The New York Times has recently drawn attention to Indiana Governor Mike Pence’s decision to initiate a needle-exchange program in the state last year in response to a growing HIV outbreak. Pence, the Republican vice-presidential candidate and a “steadfast conservative” was initially opposed to needle exchanges “on the grounds that they supported drug abuse.”
As the Republican vice-presidential candidate, Mr. Pence brings a long record of social and fiscal conservatism that serves as a counterweight toDonald J. Trump’s frequently shifting views. But rarely have the governor’s principles been tested like they were during Indiana’s worst public health crisis in years.
The question of needle exchange programs has received a lot of attention from Catholic moralists. Besides the fact that needle exchange programs have proven effective in curbing the spread of HIV, there is a growing consensus that the Catholic moral tradition offers sufficient grounds for supporting needle exchange programs.
There are many angles from which we can approach the issue of needle exchange programs (NEPs). First is intent. In NEPs, the intent (what we are ultimately aiming for) is disease prevention, that is, limiting the spread of potentially-fatal diseases like HIV. The intent in establishing these programs is not to encourage or perpetuate drug use.
Second is cooperation. There is no question that NEPs involve some degree of cooperation with an evil. Intravenous drugs are dangerous, subject to abuse, and, of course, illegal. But NEPs provide material cooperation with the evil of IV drug use, which is significantly less problematic with formal cooperation. That is, one can provide a needle without also formally condoning the use of the drugs which the needle will be used for.
Related to both of these is double effect which allows for an action to be performed that will have morally evil consequences so long as these consequences are not intended, the good done is greater than the evil, and the action itself (in this case, providing needles) is not an intrinsic evil. Here, the action of providing needles is not an intrinsic evil (see below), and does have the foreseen consequence of, if not encouraging at least condoning illicit drug use. However, the good of preventing disease outweighs this foreseen evil.
Finally, we might utilize the principle of lesser evil. This I find less helpful when looking at NEPs and other issues. It is unclear (to me—we could debate this in the comments) that NEPs are an “evil,” even a lesser kind of evil. Providing needles to IV drug users under such circumstances is a good. These are users who will continue to use IV drugs, regardless of whether they have access to safe needles. Giving them clean needles are only an effort to minimize harm and the spread of disease. The concept of “lesser evil” only seems relevant to the users’ actions which is to either use drugs with an unsafe needle or with a safe one. Those who provide needles seem engaged in an action which is only good in its object and intent (and usually, if not always, its consequences).
Lesser evil seems more relevant when talking about, say, providing contraceptives to prostitutes, only because contraceptive use is defined as an “intrinsic evil.” Needles don’t share the categorical problem a condom does, though I would be interested to hear the opinions of other moralists on this question.
Regardless, even without lesser evil, which I would hesitate to apply, the Catholic moral tradition offers more than enough resources to support Governor Pence’s decision to initiate an NEP in his state.