Birkness Katherine, Forchuk Cheryl, Serrato Jonathan, Rudnick Abraham
Queen's University, Kingston, Canada.
Western University, London, Canada.
Health Care Anal. 2025 Jun 14. doi: 10.1007/s10728-025-00530-5.
The opioid epidemic continues to be a prevalent crisis in North America. How best to address this challenge has long been debated. Abstinence is currently the preferred policy within the inpatient hospital setting, however, this is fraught with difficulties such as withdrawal and using substances in secrecy. It can also result in stigma and a lack of knowledge on substance use among health care providers. The concept of harm reduction could provide an ethical approach to supporting people with substance use disorder. Through Principlism and the principles of Autonomy, Beneficence, Justice and Non-Maleficence, this paper suggests that harm reduction practices represent a viable and more ethically sound approach to health care compared to abstinence-based approaches. Harm reduction practices could result in a more equitable health care system that reduces stigma and increases help-seeking behaviour. More empirical research in other jurisdictions or other settings such as long-term care is needed. Future research should address additional theoretical frameworks such as dialogical bioethics, care ethics and the capabilities approach.
阿片类药物流行在北美仍然是一个普遍存在的危机。如何最好地应对这一挑战长期以来一直存在争议。目前，禁欲是住院医院环境中的首选政策，然而，这充满了困难，如戒断反应和秘密使用药物。这也可能导致污名化以及医疗保健提供者对药物使用缺乏了解。减少伤害的概念可以为支持药物使用障碍患者提供一种符合伦理的方法。通过原则主义以及自主、行善、公正和不伤害原则，本文表明，与基于禁欲的方法相比，减少伤害措施代表了一种可行且在伦理上更合理的医疗保健方法。减少伤害措施可能会带来一个更公平的医疗保健系统，减少污名化并增加求助行为。需要在其他司法管辖区或其他环境（如长期护理）中进行更多实证研究。未来的研究应探讨其他理论框架，如对话生物伦理学、关怀伦理学和能力方法。
