Theological perspectives on a medically supervised injecting centre to be operated by the Uniting Church Board for Social Responsibility.
This material was prepared by the Board for Social Responsibility in March 2000 in response to the request of the Council of Synod that a short theological rationale be prepared.
In recent years there has been a growing community concern about the harm associated with the use of injecting drugs. Although more Australians die from legal drugs (nicotine and alcohol) the number of people dying from the use of illegal drugs is increasing. Governments, communities, and families are thinking about new and additional ways to reduce the harm associated with illicit drug use and to save lives. The Church is a part of this discussion.
The Church's historical role
Christian Churches have played a historic role in the establishment of hospitals and other health and community service facilities. These facilities were often established during a time when a common theological view was that sickness was a part of God's punishment on an individual or family. The Church has resisted this view, and announced that the grace and compassion of God is extended to all of God's children. Uniting Church Missions in Australia have, since the nineteenth century, conducted caring programs for people affected by the misuse of drugs and alcohol.
A medically supervised injecting centre
Injecting centres or rooms were first established in a number of European countries. They currently operate in The Netherlands, Germany, and Switzerland. They were the subject of a NSW Joint Parliamentary Enquiry, were recommended by the Royal Commissioner into Police Corruption, and the 1999 NSW Drug Summit carried a recommendation asking the Government to conduct a trial. The Tolerance Room, established prior to the Drug Summit by the Uniting Church's Wayside Chapel in Kings Cross, was an important part of the historical process.
In November 1999 the NSW Parliament passed legislation providing for a licence to be issued and the Government nominated Kings Cross as the appropriate area for a trial. The legislation provides for a trial of 18 months and for an evaluation by a separate panel of expert advisors. The licence to an operator is issued by the Police Commissioner and the Director General of Health.
The Medically Supervised Injecting Centre (MSIC) will cater for established addicts who are over 18 years of age. It will also provide access to primary health care, referral to methadone maintenance programs, detoxification and treatment, and other services such as accommodation.
Figures released in December 1999 by the National Drug and Alcohol Research Centre show that 737 Australians died from opiate overdoses in 1998. This was an increase of 23 per cent on the results from 1997. Of the total deaths, 358 occurred in New South Wales. Overseas experience has shown that the establishment of an MSIC can significantly reduce deaths by overdose. For instance, in Frankfurt (Germany) from a figure of 127 deaths in 1993 it reduced to 68 in the first year after the establishment of an MSIC to 31 in 1996. Given the pre-eminent purpose of an MSIC being to save human life, it can be said that by emphasising the preserving of life, albeit in a drug addicted form, an MSIC is upholding the ultimate sanctity of human life.
A fundamental Christian belief is the sanctity of human life. In the story of Creation we hear that "God created humankind in his image" (Genesis 1:27), and Christian faith continually emphasises the close relationship between God and humanity. A primary motivating force for the establishment of an MSIC is the belief that it will reduce deaths from overdose and save lives. Thus it focuses on the belief that all men and women are created in God's image.
God's solidarity with humanity
The Christian response to the faults of others comes from the perspective of grace and forgiveness rather than fear of reprisal and judgement. "Do not judge, so that you may not be judged" (Matthew 7:1). Bishop George Irvine said in his Bible study on addiction at the 1999 NSW Synod, that there are many more addictions in our society, and even in the Church, than those related to drugs and alcohol. Other dangerous addictions include power, money, and aspects of sexuality.
When Jesus was asked about forgiving those who continue to offend against us, he said "If another disciple offends you must rebuke the offender, and if there is repentance, you must forgive. And if the same person sins against you seven times a day, and turns back to you seven times and says 'I repent' you must forgive" (Luke 17:3–4). Surely the appropriate Christian view is that a drug addict will respond best to those who understand his/her dilemma and struggle and who accept that there are times when providing a supervised environment for injecting is the only way of continuing to maintain contact and links with the addict and keeping him/her alive.
The opponents of the above perspective may say that the sanctity of human life would be better upheld by offering drug addicts only one alternative – to give up their addiction by way of detoxification and rehabilitation. Those who press this view generally go on to argue that drug addicts will only turn to these measures either through fear or by compulsion. They claim that harm minimisation measures such as needle programs or an MSIC ameliorate that fear and therefore delay the turn to a drug-free life. At its harshest this view is that the death of a drug addict is self-inflicted and without such drastic consequences the impact of fear and danger will not be great enough for other addicts to change their ways.
While this can be argued as a logical point of view, it must be questioned as a Christian one. The very core of the Christian Gospel is the incarnation of God in Christ. God has embraced the world and has embraced humanity in the person of Jesus of Nazareth. In his mercy, through Jesus of Nazareth, God embroiled himself in the ambiguities and struggles of our human existence. The Christian Gospel is a story of both grace and forgiveness. Is it therefore possible that the only word we can give to the drug addict is to immediately put aside their habit, when experience shows that the road from addiction to recovery is never a smooth one?
Sometimes, in order to live in community with another person we must be prepared tolerate actions with which we do not necessarily agree. The dilemma of the Church in the situation of drug addiction is no different to that faced by families with drug takers: do they totally exclude the offending family member until be/she is rehabilitated or do they at least provide food and shelter and maintain the contact which, ultimately, can provide the environment for change?
The critics of an MSIC will characterise it as a place of hopelessness and despair. Some critics of the MSIC argue that it is giving the message that there is no way out for the addict and that the best that can be done is to stop them from killing themselves. This is a false image of an MSIC, especially what is proposed by the Board for Social Responsibility, where addressing general health, providing welfare advice on housing and accommodation issues, giving entry to methadone programs, and to detox and rehabilitation will all be part of the services available. Indeed, the MSIC will be rather an embodiment Christian hope because it will say to the addict, even though we don't approve of your habit, and we all know that what you are doing is illegal outside this room, we will make a space for you to inject, because we believe that our first consideration is to keep you alive so that other things can be addressed later.
The power and strength of the ministry of Jesus is that he overwhelmed people with his grace, acceptance, and forgiveness, before he ever offered a word of judgement. The word 'repent' only comes at the end after there is acceptance. In the account of the woman caught in adultery, Jesus refuses to join the Pharisees in condemning her and asks those "who are without sin to cast the first stone". It is after he has confirmed that no one has condemned her and after he has also said to her "Neither do I condemn you", that he is able to say "do not sin again". (John. 8:1–11)
In his parliamentary speech on the Bill, the Special Minister of State, Hon John Della Bosca, concluded by referring to the account in the Gospel of Luke on the Road to Emmaus.(Luke 24:13–8B) He pointed to the fact that the two disciples who were walking together on the road failed to recognise the risen Christ. The Minister said:
"I am always attracted to that passage because the greatest challenge of the Revelation in modern times is to recognise the risen Christ in those around and among us. This House knows that those who seek to look at these issues in the context of the moral demands of religion should think seriously about whether or not they recognise the needs of the risen Christ in the lives of those marginalised addicts."
The Minister could also have referred to the parable of the Great Judgement (Matthew 23) where we are challenged to see Christ in the sick, the stranger, the hungry, the naked, and the prisoner. Could we add the drug addict? And is it correct to say that we will only make contact with such people while they behave in the way we think is best for them?
Some of the critics of an MSIC will argue that it involves the Church in wrongdoing. There are several responses to this criticism, First, it can be the case that the Church will be involved in breaking the civil law when it has a conscientious reason for doing so. For instance, hiding illegal migrants as has occurred in the United States in recent times. Also, the establishment by the Wayside Chapel of its T Room was clearly an illegal act and Rev Ray Richmond was subsequently charged by the police. In order to challenge the law there are occasions when it is necessary to break the law.
However, the second point to make is that the operation of the MSIC will be completely legal and is sanctioned and authorised by an Act of the NSW Parliament. This is not to argue that being legal means that it is automatically morally right, but it must be clear that in the operation of the MSIC the Uniting Church is acting completely within the law.
The third issue has been canvassed by a number of Catholic commentators when it was thought that the MSIC would be operated by the Sisters of Charity, this is that it is necessary to make a distinction between formal and material co-operation. As Fr Gerry Gleeson, the ethicist for St Vincent’s Hospital, has pointed out, it is important not to make the "mistake of failing to distinguish between the conduct of the person taking drugs and the co-operative action of those providing an MSIC". Formal cooperation would occur if the entire purpose of the MSIC was to provide a place for addicts to freely inject with no other significant motivations. However, material cooperation is where the MSIC is primarily intended as a means of saving lives and, as stated by Fr Gerry Gleeson, "the assistance one gives is really 'incidental' to the other person's conduct and is not the true purpose of one's co-operation." While this way of arguing is more common in Catholic than in Protestant tradition, it is a very helpful way of analysing the moral issues.
Risking the way of Jesus
It is nearly always the case that he harder and more intractable a problem, the less it is able to be seen in simplistic terms. Given the complexity of the issues surrounding drug addiction, it is not surprising that there are differing views on the ethical aspects of operating an MSIC. However, the Board is not alone in the Church in wanting to test this issue in practice. Not all ethical issues can be determined by book judgements, but the practical experience of operation can assist a more definitive judgement, especially when some potential positive aspects must be put up against some potentially negative ones.
Many issues we face today involve complex ethical dilemmas without simple answers. We must be guided by Christian teaching, search our hearts and consciences, and wait on the guidance of the Holy Spirit. Sometimes we must take risks and break conventions, as Jesus did.
The Board seeks the prayers of the Church as it carries out this venture.
H Herbert and W Talbot
Get in touch
If you would like to find out more about Uniting MSIC, call us on +61 (0) 2 9360 1191 or email firstname.lastname@example.org.