Department of Philosophy, Classics, History of Art and Ideas, Centre for the Study of Mind in Nature (CSMN), University of Oslo, Blindern, Oslo.
Bioethics. 2013 Sep;27(7):395-401. doi: 10.1111/j.1467-8519.2012.01969.x. Epub 2012 Apr 12.
Does addiction to heroin undermine the voluntariness of heroin addicts' consent to take part in research which involves giving them free and legal heroin? This question has been raised in connection with research into the effectiveness of heroin prescription as a way of treating dependent heroin users. Participants in such research are required to give their informed consent to take part. Louis C. Charland has argued that we should not presume that heroin addicts are competent to do this since heroin addiction by nature involves a loss of ability to resist the desire for heroin. In this article, I argue that Charland is right that we should not presume that heroin addicts are competent to consent, but not for the reason he thinks. In fact, as Charland's critics correctly point out, there is plenty of evidence showing that heroin addicts can resist their desire for heroin. These critics are wrong, however, to conclude from this that we should presume that heroin addicts are competent to give their voluntary consent. There are, I shall argue, other conditions associated with heroin addiction that might constrain heroin addicts' choice in ways likely to undermine the voluntariness of their consent. In order to see this, we need to move beyond the focus on the addicts' desires for heroin and instead consider the wider social and psychological circumstances of heroin addiction, as well as the effects these circumstances may have on the addicts' beliefs about the nature of their options.
海洛因成瘾是否会破坏海洛因成瘾者同意参与涉及给予他们免费合法海洛因的研究的自愿性？这个问题是在研究海洛因处方作为治疗依赖海洛因使用者的方法的有效性时提出的。此类研究的参与者需要知情同意才能参与。路易斯·C·沙兰德（Louis C. Charland）认为，我们不应该假设海洛因成瘾者有能力做到这一点，因为海洛因成瘾本质上涉及失去抵抗海洛因欲望的能力。在本文中，我认为 Charland 是正确的，我们不应该假设海洛因成瘾者有能力同意，但原因并非他所想。事实上，正如 Charland 的批评者正确指出的那样，有大量证据表明海洛因成瘾者可以抵制他们对海洛因的渴望。然而，这些批评者从这一点得出结论，认为我们应该假设海洛因成瘾者有能力自愿同意，这是错误的。我认为，与海洛因成瘾相关的其他条件可能会以可能破坏他们同意的自愿性的方式限制海洛因成瘾者的选择。为了看到这一点，我们需要超越对成瘾者对海洛因的渴望的关注，转而考虑海洛因成瘾的更广泛的社会和心理环境，以及这些环境可能对成瘾者对自己选择的性质的信念产生的影响。
