Should we provide health care to people who break the law? Does it matter if they are endangering their own lives? We all have our biases (shocking!) and I have a friend who thinks that going to McDonald’s should put you lower on a list for heart surgery. I’ve wondered about withholding treatment for vaccine-preventable illnesses in children whose parents took the exemption – but then I remember that the kids shouldn’t suffer for the parent’s choice.
What about drug addicts and alcoholics? The argument is often that they chose their misery. I was motivated to write this post after reading comments about drug users in Vancouver.
Vancouver has a supervised injection site: Insite. Our local health authority runs the clinic that provides nurses, counsellors and peer support in addition to clean injection equipment. There are 12 booths were people can inject their drugs under supervision. In case of an overdose, health care staff can intervene. It works – please check out the research page of Insite for access to papers – and there have been no overdose deaths at Insite since it started in 2003.
Why does Vancouver need such a site? There are approximately 4,000 IV drug users in the downtown eastside and InSite helps to prevent infectious diseases and bring some stability to this area. Plus, the potency of heroin varies and there are cycles when lethal-strength heroin is on the street. We are in such a cycle with 21 heroin deaths so far this year compared to 8 last year – Vancouver Province, 2011). Therefore, there are posters up that state: ‘Never shoot up alone’ and places like InSite make sense.
But there is a legal battle in the Supreme Court of Canada. You see, when InSite opened as a research trial in 2003, it needed an exemption from the criminal code because heroin possession is illegal. The current federal government wants to remove this exemption, shutting down InSite and it is taking the province to court. [Just for a second think about this – I’m paying to have the provincial and federal governments fight each other.] It seems like it boils down to this:
- provincial: it is healthcare and that is the province mandate. Plus, it is saving lives
- federal: It is a crime to possess heroin and we don’t want to enable people to break the law
Both sides have a point. It’s tough because InSite works better than expected and so does that mean the criminal code should be ignored? I’ll leave you to ponder the issue.
I do find it interesting that 5 former Vancouver mayors of different political stripes support Insite (source). That article describes our former federal health minister saying ‘providing drug addicts with a supervised place to inject was akin to offering palliative care to patients with treatable forms of cancer’.
Even if his comparison holds up – and I don’t think it does but am trying to stay somewhat focused – would he withhold treatment from a cancer patient because they didn’t make his choices? If a woman decided not to treat her early breast cancer, would she be ineligible for palliative care? Our current system doesn’t allow for those decisions to be made and patients are treated for their current illness and hopefully not for their life decisions.
I hope that we stay treating the current illness and don’t bring in the moral judgements. Some people think I’m crazy for white water kayaking – does that mean that I shouldn’t get treatment if I’m hurt on the water? Or does that mean that I shouldn’t take safety gear or people because I’m doing something stupid? The trouble with moral health care is that we all have different biases.
I was talking with a friend who sees InSite as a criminal issue. Like the federal government, she agrees that InSite works but that it doesn’t matter because the initial drug possession is a crime. I asked her if it would be OK if seat belts disappeared when you started to speed. Her response: “No. But I can see a point of seat belts not working if you try to drive drunk.” Our discussion highlighted how difficult it is to decide who to protect.
I’m a bleeding heart, I admit it. Before the hockey game yesterday, I took food (salads and chocolate bars) to some of the homeless on the downtown eastside. I used to do this regularly but frequency dropped with a travel schedule. Why do I do it? I have a friend who lives on the edge of the area plus these people need help. To get an idea of life for some of these people, you should check out A Thin Blue Line, a movie done by police in the area. When I was a grad student, it helped me keep my troubles in perspective. I can’t help but think:
There but for the grace of [insert favourite deity or luck], go I.
I’m not an addict but family and friends struggle with drugs and alcohol. Most of them are lucky enough to not end up homeless in an area like the downtown eastside. Seth Mnookin, author of the great book the Panic Virus, wrote about his addictions in Salon and his description of heroin addiction resonates with my friends and family:
…because when you are a heroin addict, the only frame of reference is heroin.
What time is it? Heroin. What are you doing tomorrow? Heroin. Why are you going to the hospital? Heroin. What are your plans when you get out? Heroin. Written anything lately? Heroin.
If you are this caught up in your addiction, you aren’t thinking about consequences and to be frank, not thinking about criminal law. InSite tries to keep people alive without long term infectious diseases. And InSite doesn’t work alone but is part of a network that includes a detox centre above the supervised injection site.
IV drug users who go to InSite are taking a step, albeit a small one, towards better health. I hope that our city can continue to support them.
Caveat: I’m not an expert in this area so please let me know what I got wrong in the comments.