Substance addiction affects millions of individuals worldwide and yet there is no consensus regarding its conceptualisation. Recent neuroscientific developments fuel the view that addiction can be classified as a brain disease, whereas a different body of scholars disagrees by claiming that addictive behaviour is a choice. These two models, the Brain Disease Model and the Choice Model, seem to oppose each other directly. This article contends the belief that the two models in the addiction debate are polar opposites. It shows (...) that it is not the large amount of addiction research in itself what sets the models apart, but rather their extrapolated conclusions. Moreover, some of the most fiercely debated aspects - for instance, whether or not addiction should be classified as a disease or disorder - are irrelevant for the conceptualisation of addiction. Instead, the real disagreement is shown to revolve around capacities. Discussing addiction-related capacities, especially regarding impaired control, rather than the assumed juxtaposition of the two models can be considered the true addiction debate. More insight into the extent to which the capacities of the addicted individual were affected would be highly useful in various other areas, especially legal responsibility. (shrink)

The aim of this paper is to show how certain distinctive elements of Hegel's theory of action can provide a fresh philosophical perspective on the phenomenon of addiction. What motivates the turn to Hegel is a set of puzzles that arise out of contemporary medical and philosophical discussions of addiction. Starting with questions concerning ongoing attempts to define addiction, the paper examines the resources needed for addiction to be classed as a disorder, as it commonly is. Provisionally settling with the (...) notion of akrasia, the paper turns to Hegel for a theory of agency that fills in the gaps of the account of akrasia used in the contemporary literature on addiction and helps resolve the puzzles that occasioned the paper. (shrink)

Current legal practice holds that a diagnosis of psychopathy does not remove criminal responsibility. In contrast, many philosophers and legal experts are increasingly persuaded by evidence from experimental psychology and neuroscience indicating moral and cognitive deficits in psychopaths and have argued that they should be excused from moral responsibility. However, having opposite views concerning psychopaths’ moral responsibility, on the one hand, and criminal responsibility, on the other, seems unfortunate given the assumption that the law should, at least to some extent, (...) react to the same desert-based considerations as do ascriptions of moral responsibility. In response, Stephen Morse has argued that the law should indeed be reformed so as to excuse those with severe psychopathy from blame, but that psychopaths that have committed criminal offences should still be subject to some legal repercussions such as civil commitment. We argue that consequentialist and norm-expressivist considerations analogous to those that support punishing psychopaths or at least retaining some legal liability, might also be drawn on in favour of holding psychopaths morally accountable. (shrink)

Physicians generally recommend that patients resuscitated with naloxone after opioid overdose stay in the emergency department for a period of observation in order to prevent harm from delayed sequelae of opioid toxicity. Patients frequently refuse this period of observation despiteenefit to risk. Healthcare providers are thus confronted with the challenge of how best to protect the patient’s interests while also respecting autonomy, including assessing whether the patient is making an autonomous choice to refuse care. Previous studies have shown that physicians (...) have widely divergent approaches to navigating these conflicts. This paper reviews what is known about the effects of opioid use disorder on decision-making, and argues that some subset of these refusals are non-autonomous choices, even when patients appear to have decision making capacity. This conclusion has several implications for how physicians assess and respond to patients refusing medical recommendations after naloxone resuscitation. (shrink)

I very much enjoyed reading the interesting and original article by Steel and colleagues (2017). But I found myself strongly disagreeing with its conclusion once the real point of the argument became clear to me. At the same time, I believe that the authors are correct to draw attention to the importance of context and inequities in framing discussions of the ethics of voluntary consent in heroin prescription research. I begin with a brief summary of the authors’ conclusion, quoting directly (...) and adding my own emphases, since there are major philosophical points I wish to make that hinge on nuances in wording... (shrink)