Addiction and Autonomy: Can Addicted People Consent to the Prescription of Their Drug of Addiction?

Abstract

It is often claimed that the autonomy of heroin addicts is compromised when they are choosing between taking their drug of addiction and abstaining. This is the basis of claims that they are incompetent to give consent to be prescribed heroin. We reject these claims on a number of empirical and theoretical grounds. First we argue that addicts are likely to be sober, and thus capable of rational thought, when approaching researchers to participate in research. We reject behavioural evidence purported to establish that addicts lack autonomy. We present an argument that extrinsic forces must be irresistible in order to make a choice non-autonomous. We argue that heroin does not present such an irresistible force. We make a case that drug-oriented desires are strong regular appetitive desires, which do not compromise consent. Finally we argue that an addict's apparent desire to engage in a harmful act cannot be construed as evidence of irrational or compulsive thought. On these arguments, a sober heroin addict must be considered competent, autonomous and capable of giving consent. More generally, any argument against legalisation of drugs or supporting infringement of the liberty of those desiring to take drugs of addiction must be based on considerations of harm and paternalism, and not on false claims that addicts lack freedom of the will.

Rethinking responsibility in offenders with acquired paedophilia: Punishment or treatment?

“…As Rosati (1994) argues, circumstances can be coercive in many ways and to varying degrees, and may force us to make very difficult choices, but this does not preclude that under certain conditions such choices can be made rationally and voluntarily (for a summary of the debate on coercive offers, see Bomann-Larsen, 2013). According to Foddy and Savulescu (2006), whenever "the status quo is an option, a person offering a choice cannot be said to be harming a person or presenting an irresistible choice" (p., 7). However, what does remain of importance is the ethical permissibility of the status quo itself.…”

“…Another important element that Foddy and Savulescu (2006) point to is the potential exploitation of an individual's vulnerable situation in an unfair way. This basically entails that the option that is offered, similar to the status quo, cannot be unfair, unjust, harmful or in some other way wrong.…”

Addiction, Autonomy, and Informed Consent: On and Off the Garden Path

“…For Foddy and Savulescu (2006), for instance, addicts are simply people with strong appetites for drugs. Having a strong appetite does not in general impugn one's capacity to give informed consent; there is no reason to think that having a strong appetite for drugs in particular should be any different.…”

Addiction, recovery and moral agency: Philosophical considerations

“…Philosophers have tried to develop accounts in which addicts' agency is more or less maintained (e.g., Levy, 2006). My premise is that, other things being equal, addicts are agents just like nonaddicted people are in this respect (see for instance Foddy & Savulescu, 2006;Levy, 2006). Agency is expressed in control over action, and this control consists of reasonresponsiveness.…”