Complicity in Harm Reduction

• Published in: Health care analysis Vol. 28; no. 4; pp. 352 - 361
• Main Authors: Kirschenheiter, Timothy, Corvino, John
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-12-2020; Springer Nature B.V
• Subjects: Complicity; Ethics; Fear & phobias; Harm reduction; Health administration; Health Informatics; Medicine; Medicine & Public Health; Original Article; Philosophy of Medicine; Psychological safety; Public Health; Harm reduction; Supervised injection site; Enabling harm; Condoning harm; Complicity; Facilitating harm
• ISSN: 1065-3058; 1573-3394
• DOI: 10.1007/s10728-020-00407-9

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.