Abstract
At first glance, it seems difficult to object to any program that merits the label “harm reduction.” If harm is bad, as everyone recognizes, then surely reducing it is good. What’s the problem? The problem, we submit, is twofold. First, there’s more to “harm reduction,” as that term is typically used, than simply the reduction of harm. Some of the wariness about harm-reduction programs may result from the nebulous “more.” Thus, part of our task is to provide a clear definition of harm reduction. Next, we turn to a second problem: a worry about complicity. Those who object to harm reduction programs fear that participation in such programs would make them complicit in activities they deem immoral. In this paper we argue that this fear is largely unwarranted. We use supervised injection sites (SISs)—safe spaces for the use of risky drugs—as our paradigmatic case of harm reduction. These SISs are generally offered in the hope of reducing harm to both the drug user and the public. For this reason, our analysis focuses on complicity in harm. We draw upon the work of Gregory Mellema as our framework. Mellema offers three ways one can be complicit in harm caused by another: by enabling, facilitating or condoning it. We argue that one who operates an SIS is not complicit in any of these ways, while also laying out the conditions that must be met if one is to argue that harm reduction entails complicity in non-consequentialist wrongdoing.
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03 November 2020
The original version of this article unfortunately contained a mistake. The fourth sentence of third paragraph under section Do Harm Reduction Programs Condone Harm? Should be “One of us (Corvino)” instead of “One of us (name removed for blinded manuscript)”.
The original article has been corrected.
Notes
At least pro tanto good.
We could also imagine hypothetical programs that have nothing to do with drugs or sex that could count as harm reduction. For example, if enough people in a society pursued some risky extreme sport (e.g. bungee jumping), we could imagine a harm reduction program being built around making sure that bungee jumpers always had safe equipment.
Consider, for example, this definition from the National Health Care for the Homeless Council: “Harm reduction is an approach for substance use treatment that involves a set of practical techniques that are openly negotiated with clients around what is most likely to be achieved. The focus is on reducing the negative consequences and risky behaviors of substance use; it neither condones nor condemns any behavior.” [8].
p. 6 [1].
p. 1 [6].
Others have defined complicity differently. For example, in her book Against Purity: Living Ethically in Compromised Times, Alexis Shotwell argues that “if we want a world with less suffering and more flourishing, it would be useful to perceive complexity and complicity as the constitutive situation of our lives, rather than as things we should avoid.” p. 8 [9] – emphasis original. This definition varies from ours in two ways: (i) it does not necessarily view complicity as something to avoid, and (ii) one can be complicit even without what we could consider to be wrongful participation in another’s wrongdoing. Meanwhile, Christopher Kutz offers a relational account of complicity in his book, Complicity: Ethics and Law for a Collective Age. We lack the space for a thorough critique of Kutz’s view here but will note that Kutz’s relational account ends up granting mere customs the weight of objective morality.
p. 45 [7].
p. 45 [7].
p. 45 [7].
It is worth noting that this case itself is not harm reduction, as defined in this paper. Rather, this case is a one-off instance of harm being reduced. The aptness of the analogy, however, does not rely on this case itself being harm reduction.
This point is one that we will return to in our next section.
See Ch. 5 of Mellema for a detailed discussion on facilitating harm [7]. What differentiates enabling harm from facilitating harm is that when one’s actions enable some specific harm, those actions are necessary for the harm to occur in the way it does. When one’s actions facilitate some specific harm, however, those actions are not necessary for the harm to occur in the way it does. Rather, those actions simply make it more likely that the specific harm will occur in the way that it does.
See [3] for a summary of recent studies.
See [2] for this quote and the following.
See [10].
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Acknowledgements
The authors wish to acknowledge Wayne State University’s Graduate School for their generous funding that supported our research and work on this topic.
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Kirschenheiter, T., Corvino, J. Complicity in Harm Reduction. Health Care Anal 28, 352–361 (2020). https://doi.org/10.1007/s10728-020-00407-9
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DOI: https://doi.org/10.1007/s10728-020-00407-9