Heroin Addiction and Voluntary Choice: The Case of Informed Consent

Abstract

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.

Obstetric Autonomy and Informed Consent

“…A similar issue was raised in a recent article about heroin users(Henden 2012). There the author argued that these systematic social vulnerabilities undermined the possibility of consent.…”

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

“…Henden (2013) argues that some especially vulnerable addicts have beliefs that undermine their capacity to give informed consent: due to their marginal social position, they believe that they do not have any good options at all. These addicts may think that the offer of free heroin is better than alternatives, but-Henden claims-a choice is not properly voluntary unless at least one option is regarded by the person choosing as genuinely valuable (rather than the least of available evils).…”

“…It could be that the minority who do not succeed in eventually giving up drugs have genuinely lost control over their drug-taking behavior, whether as a direct result of addiction or as a consequence of comorbid conditions and their life situation. Since it is this subpopulation, if it exists, that would be most likely to benefit from heroin provision, their (possible) existence is no mere minor inconvenience for the argument but is central to the permissibility of such programs (Henden, 2013). 6 However, there is an even stronger reason to think that there is no special problem with regard to addicts' choices about whether to participate in research or treatment programs that provide heroin.…”

Towards a ‘Sociorelational’ Approach to Conceptualizing and Managing Addiction

“…The competence of addicted individuals, for instance, has been analysed in terms of the circumstances that are in play at the moment of decision. Those circumstances also involve aspects of freedom: one cannot choose if he lacks the ability to evaluate his options in light of his interests, nor can he choose if he is prevented from acting according to his own judgement (Henden, 2013). This individualistic view on expressing one's autonomy has, however, received a great deal of criticism for its insistence on conceptualizing the 'self' as self-sufficient (MacKenzie and Stoljar, 1999).…”