Can addiction be credibly invoked as an excuse for moral harms secondary to particular decisions to use drugs? This question raises two distinct sets of issues. First, there is the question of whether addiction is the sort of consideration that could, given suitable assumptions about the details of the case, excuse or mitigate moral blameworthiness. Most discussions of addiction and moral responsibility have focused on this question, and many have argued that addiction excuses. Here I articulate what I take to (...) be the best argument for this view, based on the substantial difficulty that people with severe addiction experience in controlling drug-related behavior. This, I argue, may in some cases be sufficient to ground a mitigating excuse, given the way in which addiction undermines agents’ responsiveness to relevant moral reasons to do otherwise. Much less attention has been devoted to a second set of issues that critically affect the possibility of applying this mitigating excuse in particular cases, derived from the ambivalent nature of agential control in addiction. In order to find a fitting response to moral harm, the person with the right standing to blame must make a judgment about the extent to which the agent possessed certain morally relevant capacities at the time of the act. In practice, this will often prove tremendously difficult to assess. The ethical challenge for the person with the right standing to blame is fundamentally one of making a judgment about matters that seem underdetermined by the available evidence. (shrink)

There is preliminary evidence, from case reports and investigational studies, to suggest that Deep Brain Stimulation could be used to treat some patients with Anorexia Nervosa. Although this research is at an early stage, the invasive nature of the intervention and the vulnerability of the potential patients are such that anticipatory ethical analysis is warranted. In this paper, we first show how different treatment mechanisms raise different philosophical and ethical questions. We distinguish three potential mechanisms alluded to in the neuroscientific (...) literature, relating to desire, control, and emotion, respectively. We explain why the precise nature of the mechanism has important implications for the patient’s autonomy and personal identity. In the second part of the paper, we consider practical dimensions of offering DBS to patients with AN in certain cases. We first discuss some limited circumstances where the mere offering of the intervention might be perceived as exerting a degree of coercive pressure that could serve to undermine the validity of the patient’s consent. Finally, we consider the implications of potential effects of DBS for the authenticity of the patient’s choice to continue using stimulation to ameliorate their condition. (shrink)

Previous discussions of addiction have often focused on the question of whether addiction is a disease. This discussion distinguishes that question – the disease question – from the question of whether addiction is a disability. I argue that, however one answers the disease question, and indeed on almost any credible account of addiction, addiction is a disability. I then consider the implications of this view, or why it matters that addiction is a disability. The disease model of addiction has led (...) many to see addiction as primarily a medical problem, and to make medical treatment of the addicted person the first priority in addressing addiction. Once addiction is viewed as a disability, different concerns are foregrounded. The problem of addiction resides not only in the addicted person, but also in the social environment in which the addicted person finds herself. The fundamental ethical question about addiction is not how addicted persons can be treated or otherwise changed, but how a just society can make reasonable accommodations for addicted persons. (shrink)

This paper is an investigation into the conditions under which anti-love biomedical intervention is justified. Our central claim is that anti-love biomedical intervention can be justified without the “simultaneous consent” of recipients (where the simultaneous consent of a person S is understood as S’s consent at time t to an intervention at t) when it contributes to increased autonomy. We begin with an overview of earlier discussions of the ethics of anti-love biomedical intervention, focusing on the pioneering work of Earp (...) and colleagues. We then present some cases in which paternalistic intervention may be effective. We will then present an argument for the idea of anti-love biomedical intervention without simultaneous consent, based on an analogy between (biomedical intervention in) addiction and (biomedical intervention in) love. One premise of this argument is that love and addiction are importantly similar in that they can compromise the autonomous capacity for self-governing. The other premise of this argument is that biomedical intervention in addiction without simultaneous consent can be justified if the intervention is expected to restore the compromised capacity for self-governing. We will propose the “Ulysses contract”, a contract to enforce anti-love biomedical intervention when the recipient refuses it, as a possible measure of such paternalistic intervention and discuss its possible risks. (shrink)

En este artículo, echo una mirada al debate acerca del estatus de la adicción como enfermedad. Aunque la adicción es comúnmente vista como una enfermedad, varios autores han esgrimido razones para el agnosticismo o el escepticismo acerca de la corrección de esta etiqueta. Cualquier intento de abordar esta discusión directamente se complica por su relación con varios otros debates abiertos, tanto del lado de las teorías de la adicción como del lado de las teorías de la enfermedad. Mi objetivo principal (...) en este artículo es identificar cuáles son los principales puntos de controversia. Mi objetivo secundario es ofrecer una defensa limitada de la tesis de la adicción como enfermedad. El punto neurálgico del debate es si la adicción es el resultado de una disfunción psicológica, y el principal obstáculo para afirmar que hay tal disfunción psicológica es que actualmente carecemos de una explicación relativamente unificada del rasgo conductual que más fuertemente sugiere la ocurrencia de algo disfuncional: la merma de la capacidad esperable para controlar la propia conducta. Según sostengo, hay un sentido en el que la afirmación de disfunción puede estar justificada incluso en ausencia de una explicación causal unificada. Esto requiere, sin embargo, suposiciones que son hasta cierto punto controversiales, incluyendo la visión de la adicción en términos de deterioro del control conductual y la aceptabilidad de predicar disfunción a partir de rasgos conductuales a nivel personal. (shrink)

In this two-part analysis, I analyze Marc Lewis’s arguments against the brain-disease view of substance addiction and for a developmental-learning approach that demedicalizes addiction. I focus especially on the question of whether addiction is a medical disorder. Addiction is currently classified as a medical disorder in DSM-5 and ICD-10. It is further labeled a brain disease by NIDA, based on observed brain changes in addicts that are interpreted as brain damage. Lewis argues that the changes result instead from normal neuroplasticity (...) and learning in response to the intense rewards provided by addictive substances, thus that addiction is not a brain disease and by implication not a medical disorder at all. I argue that even if one accepts Lewis’s reinterpretation of the brain evidence, his conclusions do not follow. Relying on my harmful-dysfunction analysis of medical disorder, I defend the view that substance addiction is in fact a medical disorder and a brain disorder. In Part 1, I identify five arguments Lewis puts forward against the brain-disease view and evaluate them as arguments that addiction is not a disorder: Addiction is not a chronic, relapsing condition; There is no clear boundary between addiction and other strong desires; Negative consequences are not unique to disorders; The brain disease model does not account for behavioral addictions; and, Addiction is like love. I argue that Lewis’s arguments are invalid because they fail to take account of the context of addiction and its relation to biological design. (shrink)

The DSM–5 characterizes mental disorders as significant disturbances in cognition, emotion, or behavior. But what might unite the disturbances on this list? We hypothesize that mental disorders can all be meaningfully characterized as failures of attention. We understand these as failures to distribute attention in the way one has most reason to, and we include both failures of tendency and of ability. We discuss six examples of mental disorders and offer a preliminary gloss of how to recast each as centrally (...) involving a failure of attention. We close by highlighting theoretical and practical upshots of our proposal. (shrink)

Current theories of addiction try to explain what addiction is, who experiences it, why it occurs, and how it develops and persists. In this article, I explain why none of these theories can be accepted as a comprehensive model. I argue that current models fail to account for differences in embodiment, interaction processes, and the experience of addiction. To redress these limiting factors, I design a proposal for an enactive account of addiction that follows the enactive model of autism proposed (...) by Hanne De Jaegher. (shrink)

Tekst stanowi próbę spojrzenia na rozumienie psychopatologii w świetle koncepcji poznania rozproszonego, która jest tu traktowana jako podejście metodologiczne, służące do opisu systemów poznawczych i relacji zachodzących między elementami leżącymi u ich podłoża. Celem artykułu jest przyjrzenie się z tej perspektywy zagadnieniu uzależnienia. Po krótkiej charakterystyce najważniejszych założeń koncepcji rozproszenia przedstawiono istotność tego podejścia w filozofii psychiatrii i filozofii psychologii. W drugiej części tekstu ukazano rozproszony charakter uzależnienia, wspierając się dodatkowo koncepcją filozofki Hanny Pickard oraz pojęciem afordancji, coraz częściej stosowanym (...) w odniesieniu do psychopatologii. Zgodnie z wnioskami, płynącymi z podjętych dociekań, perspektywa poznania rozproszonego stanowi obiecujący sposób opisu uzależnienia. ----------------------------------------- Zgłoszono: 12/04/2023. Zrecenzowano: 15/01/2024. Zaakceptowano do publikacji: 24/04/2024. (shrink)

Addiction theorists have often utilized the metaphor of the blind men and the elephant to illustrate the complex nature of addiction and the varied methodological approaches to studying it. A common purported upshot is skeptical in nature: due to these complexities, it is not possible to offer a unifying account of addiction. I think that this is a mistake. The elephant is real–there is a _there_ there. Here, I defend a dispositionalist account of addiction as _the systematic disposition to fail (...) to control one’s desires to engage in certain types of behaviors_. I explain this position, defend the inclusion of desires and impaired control, and flesh out the notion of _systematicity_ central to my account. I then illustrate how my dispositionalist framework can unify the disparate and seemingly incompatible accounts of addiction (and their respective methodological approaches). I close with a brief plan to extend and implement my account. (shrink)