Foddy Bennett, Savulescu Julian
Ethics Unit, Murdoch Research Institute, Royal Children's Hospital, Flemington Road, Parkville, Melbourne, Victoria 3052, Australia.
Bioethics. 2006 Feb;20(1):1-15. doi: 10.1111/j.1467-8519.2006.00470.x.
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.
人们常称，海洛因成瘾者在选择吸食成瘾药物还是戒除时，其自主性会受到损害。这就是声称他们无能力同意接受海洛因处方的依据。我们基于一些实证和理论依据驳回这些说法。首先，我们认为成瘾者在与研究人员接触以参与研究时，很可能是清醒的，因而有能力进行理性思考。我们驳回那些据称能证明成瘾者缺乏自主性的行为证据。我们提出一个观点，即外在力量必须是不可抗拒的，才能使一个选择不具有自主性。我们认为海洛因并不构成这样一种不可抗拒的力量。我们提出理由表明，以毒品为导向的欲望是强烈的正常食欲欲望，并不影响同意的有效性。最后，我们认为成瘾者明显想要实施有害行为的欲望不能被解释为非理性或强迫性思维的证据。基于这些论点，清醒的海洛因成瘾者必须被视为有能力、有自主性且能够给予同意。更普遍地说，任何反对毒品合法化或支持侵犯那些想要吸食成瘾药物者自由的论点，都必须基于对危害和家长主义的考量，而不是基于成瘾者缺乏意志自由这种错误说法。
