The Hippocratic Oath, as presumably most of us know, is the oath taken by physicians promising to uphold ethical standards in treating their patients. The four pillars of medical ethics primarily stem for this oath: autonomy, beneficence, non-maleficence, and justice. The world we see now is socially different compared to what it was when Hippocrates was alive. Physicians and policymakers in health care now face new ethical challenges that they need to adapt to. How we deal with drug abuse is an excellent example of that. It often sparks controversy about where the fine line is between doing what is in the best interest of patients and ensuring patients avoid harm. For me, this tension grew as I recently approached the idea of state establishment of supervised injection facilities (SIF).
SIF establishments allow illicit drug users to take their drugs under medical supervision with the aim of preventing harms associated with the improper use of needles, contaminated needles and the potential of overdose. I must admit that at the outset, I thought this idea was very unethical. I cannot imagine myself as a physician partaking in a service that facilitates and “glorifies” illicit drug use instead of working towards their prevention and saving lives. It appeared to me that SIF is the policymaker’s easy way out and I still do see it that way. However, I came to re-evaluate that position as the research on SIF services offered in Canada and Australia is compelling scientifically. There is evidence that rates of infections associated with drug use and overdose rates are both reduced.
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