WE LOVE BECAUSE GOD FIRST LOVED US: REFORMED THEOLOGY AND THE ETHICS OF HARM REDUCTION
Return of the Prodigal Son, by Rembrandt. Found on Wikipedia.
In the summer of 1995, a new provincial government took power in the province of Ontario, Canada. Having run on a platform including both tax cuts and the reduction of budget deficits, the new government's enactment of sweeping cuts to welfare and social service spending was swift. By winter's arrival, the need for space in homeless shelters had skyrocketed, and the space in existing shelters was no longer adequate. By February of 1996, three homeless men with severe alcohol dependency had frozen to death on Toronto's streets.
Advocates for the homeless responded, and in 1997 the Seaton House Annex Harm Reduction Program opened at Seaton House, Toronto's largest shelter for men. Seaton House had been a dry shelter since its beginning in 1931 - the use of alcohol by shelter residents was strictly prohibited. The Harm Reduction Program operated under a different model, designed to increase shelter access for those with a high level of physical alcohol dependency. At Seaton House's "wet shelter," and at others like it around the world, residents can receive a measured pour of wine once an hour as long as they are not inebriated - a policy which simultaneously keeps residents away from more dangerous practices like shoplifting or drinking mouthwash and rubbing alcohol, but which also prevents the hellish and potentially fatal seizures and other symptoms that characterize severe alcohol withdrawal. Residents are not required to be seeking sobriety; the program only refuses to tolerate violent behavior or outright intoxication.
Wet shelters are one example of harm reduction, which is a broader and often controversial philosophical approach to public health. Harm Reduction International, a group committed to the application of harm reduction principles to policy and programs related to drug use, describes harm reduction in these four principles: Respecting the rights of people who use drugs, a commitment to evidence, a commitment to social justice and collaborating with networks of people who use drugs, and the avoidance of stigma. These principles translate readily to all forms of harm reduction work, whether focused on alcohol, drugs, tobacco, sexual activity, or any other potentially "risky" behavior.
At first glance, the connection between Reformed theology and support for harm reduction is less than obvious. Calvinist anthropology, whatever else it may be known for, has not historically been associated with the avoidance of stigma. Nevertheless, a robust understanding of the doctrine of total depravity and the bondage of the will, paired with an equally-robust theology of God's endless and unmerited favor and kindness toward humanity, can provide an excellent foundation on which congregations and individual Christians can ground harm reduction efforts.
Article IX of the Articles of Religion tells us that we are all “very far gone from original righteousness, and [are] of [our] own nature inclined to evil.” Article X continues the reflection, saying that we “cannot turn and prepare [ourselves], by [our] own natural strength and good works, to faith, and calling upon God.” Article XI therefore concludes that we are saved from danger and from the consequences of our actions not on the basis of “our own works or deservings,” but by grace, through faith.
Before proceeding much further, it is important to be clear that the connection to be made here is not that people who use drugs or alcohol are the depraved, and those who help them are like God. The relationship between acceptance of total depravity and support for harm reduction is not one of metaphor. Indeed, one of the key aspects of total depravity as a doctrine is that every human alive, and every human who has ever lived (other than Christ himself), is fully and equally fallen, and we are all born with wills that are fully and equally captive.
The point, rather, is that God has clearly demonstrated a love that refuses to consider worthiness or propriety of action when extending mercy, protection, and compassion. And as people who have received the ultimate act of unconditional care, each Christian is, in turn, obligated to extend genuinely unconditional care for the wellbeing of our neighbor - not as a way of playing God, but in recognition that there is fundamentally no difference between us and our neighbor. There is no one who is more deserving than another of protection from Hepatitis or HIV or tuberculosis, and there is no one whose safety matters less than another’s.
The central criticism of harm reduction is rooted in a deeper spiritual disorder - the desire to determine what subset of people need to be punished, and then to ensure the suffering of that punishment is not subverted or avoided. We see it in demands for the closure of needle exchange programs, in the criminalization of the provision of aid to migrants crossing the Sonora Desert, in calls for three strikes sentencing laws that send the desperate to prison for life over the theft of twenty dollars, in attempts to make emergency contraception illegal, in every attempt to shame and ostracize any member of society who finds themself in need.
Opponents of programs focused on risk-reduction rather than the enforcement of total abstinence argue that supervised injection sites and the distribution of free condoms and the expanded use of naloxone all encourage people to continue engaging in behaviors that society resents, and that the provision of social services should be predicated on a model that demands total abstinence as a condition of continuing care. The theological equivalent of this perspective - to which I hope we can all say a resounding “God forbid!” - would be to indict God for providing grace too recklessly, and of tacitly supporting sin by not demanding human perfection.
As humans, fully fallen and redeemed by pure grace, our job is not to play God, or worse, to play judge. Instead our job is to recognize just how pervasive the powers of sin and death are in our world and in ourselves, to recognize that God alone has the ultimate responsibility and capacity to make each of us who we were meant to be, and to work to create a world where, in the meantime, we are each able to extend and receive unearned kindness and care.
Too often we assume that, if a behavior is dangerous enough, people will be deterred from engaging in it. This simply isn’t the case - not a single one of us can will ourselves into a life of perfect choices, even if we know full-well what we “should” do. The choice is rarely between a needle exchange and rehab - it’s between a needle exchange and re-used or shared needles. When you hand someone a clean syringe, you aren’t increasing the chance of anything other than the chance that they won’t needlessly contract a preventable disease.
Contact your nearest needle exchange, methadone clinic, or naloxone distribution center and ask how your church can help care for those the world shuns, but Jesus adores. Ask your pharmacist how you can get naloxone of your own, often without a doctor’s prescription. Consider providing an FDA-approved sharps container somewhere outside at your church, so that individuals will be able to dispose of needles safely and anonymously. (See safeneedledisposal.org for information on how to dispose of the sharps container when needed.) These kinds of programs and actions may be politicized, but they are not fundamentally political - they’re moral.
Do unto others as God has already done for you.
