Ethical approaches to the harm reduction debate: “Virtue ethics as an alternative to deontological and consequential reasoning in the harm reduction debate”

Aristotle’s virtue ethics https://youtu.be/VFPBf1AZOQg

What is harm reduction? An approach to addiction that seeks to reduce harm without requiring individuals to abstain from using substances they are addicted to. The reasoning is something like, people are going to use anyway, so we should figure out ways to help them stay alive and as healthy and safe as possible. This approach tries to ultimately reduce harm. The authors write: “The harm reduction approach claims that many of the negative consequences associated with problematic substance use are avoidable through specific interventions, and these interventions can be effective regardless of whether substance use persists” (52).

Harm reduction While there are multiple forms of harm reduction regarding substance use, the authors focus specifically on needle exchanges and safe injection sites.

In contrast… Abstinence-based approaches claim “that it is important to get individuals off drugs or at least to decrease consumption. This latter approach generally maintains that, since harm reduction interventions tolerate continued substance use, they send the wrong message” (52). In other words, this approach sees the only remedy to addiction as being to get individuals to stop using substances—and sees the other approach as condoning substance abuse (and sees this as problematic).

Criticisms of harm reduction 1) it encourages drug use 2) it sends a mixed message 3) it doesn’t get people off of drugs There is, however, ample evidence showing that harm reduction approaches do facilitate getting people off of drugs—perhaps more than abstinence only approaches.

The authors’ aim: The authors look at the abstinence-only versus harm reduction debate through the lens of three well-known theories in ethics: consequentialism, deontologicalism, and virtue ethics. Typically, applied ethics relies on the moral intuitions of the authors. Basically, what they intuitively think is right. However, the authors see this as a problem—and seek a more ‘objective’ route. I’ll explain these theories in what follows.

Utilitarianism – John Stuart Mill We can only justify limiting one’s freedom if it poses harm to others (the harm principle). Rights are instrumental, not natural or intrinsic. A right action is that which promotes happiness for the greatest number, and an action if wrong if it does not do this. For Mill, happiness is defined as “pleasure in the absence of pain”.

Utilitarianism and the harm reduction debate The authors argue that utilitarianism would lead us to prefer a harm reduction approach to substance use, seeing as a harm reduction approach would reduce the amount of suffering for a great number of people. The abstinence-based approach, in contrast, leads to a number of negative consequences, such as infection, disease, incarceration, and death (to name a few).

Deontologicalism - Kant An action is either right or wrong regardless of the situation. The only actions with moral worth are those motivated by a sense of moral duty. The categorical imperative: only do X if it should be the case that X were a universal law. (in other words, only do X if you think that everybody should do X).

Deontological ethics and harm reduction According to Kant, we are to focus on the action, not on the consequences. But, as the authors write, the entire debate for harm reduction focuses on the consequences of substance use. Harm reduction would not be considered ethical under Kant’s doctrine, since it isn’t something that is ‘good in itself’; rather, it focuses on consequential or instrumental goods.

Virtue ethics - Aristotle Focuses on the character of the individual and not on the act or the consequences. Takes a contextual approach to determining what is ethical.

Virtue ethics and harm reduction As it is virtuous to promote virtue, we can argue that virtue ethics supports a harm reduction approach. Because we know that harm reduction approaches do promote better outcomes for substance users, we can say that we are aiding them in becoming more virtuous people by providing harm reduction programs. What’s more, harm reduction approaches demonstrate the virtue of compassion, whereas abstinence-only approaches do not.

Virtue ethics justifies a harm reduction approach This is because it “takes account of the social consequences but also the moral character of the agent” (57). In aiding people with addiction problems to lead safer and healthier lives, we are both demonstrating compassion, which is a virtue, and promoting the virtue of others. We are allowing them more of an opportunity to thrive and become virtuous people, rather than casting them aside to deal with problems on their own.

Do we think this is right? Are the authors correct in thinking that harm reduction is congruent with virtue ethics, and that it is in fact virtuous to favour and promote a harm reduction approach?