The Ethics and Politics of Harm Reduction
Harm reduction is an ideology or an approach taken in nursing that emphasizes the importance of harm reduction among populations that have to face barriers to healthcare or are representatives of vulnerable populations. According to Pauly (2008b), the prevailing perception of patients as those that need “fixing” negatively affects both patients and nurses because not all groups of patients can be “fixed” quickly. Some of them, such as individuals with mental health issues or addicts, might need more than “fixing” or even start believing that they cannot be fixed.
In this case, the philosophy of harm reduction is used as it emphasizes the need of reducing harm from some actions taken by patients (such as drug use, for example). An ethical approach, in this case, is that instead of judging the patient, nurses need to prevent further harm from being developed: “needle exchange and supervised injection sites” are considered as practical tools for harm reduction (Pauly, 2008b, p. 6). The philosophy of harm reduction is a more ethical approach to vulnerable populations as the perception of them changes: they are not seen as patients who do not deserve care for some reason but as equal citizens who should be admitted to care and whose condition is seen as complex and chronic.
The underlying principles of harm reduction (pragmatism, humanistic values, cost, and benefits balancing, supervised injection sites, and harm reduction) can help transform policies that target homeless and addicted patients (Pauly, 2008a). It is directly connected to the applied communitarian ethics, where the distribution of good in the society is viewed through the lens of democratic processes. It will help draw attention to power inequities and corresponding inequalities and barriers, ensuring that vulnerable populations are taken into consideration during policy-making processes.
What is the Relevance of a Using a Gender-Based Lens to Understand System-Level Issues in Healthcare?
Although it might not be evident, gender-based judging and gender as it is have a significant impact on healthcare, leading to biased perceptions of patients and health promotion. For example, Armstrong (2010) points out that the studying of CVD was mostly based on male participants and developed guidelines are also based on the recommendations for males, while females can experience an entirely different range of symptoms. The underlying assumption was that signs of CVD would be similar both in men and women, although it turned out that this assumption was false. This gender-based perception results in women having more subtle symptoms that are not recognized correctly, the decreased likelihood of women being hospitalized, and increased the length of stay in the hospital (Armstrong, 2010). Reid, Pederson, and Dupere (2012) suggest viewing research through a gender-based lens to estimate what population the research targets, how human commonalities and differences are recognized, and how bias is avoided by the researchers. The healthcare system needs to be transformed to respond to women’s needs adequately, as today some global issues, such as violence against women, remain to be ignored (García-Moreno et al., 2015). A gender-based lens can help address identified issues and bring women’s needs to light.
Canadian Institutes of Health Research (2014) report that the stigma surrounding transgender individuals and transphobia affect their psychological well-being and causes depression as they are being included from the society or judged by it. The healthcare system’s inability to address this stigma also results in a decreased vulnerability of transgender individuals, although the main problem here is the society’s perception of gender (Blosnich et al., 2013). As can be seen, a gender-biased understanding of healthcare problems prevents various populations from having free access to care, and profound changes in the latter are necessary.
References
Armstrong, P. (2010). Gender, health, and care. In D. Raphael, T. Bryant, & M. H. Rioux (Eds.), Staying alive: Critical perspectives on health, illness, and health care (pp. 331-347). Toronto, Canada: Canadian Scholars’ Press.
Blosnich, J. R., Brown, G. R., Shipherd, J. C., Kauth, M., Piegari, R. I., & Bossarte, R. M. (2013). Prevalence of gender identity disorder and suicide risk among transgender veterans utilizing Veterans Health Administration care. American Journal of Public Health, 103(10), 27-32.
Canadian Institutes of Health Research. (2014). Science fact or science fiction: Is gender nonconformity a mental disorder?Web.
García-Moreno, C., Hegarty, K., d’Oliveira, A. F. L., Koziol-McLain, J., Colombini, M., & Feder, G. (2015). The health-systems response to violence against women. The Lancet, 385(9977), 1567-1579.
Pauly, B. (2008a). Harm reduction through a social justice lens. International Journal of Drug Policy, 19(1), 4-10.
Pauly, B. B. (2008b). Shifting moral values to enhance access to health care: Harm reduction as a context for ethical nursing practice. International Journal of Drug Policy, 19(3), 195-204.
Reid, C., Pederson, A., Dupere, S. (2012). Addressing diversity and inequities in health promotion: The implications of intersectional theory. In I. Rootman, S. Dupere, A. Pederson, & M. O’Neill (Eds.), Health promotion in Canada: Critical Perspectives on Practice (3rd ed.) (pp. 54-66). Toronto, Canada: Canadian Scholars’ Press.