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Ethics and Addiction

Santa Clara, Calif.

I read with considerable interest Dr. Brealyn Sellers’ Resident’s Forum titled "Conflicting Social Forces Impede Addiction Treatment" in the August 2 issue. The elaboration of the ethical dilemma surrounding such efforts as methadone maintenance and needle-exchange programs was most eloquent: "[I]t can be a stretch to feel on solid ethical grounds in an environment that does so much to improve the quality of the addict’s experience of addiction, to participate actively in abetting overtly self-destructive behavior."

I happen to believe that such programs do indeed support the perpetuation of self-destructive behavior in the form of addictive disease, and in no way can these programs be considered "treatment" of addictive disease. Harm reduction is public-health preventive medicine that, one could hope, would be a prelude to abstinence-based treatment.

It was disappointing to read that Dr. Sellers suggests that we physicians might be willing to alter our ethical stance to accommodate the harm-reduction approach. Ethics is defined as a system of moral principles, and she rightly suspects that harm-reduction efforts constitute a violation of the principle of "physician, do no harm." To abandon one’s ethical principles is to engage in the moral relativism that grips Western culture today.

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