The Island of Doubt

The latest example of irrational, Medieval policy-making in Washington to outrage these parts of the blogosphere is a three-week-old story from NPR in which we learn that federal officials oppose the distribution of cheap "overdose-rescue" kits to heroin addicts. Why? Well, according to Dr. Bertha Madras, deputy director of the White House Office on National Drug Control Policy...

the rescue programs might take away the drug user's motivation to get into detoxification and drug treatment.

"Sometimes having an overdose, being in an emergency room, having that contact with a health care professional is enough to make a person snap into the reality of the situation and snap into having someone give them services,"

In other words, we wouldn't want to actually save real lives -- we're only interested in theoretical ones. As Tom Levenson writes at Inverse Square:

The essential claim Madras makes is that improving a user's chance of surviving an overdose will encourage further drug use, while avoiding death under the care of medical professional will induce the lucky survivors to seek drug treatment.

These are at least nominally empirical claims. They can and should be tested. But as far as we can tell, Madras pulls these statements out of her gut (I'm trying to be polite here). To the extent that there is any real data, NPR's story also reports that "one small study suggests that overdose-rescue programs reduce heroin use and get some people into treatment."

There's nothing particularly surprising about this policy, though. We're talking about a world view that opposes contraception in favor of abstinence-only education, despite the incontrovertible fact that the best way to reduce unwanted pregnancies and abortions is to improve access to contraception.

It all comes down to a slavish devotion to the black-and-while simplicity of a philosophy in which the ends can never justify the means. How many times have you heard that one? We can't fund needle-exchange programs because that would be condoning drugs. We can't fund family planning because that would condone murder. We can't have young girls being vaccinating against HPV because that would condone teenage sex. And now we can't hand out life-saving medicine because that would only encourage the addicts.

Please. As any honest ethicist will tell you, sometime the means are justified. Sometime they don't, but often they can. The case of abortion is a perfect example. If you want to reduce the number of unwanted children, and therefore the demand for abortion, then the best way is to make sure everyone has ready access to contraception. And because the demand for abortion is unaffected by the laws governing the procedure, the best way to reduce the maternal mortality associated with the process is to make it legal and easy to procure.

New Scientist recently reported on a comprehensive study of the subject recently published in the Lancet (vol 370, p 1338):

Tellingly, the number of abortions fell almost exclusively in rich countries where terminating a pregnancy is both legal and safe. In poorer countries, where access to abortion is often restricted or illegal, there has been very little progress in reducing the number of abortions, says Shah.

In such countries, women are prepared to endanger their lives to terminate a pregnancy (see "By any means available"). In Africa, for example, where access to safe, legal abortions is almost non-existent, there were 29 abortions per 1000 women of childbearing age in 2003. In Europe, where abortion is widely available and legal (with the exception of Poland and Ireland), the rate was almost identical, at 28.

There is a crucial difference, notes the report. While 98 per cent of abortions in Africa are unsafe, leading to widespread maternal death and disability, less than 1 per cent of European women suffer complications such as haemorrhaging and post-abortion infection. "Making abortion illegal doesn't stop it happening, and if it happens in a context that's not safe, women will die," says Ann Starrs of Family Care International, a charity in New York lobbying to improve women's global health and status.

It's the same thing with many of the issues that divide progressives from conservatives. Take gun control. Despite the evidence that tight regulations on firearms can reduce the accidental death and homicide rates, NRA types oppose such measures because they would constitute an infringement of their Second Amendment right to bear arms (They're wrong on that, but let's leave that aside). Even when saving lives is the end, says the NRA, the means are unjustified.

Of course, in a world in which ends can be measured. some, though not all, means are justified. We all know that. So when you here someone make an "ends can't justify the means" argument, what you're really getting is an argument denying the ends as worthy of justifying. Those who would rather see pregnant women, young girls or addicts suffer rather than offend some bizarre religious, philosophical or religious sensibility are basically saying they don't care about the pregnant women, young girls or addicts. Call them on it.