Addiction and autonomy: can addicted people consent to the prescription of their drug of addiction?

Bioethics. 2006 Feb;20(1):1-15. doi: 10.1111/j.1467-8519.2006.00470.x.


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.

MeSH terms

  • Clinical Trials as Topic / ethics*
  • Coercion
  • Compulsive Behavior
  • Ethical Analysis
  • Heroin / therapeutic use*
  • Heroin Dependence / drug therapy*
  • Heroin Dependence / psychology*
  • Heroin Dependence / rehabilitation*
  • Humans
  • Informed Consent / psychology*
  • Mental Competency
  • Motivation
  • Paternalism
  • Research Subjects


  • Heroin