Unit 3 Assignment
In a 3- to 5-page scholarly paper, you will integrate
information from multiple sources regarding
an ethical topic of your choice. You will also explore
how personal beliefs, values, and biases
can impact ethical decision making and how you will
apply the Ethics Code in your future
career. The majority of the paper will focus on the
synthesis of information from your sources.
The exploration of personal beliefs, values, and
biases should be no more than 1 page.
Use the readings from Units 1, 2, and 3 to guide your
topic selection using the APA Ethics
Code. Once you select a topic, find and incorporate at
least three articles from the Kaplan
Library pertaining to your topic. (I have selected
the articles; they are on needle exchange programs—attached below)
In this paper, you will synthesize the readings from
the textbook along with the articles you
chose. Consider
the following for each article:
What is the main issue the author is addressing?
What is the author’s central point?
What are the strengths and weaknesses of the
article?
What makes the article interesting and important?
How will this synthesis of what the author has to
say help you apply what you are
learning to your own work in the profession? (Addiction)
·
After synthesizing the ideas from the
readings (articles and textbook), reflect on your personal background (biases,
beliefs, values, etc) and discuss how this could influence your ethical decision
making. How will you balance your personal influences with the guidelines you
find in the Ethics Code? How will you apply the Ethics Code in your career? (My
career will be psychology with emphasis on addictions)
The paper should:
Follow assignment directions (review grading rubric
for best results—below).
Use correct APA formatting per the APA Publication
Manual, 6th Edition.
Demonstrate college-level communication through the
composition of original materials
in Standard American English.
Be written in Standard American English and be
clear, specific, and error-free.
APA template is attached as well…This paper needs to be original and not plagiarized with in-text citations.
Unit 3 Project Rubric
Course Content
Student synthesizes and addresses the
following: each article
(1) What are
the main issues the authors are addressing in the articles?
(2) What are
the author’s central points they are making.
(3) What are
the strengths and weaknesses of the articles?
(4) What
makes the articles interesting and important?
(5) How will
this synthesis of what the authors have to say help you make application of
the material in your own work?
Uses appropriate references to course
material in addition to the required number of scholarly resources.
Student clearly synthesizes
ideas from the readings, reflects on their personal background and discusses
how this could influence their future work in psychology. In addition,
student clearly discusses:
(1) How they will balance personal
influences with the ethics code regarding ethical decision making.
(2) How the ethics code will be
applied in their career.
Writing
Style and
Mechanics: Includes
introduction with clear thesis statement, complete paragraphs, and brief summary
paragraph rephrasing thesis.
APA Style:Uses correct grammar, spelling, punctuation, and APA
format. Meets the 3 – 5 page essay requirement, which does not include
the cover and reference page.
thinking_ethically_about_needle_article.pdf
ethical__legal_and_social_context_of_harm_reduction.pdf
ethical_issues_raised_by_needle_exchange_programs_article.pdf
sample_apa_template.doc
Unformatted Attachment Preview
Substance Use & Misuse, 41:815–825
Copyright © 2006 Taylor & Francis Group, LLC
ISSN: 1082-6084 (print); 1532-2491 (online)
DOI: 10.1080/10826080600668670
Thinking Ethically About Needle
and Syringe Programs1
JOHN KLEINIG
Professor of Philosophy, John Jay College of Criminal Justice, City University of
New York; Professorial Fellow in Criminal Justice Ethics, Centre for Applied
Philosophy and Public Ethics, Charles Sturt University, Australia
Accepting—for the sake of argument—our current legal policies concerning heroin use
and its users, what ethical questions are raised for needle and syringe program (NSPs)?
Do they weaken drug laws, send the wrong message or obscure the right message,
do little to eliminate the harm of drugs, detract from alternatives, and/or constitute
a counsel of despair? I suggest that in the absence of established better alternatives,
NSPs constitute a morally acceptable and in some cases even desirable option despite
the continued criminalization of injecting drug use. Yet they must be conceived and
administered in ways that do not reinforce prevailing social prejudices.
Keywords aggregative versus distributive; counseling; criminalization; ethics; halfway house; harm reduction; HIV/HCV transmission; moral message; needle and syringe
programs; needle exchange programs; zero tolerance
For reasons best known to itself, our society has chosen to criminalize the use of certain
psychoactive drugs and, in addition, to stereotype and marginalize their users. That it should
wish to control or discourage the use of such drugs is not, perhaps, surprising, given the
multiple impacts of their unregulated use. That our policies of legislative response have
sometimes taken the form of a stigmatized criminalization rather than of restricted access,
prescription, taxation, and various other options—along with education and treatment—is
to a considerable extent lost in the vagaries of our political history. But it is that to which
we are currently heirs, and though those policies may seem—and I am sure are—frequently
arbitrary and misguided, we are still left with the need to respond to the personal and social
effects of drug use. Some of those effects are intrinsic to the drugs themselves; others relate
more distinctively to drug-using practices.
Harm-reduction policies appear to offer a humane response, albeit primarily to drugusing practices. Rather than saying, in Victorian fashion, “You’ve made your bed, now you
must lie in it,”2 such policies seek to reduce some of the deleterious effects that are associated
with a particular form of drug administration. These effects on both the users themselves and
others who may be affected or infected by them—via transmissible viruses such as HIV and
Address correspondence to John Kleinig, Ph.D., Department of Law & Police Science, John
Jay College of Criminal Justice, CUNY, 899 Tenth Avenue, Suite 422, New York, NY, 10019, USA.
E-mail: jkleinig@jjay.cuny.edu
1
This article was originally delivered as a keynote address at the Anex Harm Reduction
Conference, Melbourne, Australia, June 7, 2005.
2
This hard saying also makes tendentious suggestions about responsibility for drug dependence.
For discussion, see Tziporah Kasachkoff, “Drug Addiction and Responsibility for the Health Care of
Drug Addicts,” Substance Use & Misuse, 39(3) (2004), 489–509.
815
816
Kleinig
hepatitis C virus (HCV)3 —are, I believe most of us would accept, grossly disproportionate
to whatever may be the inappropriateness of the drug use that transmitted them.4
I have been asked if I would comment on some of the ethical issues surrounding the
use of what in Australia are known as needle and syringe programs (NSPs). Elsewhere,
or, partly because of the ways in which they operate, they are known as needle exchange
programs (NEPs), syringe exchange programs, syringe and needle exchange programs,5
and sometimes there are also references to satellite needle distribution or secondary needle
exchange programs and practices.6
Why should we look at the ethical dimensions of this issue rather than simply at their
practicalities, with which, I imagine, many of you are involved? At one level the answer
is quite simple. Ethical concerns are basic to human interaction. They are the fundamental
currency of interpersonal conduct. It is, most probably, an ethical concern—whether of
compassion, beneficence, or justice—that prompts us to commit ourselves to social welfare
or harm-reduction, a sense that we cannot simply stand on the sidelines as people risk
catastrophic harm to themselves and to individual and collective others. We do not wait
for bad consequences to occur in other spheres—we have safety standards and seatbelt
regulations, for example—and there is no adequate reason for making an exception here.
But ethical concerns are fundamental in another and deeper sense. It is via ethical
judgments that we assess and evaluate other norms of human interaction, whether they are
3
NSPs may also reduce hepatitis B virus (HBV) and bacterial infections.
There are, unfortunately, those who see it either as God’s punishment on certain kinds of
behavior or, less personally, as some form of natural sanction (cosmic justice).
5
In some jurisdictions injecting equipment is provided only on a one-to-one exchange basis;
sometimes that is simply an aspiration; sometimes there is no exchange requirement or even
expectation. The name used need not be tightly correlated with practice. In decisions about how
a program is to be administered, trade-offs are involved. A strict exchange program may minimize
the number of abandoned—and infected or otherwise dangerous—needles; on the other hand, a
strictly administered exchange program may, for various reasons, increase the likelihood of using
infected paraphernalia. In general, the less tolerant a jurisdiction, the more likely it is that exchange
is “expected.” It is not unreasonable to believe that a program that dispenses according to need
(rather than some form of exchange) diminishes the likelihood of reuse/sharing and thus of riskier
behavior. Generally, programs—and communities—that distribute according to need also provide
facilities (often also in public restrooms) for needle disposal. Strict one-for-one exchanges sometimes
encourage needle reuse because injection drug users who carry paraphernalia all the time face an
increased likelihood of apprehension by police. For some comparative discussion, see Alex H. Kral,
Rachel Anderson, Neil M. Flynn, & Ricky N. Bluthenthal, “Injection Risk Behaviors Among Clients
of Syringe Exchange Programs With Different Syringe Dispensation Policies,” Journal of Acquired
Immune Deficiency Syndromes, 37(2) (October 1, 2004), 1307–1312. On syringe disposal under
different regimes, see Jennifer Lorvick, Ricky N. Bluthenthal, Lauren Gee, Rachel Anderson, Neil M.
Flynn, Andrea Scott, Mary-Lou Gilbert, & Alexis Martinez, “Disposal of Used Syringes by Clients
of Syringe Exchange programs, California, 2003,” presentation at the National Harm Reduction
Conference, New Orleans, November 2004, which suggested that although unsafe disposal practices
may increase somewhat with need-based programs, the differences are not significant. At the same
time, 1–1 exchange programs were associated with a greater level of needle sharing.
6
The acronyms can be confusing, since “S” may dummy for “syringe,” “satellite,” or “secondary.”
Satellite needle distribution is defined as: “receiving a new syringe from another individual through
trading, purchasing, borrowing, or being given the syringe outright, or supplying a syringe to
another individual through trading, selling, lending, or giving a syringe outright.” Secondary needle
exchange occurs when programs allow users to exchange needles not only for themselves but
also for others. See Mark W. Tyndall, J. Bruneau, S. Brogley, P. Spittal, M.V. O’Shaughnessy, &
M.T. Schechter, “Satellite Needle Distribution Among Injection Drug Users: Policy and Practice
in Two Canadian Cities,” Journal of Acquired Immune Deficiency Syndromes, 31(1) (Sept 1,
2002); 98–105; Mark W. Tyndall, J. Bruneau, S. Brogley, P. Spittal, M.V. O’Shaughnessy, & M.T.
Schechter, “The Role Of Secondary Needle Exchange: Policy And Practice In Two Canadian Cities,”
.
4
Thinking Ethically About Needle and Syringe Programs
817
political, economic, legal, or customary. We do not judge ethical standards by reference
to these other ways of structuring and judging our behavior, but we appeal to ethical
considerations in evaluating those others. If laws and governmental policies don’t conform
to ethical requirements, we have a strong reason for seeking to change them; if economic
policies fall short of what we believe is ethically acceptable, we have a strong reason to
seek their restructuring; if political decisions are ethically suspect we have a powerful
reason for protesting them. Being sensitive to the ethical issues surrounding NSPs is
therefore of fundamental significance, even more fundamental than—though of course not
independent of—whether they work. Not everything that might work is ethically required
or even permissible, as we are reminded by current controversies about the use of harsh,
even torturous, interrogation tactics,7 and probably should be reminded by the tendentious
language of the “war on drugs.”
Not only are ethical issues fundamental, they are also pervasive; they arise at every
point of our interactions. They are not restricted to special occasions. Even the simplest
transaction—such as the purchase of a newspaper—is invested with ethical significance:
whether I act politely and with respect toward the seller of the newspaper or with surliness
and condescension. The same might be said about the delivery of drug paraphernalia: Is
distribution mechanical or is there recognition that the recipients are our fellows, albeit
deeply affected by drugs? There are in addition even larger ethical questions lurking behind
such transactions—in the first example, about whether a particular newspaper ought to be
published and whether that vendor should stock it, and in the case of NSPs whether they
ought to exist and, if so, who should operate them. We should remember, however, that
these latter questions are distinct from, even though they may be related to, questions about
whether the judgments we make ought to be enforced or otherwise officially sanctioned.8
Ethical judgment is complex and nuanced.
Because of the way in which our society has chosen to respond to certain drugs and their
users, some of these general questions tend to arise more visibly. Because we have chosen
to criminalize the use of heroin and cocaine, ethical questions about the status of NSPs tend
to be more pressing than would be the case were those drugs’ use not criminalized.
This is not the occasion to address some of these more fundamental issues, though
they certainly need to be addressed. What I want to do here is review and offer an
assessment of some of the ethical questions that are posed for NSPs within the existing
Anglo-American sociopolitical system. Accepting the sociopolitical status quo, the most
fundamental question is whether NSPs ought to exist. In the Australian context, fortunately,
one is not forced to do too much work on this question, though I later argue that there remain
significant ethical issues concerning the ways in which such programs are implemented.
NSPs originated in Australia in the 1980s, and governmental support for harm reduction
and, in particular, needle programs, has been significant, even if not always wholehearted.9
However, were I giving this talk in the United States, where I normally reside, I would have
a much tougher job, for the zero tolerance policies that often prevail frequently express
themselves resolutely against NSPs.
7
See, for example, Mark Danner, Torture and Truth: America, Abu Ghraib, and the War on
Terror (New York: New York Review of Books, 2004).
8
One might, for example, question the appropriateness of permitting owners of private “shooting
galleries” to operate such programs, given what we know of their history and the difficulties of
ensuring that sterile needles are exchanged.
9
Alex Wodak, “Needle Exchange and Bleach Distribution Programmes: The Australian
Experience,” International Journal of Drug Policy, 6(1) (1995), 46–56; N. Crofts, C.K. Aitken,
& M.J. Kaldor, “The Force of Numbers: Why Hepatitis C is Spreading Among Australian Injecting
Drug Users while HIV is Not,” Medical Journal of Australia 170 (1999), 220–221.
818
Kleinig
In his 2000 presidential campaign, (then) Governor George W. Bush stated the
following10 :
I do not favor needle exchange programs and other so-called “harm reduction”
strategies to combat drug use. I support a comprehensive mix of prevention,
education, treatment, law enforcement, and supply interdiction to curb drug
use and promote a healthy, drug-free America, not misguided efforts to weaken
drug laws. Drug use in America, especially among children, has increased
dramatically under the Clinton-Gore Administration, and needle exchange
programs signal nothing but abdication, that these dangers are here to stay.
Children deserve a clear, unmixed message that there are right choices in life
and wrong choices in life, that we are all responsible for our actions, and that
using drugs will destroy your life. America needs a President who will aim
not just for risk reduction, but for risk elimination that offers people hope and
recovery, not a dead-end approach that offers despair and addiction.
There are several claims embedded in this campaign statement, and they constitute a
useful peg on which to hang my discussion.
(A) There is the assertion that NSPs (or NEPs) are “misguided efforts to weaken drug
laws.” It is, of course, a claim we might wish to challenge. Maybe these are laws that we
should seek to weaken—not necessarily, of course, because we are opposed to drug laws
but because we believe that the kinds of laws we have are inappropriate to the problem to
which they are addressed. But, as I mentioned, I am here prescinding from that inquiry.
Taking it at its face value, how is this weakening intended (as suggested) or, if not
intended, then consequent upon NSPs? Three possibilities are hinted at. One is that NSPs
convey the message that drug use is not as seriously wrong as it really is: If you provide
means whereby people can continue to do what the law forbids, then you weaken its
condemnatory force. A second is that access to such means actually increases the amount
of illicit behavior. And the third is that harm reduction is not enough; we should be aiming for
harm minimization or, better, harm elimination, and NSPs impede the latter’s achievement.
(1) Take first the most intractable claim, namely, that NSPs put a question mark against
the law’s condemnation of drug use. There are really two issues embedded in this. One
concerns symbolism, whereas the other is about ends.
Let us concede that some means of delivering sterile equipment—say, vending
machines—by being relatively neutral with respect to prevailing social judgments
concerning drug use could lead one to believe that the only social judgment relevant
to drug use concerns the transmission of disease.11 For the moralistic opponent of drug use,
that inference is drawn, rendering both the symbolism and the ends of vending machine
dispensation unacceptable.12 Of course, whether that would be a legitimate reading of their
availability is another matter. But it is not clearly excluded.
10
George W. Bush, Response of Governor George W. Bush to the AIDS Foundation of Chicago
(2000): http://www.aidschicago.org/pdf/GWB response.pdf
11
Needle vending machines—unlike condom dispensers—may have other problems associated
with them, given that needles are inherently dangerous. Nevertheless, if, as may be the case,
the clientele of vending machines differs significantly from that of staffed NSPs, that may be a
reason for having both. See Alex Wodak & Annie Cooney, Effectiveness of Sterile Needle and
Syringe Programming in Reducing HIV/AIDS Among Injecting Drug Users (Geneva: World Health
Organization, 2004), 21.
12
This is not to reject them—only to say that they probably cannot be reconciled to the outlook
of those who take this position. It might be open to their defenders to argue that whatever the merits of
that outlook, it ought not to be translated into social policy. However, those who take such a position
Thinking Ethically About Needle and Syringe Programs
819
In the case of staffed NSPs, however, the situation is more complex. Consider first
the issue of ends. It is at least arguable—and later on I argue it—that an optimal program
should embed needle distribution within a framework of services that seeks to overcome
drug dependence.13 Needle programs might reasonably be construed as half-way houses
to keep users (as well as others) relatively safe until such users are ready to address their
dependence constructively. If we add to this the evidence that counseling, treatment, HIV
and HCV prevention messages and testing, abscess wound care, and other clinical services
(such as vaccination) are more likely to be sought and provided in the context of such
programs than outside them,14 then NSPs might be seen as important elements of social
and public health policies designed to achieve ends that are not too different from those of
existing drug laws.15
And the symbolism of NSPs, even if not moralistic, need not be unacceptable.
True, the message is not one of moral condemnation, but that does not prevent them
from conveying the view that drug dependence is a bad thing: bad for those who
are dependent and bad also for others. I take it from the fact that many program
workers were once substance users that the message is ultimately about overcoming a
condition—about “recovery,” albeit in the context of safety. I concede that this may
be thought insufficient by those who wish to convey an unnuanced message of moral
condemnation.16 But it is not a message of normative neutrality or of condonation.17
Other things being equal, being drug dependent is not a good thing to be.18
often hold in addition that their views ought to be legislatively enforced. See, for a helpful overview,
“Syringe- Dispensing Machines,” anex bulletin, 3(2) (n.d.): 1+.
13
Here I follow the World Health Organization in using the term “drug dependence” to cover
what it previously distinguished as “addiction,” “habituation,” and “drug dependence.” The virtue of
the old distinction was that it recognized a range of drug-related “dependencies,” with varying
implications for ethically appropriate responses. The problem with the old categorization was
the artificial way in which it divided up drug users: Dependent users display varying degrees of
control (or lack thereof) with respect to their condition, and ethical social responses need to regard
this.
14
R. Heimer, “Can Syringe Exchange Serve as a Conduit to Substance Abuse Treatment?”
Journal of Substance Abuse Treatment, 15(3) (1998), 183–191; H. Hagan, J.P. McGough, H.
Thiede, S. Hopkins, J. Duchin, & E.R. Alexander, “Reduced Injection Frequency and Increased
Entry and Retention in Drug Treatment Associated with Needle-Exchange Participation in Seattle
Drug Injectors,” Journal of Substance Abuse Treatment 19 (3) (2000), 247–252; R.N. Bluthenthal,
A. Gogineni, D. Longshore, & M. Stein, “Factors Associated with Readiness to Change Drug Use
Among Needle-Exchange Users,” Drug & Alcohol Dependence 62 (2001), 225–230. Merely entering
a program of course is no guarantee of its success—a “therapeutic engagement” or “alliance” is of …
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