived in my mail box a few minutes ago. Here is a link to the online version of their article about Project Safe Point: http://www.evangelist.org/archive/htm10/0204needle.html. It provides some of the data and the reasoning behind the decision.
Bishop Hubbard is my bishop. I live in the Albany diocese and it was Bishop Hubbard who welcomed me during my Rite of Election last year as a catechumen in an RCIA program. Before he became bishop he was the pastor of my Godfather’s parish. He has served us with tremendous love and care and I thought it might be helpful to understand a little more about him before we rush to judgment.
In 1967, then Fr. Hubbard, began Hope House which is now a model for addiction recovery programs as well as performing a number of other critical outreach efforts. See: http://www.hopehouseinc.org Bishop Hubbard has devoted his life to healing the real life “lepers” in our community and bringing them back home to a full life. This is a man who got his hands dirty doing street-level work; doing God’s work. This is not a casual issue for him.
Our location in NY’s Capital District gives us access to some of the best public health experts and research in the world. Here are some relevant quotes about the scientific basis of the project:
“Needle exchange programs have reduced the number of new drug-related AIDS cases by 43 percent, according to the New York State Department of Health studies. Catholic Charities AIDS Services in the Albany Diocese studied such programs for five years and consulted law enforcement, public health officials, substance abuse treatment providers and others before launching Project Safe Point.”
“Clients can also safely dispose of used needles in the van in hopes of reducing the risk of children stepping on them in playgrounds, [Program Director Angela] Keller said.
“It is about the safety of the person, but it’s also about the safety of the community,” she said, calling Project Safe Point a public health initiative.”
“Objections to the program have come from those fearful it would encourage drug use. But studies show similar programs nationwide do not increase drug use or recruit first-time users; they actually can help illegal drug users quit, according to the Centers for Disease Control and Prevention website.”
And here is what Bishop Hubbard had to say:
“It may appear to some that we are complicit in the evils of drug use. However, the Church has long recognized that it is impossible to completely disassociate oneself from evil in all forms, and still participate in the world and offer meaningful help to those in need.”
“To guide us, the Church provides us with the principles of permissible cooperation in evil and the counseling of the lesser evil. The sponsorship of the Catholic Charities in the Project Safe Point, then, is based upon the Church’s standard moral principles.”
TDR
Cathleen wrote: “It’s a cooperation with evil problem.”
The Albany dicoesan paper story linked in the comment directly above this one bears that out. Looks like a case of prudential judgment.
I agree this program is a “no brainer.”
“Sorry, your approach takes us back to seeing all addiction, etc. as human weakness and/or sin. It is the polar opposite of an enlightened understanding that most addictions are medical diseases just like cancer.”
I’m not a medical expert, and apparently far from enlightened, but this comment seems terribly insensitive to those suffering from cancer.
“Is saying studies show of nil probarive value or merely an argument coming friom a don’t let facts bother me perspective?”
Bob–You did not read my post carefully.