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[Acceptability of harm reduction interventions: contributions of members of the population to the debate about public health ethics].

https://arctichealth.org/en/permalink/ahliterature152246
Source
Can J Public Health. 2009 Jan-Feb;100(1):24-8
Publication Type
Article
Author
Eve Dubé
Raymond Massé
Lina Noël
Author Affiliation
Institut national de santé publique du Québec, Québec. eve.dube@ssss.gouv.qc.ca
Source
Can J Public Health. 2009 Jan-Feb;100(1):24-8
Language
French
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Attitude to Health
Drug Users - psychology
Female
Government Programs - ethics
Harm Reduction - ethics
Humans
Interviews as Topic
Male
Middle Aged
Needle-Exchange Programs - ethics
Public Health - ethics
Public Opinion
Quebec
Social Control Policies - ethics
Substance Abuse, Intravenous - microbiology
Young Adult
Abstract
To explore convergence and divergence in ethical stances of public health and of members of the population regarding acceptability of harm reduction interventions, in particular needle exchange programs.
Forty-nine semi-structured interviews were conducted with French-speaking residents of Quebec City. Content analysis was done to explore the views of the respondents with regard to injection drug users (IDUs) and interventions addressed to them, as well as Quebec policies on harm reduction.
Four main categories of social representations about IDUs have emerged from the discourses of the respondents. IDU were represented as: suffering from a disease (n = 17); victim of a situation that they could not control (n = 14); having chosen to use drugs (n = 12); or delinquent people (n = 6). Those social representations were associated with different ethical stances regarding acceptability of harm reduction interventions. Main divergences between respondents' ethical positions on harm reduction and public health discourses were related to the value of tolerance and its limits.
The Quebec City population interviewed in this study had a high level of tolerance regarding needle distribution to drug addicts. Applied ethics could be a useful way to understand citizens' interpretation of public health interventions.
PubMed ID
19263971 View in PubMed
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Harm reduction through a social justice lens.

https://arctichealth.org/en/permalink/ahliterature159118
Source
Int J Drug Policy. 2008 Feb;19(1):4-10
Publication Type
Article
Date
Feb-2008
Author
Bernadette Pauly
Author Affiliation
School of Nursing, University of Victoria, Box 1700, Victoria, BC V8W 2Y2, Canada. bpauly@uvic.ca
Source
Int J Drug Policy. 2008 Feb;19(1):4-10
Date
Feb-2008
Language
English
Publication Type
Article
Keywords
Canada
Harm Reduction - ethics
Health Policy
Health Services Accessibility - ethics
Health status
Homeless Persons
Humans
Poverty
Social Justice
Social Problems - prevention & control
Street Drugs
Substance-Related Disorders - prevention & control
Abstract
People who are street involved such as those experiencing homelessness and drug use face multiple inequities in health and access to health care. Morbidity and mortality are significantly increased among those who are street involved. Incorporation of a harm reduction philosophy in health care has the potential to shift the moral context of health care delivery and enhance access to health care services. However, harm reduction with a primary focus on reducing the harms of drug use fails focus on the harms associated with the context of drug use such as homelessness, violence and poverty.
Ethical analysis of the underlying values of harm reduction and examination of different conceptions of justice are discussed as a basis for action that addresses a broad range of harms associated with drug use.
Theories of distributive justice that focus primarily on the distribution of material goods are limited as theoretical frameworks for addressing the root causes of harm associated with drug use. Social justice, reconceptualised and interpreted through a critical lens as described by Iris Marion Young, is presented as a promising alternative ethical framework.
A critical reinterpretation of social justice leads to insights that can illuminate structural inequities that contribute to the harms associated with the context of drug use. Such an approach provides promise as means of informing policy that aims to reduce a broad range of harms associated with drug use such as homelessness and poverty.
PubMed ID
18226520 View in PubMed
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Shifting moral values to enhance access to health care: harm reduction as a context for ethical nursing practice.

https://arctichealth.org/en/permalink/ahliterature157261
Source
Int J Drug Policy. 2008 Jun;19(3):195-204
Publication Type
Article
Date
Jun-2008
Author
Bernadette Bernie Pauly
Author Affiliation
School of Nursing, University of Victoria, Box 1700, Victoria, BC V8W 2Y2, Canada. bpauly@uvic.ca
Source
Int J Drug Policy. 2008 Jun;19(3):195-204
Date
Jun-2008
Language
English
Publication Type
Article
Keywords
Anthropology, Cultural
Canada
Data Collection
Ethics, Nursing
Female
Harm Reduction - ethics
Health Policy
Health Services Accessibility - ethics
Homeless Persons
Humans
Male
Nurse's Role - psychology
Social Justice
Substance-Related Disorders - nursing - rehabilitation
Abstract
People who are street involved including those experiencing homelessness and substance use are at increased risk of morbidity and mortality. Such inequities are exacerbated when those facing the greatest inequities in health have the least access to health care. These concerns have rarely been addressed in bioethics and there has been a lack of explicit attention to the dominant societal and organizational values that structure such injustices. The purpose of this paper is to describe the underlying value tensions that impact ethical nursing practice and affect equity in access to health care for those who are street involved.
In this paper, findings from a larger qualitative ethnographic study of ethical practice in nursing in the context of homelessness and substance use are reported. The original research was undertaken in two 'inner city' health care centres and one emergency department (ED) to gain a better understanding of ethical nursing practice within health care interactions. Data were collected over a period of 10 months through face-to-face interviews and participant observation.
In order to facilitate access to health care for those who are street-involved nurses had to navigate a series of value tensions. These value tensions included shifting from an ideology of fixing to reducing harm; stigma to moral worth; and personal responsibility to enhancing decision-making capacity. A context of harm reduction provided a basis for the development of relationships and shifted the moral orientation to reducing harm as a primary moral principle in which the worth of individuals and the development of their capacity for decision-making was fostered.
Implementation of a harm reduction philosophy in acute care settings has the potential to enhance access to health care for people who are street involved. However, explicit attention to defining the harms and values associated with harm reduction is needed. While nurses adopted values consistent with harm reduction and recognized constraints on personal responsibility, there was little attention to action on the social determinants of health such as housing. The individual and collective role of professional nurses in addressing the harms associated with drug use and homelessness requires additional examination.
PubMed ID
18467086 View in PubMed
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