A theological justification for the provision of medically supervised injecting facilities for
\npeople who inject illicit drugs

The aim of this thesis is to make a case that medically supervised injecting facilities for people who inject illicit drugs are morally permissible and that Roman Catholic healthcare professionals should be involved in establishing and running such facilities if they feel called to do so.
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\nMedically supervised injecting facilities (MSIF) are places where people can inject illicit drugs in a clean environment, using sterile equipment and under the supervision of healthcare professionals. MSIFs aim to reduce the harm caused by injecting illicit drugs and so are considered a form of harm reduction. The purpose of an MSIF is to reduce infections, overdoses, and deaths among people who inject drugs (PWIDs) and to reduce public nuisance and the risk of infection to the public. Globally, there is a small but expanding number of MSIFs.
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\nThere are questions around the effectiveness of MSIFs. In addition, there are social, legal and moral questions around the provision of MSIFs. The provision of MSIFs is a contentious issue and within the Roman Catholic Church, questions have been raised about the moral acceptability of such facilities.
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\nThis thesis aims to answer two questions. Are medically supervised injecting facilities for people who inject drugs morally acceptable? Is the provision of an MSIF an authentic way for Roman Catholic healthcare professionals to live out their commitment to Gospel values? The principles of cooperation in evil and gradualism are used to deal with these questions. The issues discussed in this thesis focus on the debates about the establishment of MSIF in Australia, North America, Ireland and Scotland.
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\nChapter 1 provides a historical background to illicit drug injecting and describes the origins, development and contentiousness of medically supervised injecting facilities.
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\nChapter 2 explains the role of practical theology within this thesis, the research methodology that is used and focusses on the reflexivity of practical theology and the vocation of the laity within the Roman Catholic Church.
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\nChapter 3 presents evidence that shows that MSIFs are both clinically and economically effective.
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\nChapter 4 applies the principle of cooperation in evil to justify the provision of MSIFs. The provision of a medically supervised injecting facility involves some degree of cooperation in illicit drug injecting. Injecting illicit drugs is understood as a moral evil. The principle of cooperation in evil is a traditional moral theology principle that is used to determine whether and to what degree one can cooperate in an evil act, in this case illicit drug injecting.
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\nChapter 5 applies the idea of gradualism to the provision of medically supervised injecting facilities. Gradualism is based on the understanding that moral development is a step-by-step process. Having found that the principle of cooperation in evil principle requires qualification to do justice to certain situations, the case is made that gradualism is an appropriate tool, in addition to the principle of cooperation in evil, for exploring the morality of the provision of MSIFs. Gradualism involves a purpose of amendment. The use of an MSIF by a PWID to reduce the harm caused by injecting illicit drugs can indicate a purpose of amendment and a significant step in the right direction.
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\nChapter 6 discusses the situation that arose in Australia in 1999 when the Sisters of Charity planned to establish an MSIF in Sydney and the Congregation for the Doctrine of the Faith (CDF) blocked this proposal. The response from the CDF is analysed in detail and shown to be flawed.
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\nChapter 7 discusses the situation in North America comparing the very different views taken by the Canadian Conference of Catholic Bishops (CCCB) and the United States Conference of Catholic Bishops to the provision of harm reduction for PWID. The CCCB has given cautious approval of MSIFs. However, the USCCB has taken a much harder line to harm reduction in general to the extent of dismissing needle exchange as an appropriate means of harm reduction in 1990. Although the USCCB has not made any statement on the provision of MSIFs, several American theologians and at least one bishop have argued against MSIFs. Their arguments are analysed and criticised in this chapter.
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\nChapter 8 discusses the situation in Ireland, in particular the attempts by the Franciscan friars to set up an MSIF. Merchants Quay Ireland, a project run by the Franciscans was chosen by the Irish government to run a pilot MSIF in 2018. This proposed MSIF does not seem to have attracted any objection from within the Roman Catholic Church. However, the implementation of the MSIF has been delayed by legal problems and objections from the local community.
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\nChapter 9 discusses the attempts to set up a medically supervised injecting facility in Glasgow. A plan for an MSIF in Glasgow has run into legal difficulties. These difficulties and the response of the Roman Catholic Church in Scotland and the Church of Scotland to the proposal are discussed in this chapter. In addition, the decision by Peter Krykant to set up a mobile MSIF in Glasgow is discussed.
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\nConclusion.
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\nThe thesis finds that:
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\nThe provision of medically supervised injecting facilities for people who inject illicit drugs is morally permissible within certain conditions. Furthermore, the provision of medically supervised injecting facilities is not just morally permissible but is morally desirable because it is in harmony with the preferential option for the poor. Although opinion on the morality of the provision of MSIFs is divided in the Roman Catholic Church, this thesis argues that Roman Catholic healthcare professionals are morally justified in establishing and running medically supervised injecting facilities.

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