Harm reduction

Harm Reduction
Speed limits. Cross walks. Innoculations. Physical checkups.
Most of us agree with this type of harm reduction (whether we think they should be meant for us or not!).

Less easy to sort-out for many: harm reduction choices such as free condoms or abstinence, safe injection sites or detox beds.

But what about the even more controversial types of harm reduction? Decisions that are a choice between which one is less harmful, knowing both choices are not healthy?

I was challenged on that this week. I was horrified to hear the story of a chronic and very ill alcoholic who ended up in Shelter. Staff worked hard at finding a detox bed for this individual, and eventually succeeded – although it was several hours away.

Then began the work of keeping this person alive until the detox bed was ready. The ambulance was called, but didn’t help -- couldn't help, because this person summoned just enough lucidity to turn away assistance. At the same time there was a very real and high risk of death due to seizure from alcohol withdrawal.

Because of the advanced state of alcoholism (which combined a high need for the substance-of-choice with a complete inability to make rational or healthy choices) there were some difficult choices for staff for the short term:
• Evict someone to the street whose behaviour was extremely challenging and harmful to themselves (knowing that this was likely a death sentence).
• Give in and, against policy (and realizing that the "substance of choice" acted as a poison to this individual) turn a blind eye to imbibing.
• Find some middle ground that built relationship, that respected freedom of choices, followed policy, and kept this person safe for the 36 hours.

It was a difficult weekend, but the client made it to detox, thanks to staff.

There are those who ask, "Why bother - if s/he doesn't respect their own life, why should we?" And of course there are many answers to that, but they come down to this: Where there is life, there is hope.