That these applications of the concept of harm reduction have been contentious is not surprising. It is not only Christians who object to anything that deflects from the ideal answer to the harm caused by intravenous drug abuse or sexual intercourse outside a mature stable relationship. From a theological and biblical perspective the ideal answer is clearly to abstain from taking drugs and from sexual intercourse outside monogamous heterosexual marriage.
This is the optimum way of reducing harm and it prefigures the world where there will be 'no more...mourning or crying or pain'. (4) The question to be examined briefly here is whether there is any biblical or theological reason to countenance the type of harm reduction strategies referred to above, as well as the fail safe strategy of abstinence.
Old Testament Law
The law is clearly a mixture of absolute ideal principles and prescriptions for situations that are less than ideal. This is sometimes so obvious that it almost sounds as if the law contradicts itself. In Deuteronomy 15:4 it declares that 'there should be no poor among you' while verse 11 of the same chapter states: 'There will always be poor people in the land'. Perfect obedience would mean prosperity for all, but God provides for failure to reach that norm. Given the equation of obedience = plenty in verses 5-6, those with plenty could be tempted to think that it was always the result of their obedience, and that the poverty of some was always the result of their disobedience. However, this was not a judgment God allowed the prosperous to make, as he commanded them not to be hard-hearted or tight-fisted in their lending to the poor. Mercy was to be shown even to those perceived to be damaged by disobedience.
Taking action in a situation that is far from perfect, in order to reduce harm to those who are vulnerable, is clearly prescribed in the law. The divorce law in Deuteronomy 24:1-4 is a clear case in point. The practical effect of this law was to 'protect the unfortunate woman from becoming a kind of marital football, passed back and forth between irresponsible men. It is likewise for the woman's protection that a certificate of divorce is to be given to the woman...since it proves her status as free to marry the second man.' (5)
What the law does in this case is reduce the harm that could be done as a result of divorce, which was allowed even though it fell short of God's ideal. While affirming the ideal, the law also recognises that the real world in which we live falls far short of it, and provides legislation that mitigates the damage resulting from this falling short. It can be argued that we have a principle here that justifies harm reduction even when subsequent actions contravene God's absolute standard. If some of the laws of the Old Testament were meant to reduce harm then it may be right in principle in a world that falls short of God's ideal to seek to reduce the harm caused by sin – especially if that ensures the physical survival of those addicted to harmful behaviour.
The difference between Jesus and the Pharisees was that he saw religion as a matter of faith in himself leading to inward and hence outward transformation, while they saw it as outward conformity to ritual laws. Jesus was, therefore, happy for 'unclean' people, or 'sinners', in both the ritual and moral senses, to come close to him because it was through realising who he was that they could enter into a transformed life of spiritual and moral purity. The Pharisees, on the other hand, kept 'sinners' at a distance because of their polluting effect and expected them to change before they could be accepted into their exclusive religious 'club'.
When Jesus refers to himself as our paradigm he emphasises readiness to deny self and take up the cross. (6) Since being a 'friend of…”sinners”' (7) was one of the reasons for the hatred that led finally to the cross, following Jesus must involve friendship with sinners. In our context this will almost inevitably involve close contact with substance abusers and/or the sexually promiscuous. Friendship in the way of Jesus means commitment to the total wellbeing of our friend.
Is it possible to call ourselves the friend of a drug addict or a promiscuous person, who is not yet prepared to repent and believe in Jesus but where HIV infection is a real risk, while refusing to countenance any harm reduction strategy? Some may object to this question because of its bias, but in many parts of the world today the alternatives that face those who make friends with such 'sinners' are stark. Do we insist on total abstinence and almost certain death from AIDS, or adopt a harm reduction strategy that could preserve the life of the friend?
Jesus made it very clear that he had not come to condemn. Refusing to give clean needles or condoms to our 'sinner' friends is tantamount to condemning them to death and, therefore, incompatible with the spirit of Jesus. In this world that is so very far from God's ideal there is no contradiction between giving a 'sinner' friend the means to preserve their earthly life while also encouraging them to believe in Jesus, turn away from their sinning, and enter into a more abundant life.
Protecting the vulnerable
Protecting the vulnerable is a fundamental principle of biblical ethics. (8) It is now claimed that the surest way for a woman to become HIV-positive in many African countries is for her to marry! Ironically most marriages are conducted in churches, many of which are unwilling to countenance the use of condoms to reduce the harm caused by HIV/AIDS. Added to this, women are also made vulnerable because of cultural practices and poverty, the latter being the main engine that drives the worst horrors of the sex trade.
And it is not the women only who suffer but the children who are left motherless when they die, or who are born to them HIV-positive. Not to promote the use of condoms by men in this situation is nothing short of callous. Biblically, protecting women and children should far outweigh any scruples we might have about making it possible for men to sin safely – and we can warn such men that no one is ultimately allowed by God to sin with impunity. God will be their judge.
In the UK most medical practitioners are public servants who are under obligation to serve the common good of the society that pays for their services. For better or ill, medical practice in the public service has been professionalised. This means, for example, that the GP's relationship with the overwhelming majority of his or her adolescent patients is unlikely to make it possible to give strong moral/spiritual advice about the dangers of casual sex.
Challenging the cultural context
So, how can medical practitioners be 'friends' to adolescent girls in an appropriate professional way? Maybe a key factor is to recognise the cultural pressure on girls (and boys) to conform to the common belief that sexual intercourse is a trivial recreational activity. Since most young people do not grow up in a moral context at home or church or mosque where resolve not to engage in casual sex can be bred, most are very vulnerable.
They are still responsible before God but their social responsibility is diminished, and since medical practitioners are social/public servants their primary responsibility in this anarchic moral context is to protect the young from the consequences of what have become socially acceptable practices.
However, Christian doctors as citizens will want to take every opportunity that church and various Christian agencies give to teach God's ideal and restore a moral context to behaviour.