Delegates opt for ethics of needle exchange program
A policy supporting syringe exchange programs ignited controversy Sept. 16 at the AAFP Congress of Delegates.
The policy promotes syringe exchange programs as part of a comprehensive effort to prevent infectious diseases. The Reference Committee on Public Health and Science, which received little comment on the proposed policy, relegated it to a consent calendar.
Delegate Donnie Batie, M.D., of Baton Rouge, La., retrieved the policy from the calendar and called for referral to the Board, not adoption.
"It has been demonstrated that syringe exchange programs are effective, primarily with hepatitis B and C," said Batie. "My concern is that under this policy, we'd be supporting something illegal in most states, and I feel the policy's immoral."
The first votes on referral were inconclusive, so tellers conducted a count and found 62 delegates for referral, a bare minimum.
Immediately, Delegate Carolyn Lopez, M.D., of Chicago spoke up.
"I move to reconsider, in the interest of public health," said Lopez, a member of the Commission on Public Health that developed the policy.
The commission chair, Director Melvin Gerald, M.D., M.P.H., of Washington said, "There's been extensive discussion on this policy by the commission and Board."
The delegates voted to reconsider, and the debate was on.
"I practice in inner-city Baltimore, and we've had a needle exchange program for a number of years," said Delegate Joseph Zebley III, M.D. "Needle exchange is one of the very few things that gets people into drug treatment. It's one of the very few programs that combats STDs and even HIV. There's been a lot of soul-searching and worrying about the ethical and moral stance and the message the program would send. But in the end, isn't it disease we're trying to fight and lives we're trying to save?"
Delegates applauded his statement and later ones favoring adoption.
Batie countered, "I'm going to have trouble going home and telling members we support giving drug addicts clean needles."
Delegate James White Sr., M.D., of Lexington, Tenn., added, "We should not be doing something unethical and illegal."
Lopez repeated a comment of an AMA leader, stressing the ethical responsibility of physicians to advocate on behalf of their patients, even in opposition to the law. Lopez also mentioned the policy's provision for local discretion in deciding to establish syringe exchange programs.
Alternate Delegate Patrick Bell, M.D., of Tishoming, Okla., said, "The AAFP has as one of its mainstays patient advocacy, and that far outweighs legal considerations."
Delegates eventually voted to adopt the policy, applauded their victory and quashed a move to reconsider their action.
