Heroin prescription involves the medical provision of heroin in the treatment of heroin addiction. Rudimentary clinical trials on that treatment modality have been carried out and others are currently underway or in development. However, it is questionable whether subjects considered for such trials are mentally competent to consent to them. The problem has not been sufficiently appreciated in ethical and clinical discussions of the topic. The challenges involved throw new light on the role of value and accountability in contemporary discussions (...) of mental competence. (shrink)

Informed consent is the practical expression of the doctrine of autonomy. But the very idea of autonomy and conscious free choice is undercut by the view that human beings react as their unconscious brain centres dictate, depending on factors that may or may not be under rational control and reflection. This worry is, however, based on a faulty model of human autonomy and consciousness and needs close neurophilosophical scrutiny. A critique of the ethics implied by the model takes us towards (...) a 'care of the self' view of autonomy and the subject's attunement to the truth as the crux of reasoning rather than the inner mental/neural state views of autonomy and human choice on offer at present. (shrink)

This article addresses the following problems: What is a mechanism, how can it be discovered, and what is the role of the knowledge of mechanisms in scientific explanation and technological control? The proposed answers are these. A mechanism is one of the processes in a concrete system that makes it what it is — for example, metabolism in cells, interneuronal connections in brains, work in factories and offices, research in laboratories, and litigation in courts of law. Because mechanisms are largely (...) or totally imperceptible, they must be conjectured. Once hypothesized they help explain, because a deep scientific explanation is an answer to a question of the form, "How does it work, that is, what makes it tick—what are its mechanisms?" Thus, by contrast with the subsumption of particulars under a generalization, an explanation proper consists in unveiling some lawful mechanism, as when political stability is explained by either coercion, public opinion manipulation, or democratic participation. Finding mechanisms satisfies not only the yearning for understanding, but also the need for control. Key Words: explanation • function • mechanism • process • system • systemism. (shrink)

The aim of this article is to elucidate the notions of explanation and mechanism, in particular of the social kind. A mechanism is defined as what makes a concrete system tick, and it is argued that to propose an explanation proper is to exhibit a lawful mechanism. The so-called covering law model is shown to exhibit only the logical aspect of explanation: it just subsumes particulars under universals. A full or mechanismic explanation involves mechanismic law statements, not purely descriptive ones (...) such as functional relations and rate equations. Many examples from the natural, biosocial, and social sciences are examined. In particular, macro-micro-micro-macro social relations are shown to explain other wise puzzling macro-macro links. The last part of the article relates the author's progress, over half a century, toward understanding mechanism and explanation. (shrink)

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. (shrink)

Centre for Applied Philosophy and Public Ethics University of Melbourne, Parkville, 3010, Australia and.

There continues to be a debate on whether addiction is best understood as a brain disease or a moral condition. This debate, which may influence both the stigma attached to addiction and access to treatment, is often motivated by the question of whether and to what extent we can justly hold addicted individuals responsible for their actions. In fact, there is substantial evidence for a disease model, but the disease model per se does not resolve the question of voluntary control. (...) Recent research at the intersection of neuroscience and psychology suggests that addicted individuals have substantial impairments in cognitive control of behavior, but this "loss of control" is not complete or simple. Possible mechanisms and implications are briefly reviewed. (shrink)

The author comments on the article “The neurobiology of addiction: Implications for voluntary control of behavior,‘ by S. E. Hyman. Hyman presents that addiction is a brain disease or a moral condition. The authors present that addiction is a strong preference, similar to appetitive preferences. They state that addiction is merely a form of pleasure-seeking. The authors conclude that the problem of addiction is the problem of the management of pleasure, not treatment of a disease. Accession Number: 24077914; Authors: Foddy, (...) Bennett 1; Email Address: [email protected] Savulescu, Julian 2; Affiliations: 1: University of Melbourne, Monash University, Australia; 2: University of Oxford; Subject: EDITORIALS; Subject: ADDICTIONS; Subject: HYMAN, S. E.; Subject: BRAIN -- Diseases; Subject: PLEASURE; Subject: NEUROBIOLOGY; Subject: BEHAVIOR; Number of Pages: 4p. (shrink)

The author comments on the article “The neurobiology of addition: Implications for voluntary control of behavior,‘ by S. E. Hyman. The author agrees with Hyman that debate persists whether addiction is a brain disease or a moral condition. The author suggests that even if we understand the neurobiology of addiction, it will make sense to seek accountability from the addict and to modify his behavior. He also suggests that no facts about neurobiology will change these moral requirements. Accession Number: 24077917; (...) Authors: Cochrane, Thomas I. 1; Email Address: [email protected]; Affiliations: 1: Harvard Medical School; Subject: EDITORIALS; Subject: ADDICTIONS; Subject: NEUROBIOLOGY; Subject: BEHAVIOR; Subject: HYMAN, S. E.; Number of Pages: 2p. (shrink)

The author comments on the article “The Neurobiology of Addiction: Implications for Voluntary Control of Behavior,‘ by S. E. Hyman. Hyman’s article suggests that addicted individuals have impairments in cognitive control of behavior. The author agrees with Hyman’s view that addiction weakens the addict’s ability to align his actions with his judgments. The author states that neuroethics may focus on brains and highlight key aspects of behavior but we still risk missing explanatory elements. Accession Number: 24077912; Authors: Levy, Neil 1,2; (...) Email Address: [email protected]; Affiliations: 1: University of Melbourne, Parkville 3010, Australia; 2: University of Oxford; Subject: ADDICTIONS; Subject: ALCOHOLISM; Subject: COGNITION; Subject: BEHAVIOR; Subject: JUDGMENT; Subject: HYMAN, S. E.; Subject: NEUROBIOLOGY; Number of Pages: 2p. (shrink)

‘Neuroethics’ is a term which has come into use in the last few years, and which is variously defined. In the Preface to his book, Grant Gillett indicates the sense in which he is using it: the central questions in neuroethics, he says, are those of ‘human identity, consciousness and moral responsibility or the problem of the will’. His aim is to offer an account of human identity which can shed light on issues both in general philosophy and in bioethics.The (...) question which this account seeks to answer is stated in various ways in the book, but perhaps the simplest formulation is this: what is the difference between being somebody and being some body? The Cartesian answer, that the difference lies in the possession of an immaterial thinking substance, is rejected on the grounds that a thinking thing cannot be only a thinking thing: to think is to respond to the world in various ways, which requires bodily means of response. But the same argument also applies to the ‘Cartesian materialism’ which would identify ‘mind’ with ‘brain’. Instead …. (shrink)

In 1995, the Dutch Minister of Health proposed that a randomized clinical trial (RCT) with heroin-maintenance for severe abusers be conducted. It took nearly four years of lengthy debates before the Dutch Parliament consented to the plan. Apart from the idea of prescribing heroin, the minister and her scientific advisers had to defend the quite high material and non-material costs that would arise from employing the randomized controlled design. They argued that the RCT represented the truly scientific approach and was (...) the royal way to unambiguous results. In the present article, I question this common dual justification of RCTs. First, I situate the historical origins and the basic assumptions of the ideal experiment in 20th-century economic liberalism. Secondly, using the Dutch heroin experiment as an example, I discuss human-science experimentation as an attempt to create reality rather than merely record it. Finally, I discuss some surprising responses by heroin users. These responses display the assumptions of RCTs discussed in the historical section, and underline the importance of the culture of heroin use. In the epilogue, I suggest that cultural aspects of heroin consumption can best be studied by thorough ethnographic research. (shrink)

I examine current models of self-destructive addictive behaviour, and argue that there is an important place for Ulysses contracts in coping with addictive behaviour that stems from certain problematic preference structures. Given the relevant preference structures, interference based on a Ulysses contract need not involve questionably favouring an agent’s past preferences over her current preferences, but can actually be justified in terms of the agent’s current concerns and commitments.