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Providing free heroin to addicts participating in research – ethical concerns and the question of voluntariness

  • Edmund Henden (a1) and Kristine Bærøe (a2)
Summary

Providing heroin to people with heroin addiction taking part in medical trials assessing the effectiveness of the drug as a treatment alternative breaches ethical research standards, some ethicists maintain. Heroin addicts, they say, are unable to consent voluntarily to taking part in these trials. Other ethicists disagree. In our view, both sides of the debate have an inadequate understanding of ‘voluntariness’. In this article we therefore offer a fuller definition of the concept, one which allows for a more flexible, case-to-case approach in which some heroin addicts are considered capable of consenting voluntarily, others not. An advantage of this approach, it is argued, is that it provides a safety net to minimise the risk of inflicting harm on trial participants.

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Copyright
This is an open-access article published by the Royal College of Psychiatrists and distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
Correspondence to Edmund Henden (edmund.henden@hioa.no)
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Declaration of interest

None.

Footnotes
References
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1 Charland, LC. Cynthia's dilemma: consenting to heroin prescription. Am J Bioethics 2002; 2: 3747.
2 Foddy, B, Savulescu, J. Addiction and autonomy: can addicted people consent to the prescription of their drug of choice? Bioethics 2006; 20: 115.
3 Nelson, RM, Beauchamp, , Miller, VA, Reynolds, W, Ittenbach, RF, Frances Luce, M. The concept of voluntary consent. Am J Bioethics 2011; 11: 616.
4 Olsaretti, S. Freedom, Force and choice: against the rights-based definition of voluntariness. J Polit Philos 1998; 6: 5378.
5 Henden, E. Heroin addiction and voluntary choice: the case of informed consent. Bioethics 2013; 27: 395401.
6 Lintzeris, N. Prescription of heroin for the management of heroin dependence: current status. CSN Drugs 2009; 23: 463–76.
7 Fischer, B, Oviedo-Joekes, E, Blanken, P, Haasen, C, Rehm, J, Schechter, MT, et al. Heroin-assisted treatment (HAT) a decade later: a brief update on science and politics. J Urban Health 2007; 84: 552–62.
8 Bandura, A. Self-Efficacy: The Exercise of Control. W.H. Freeman, 1997: 343–9.
9 Gossop, M, Green, L, Phillips, G, Bradley, B. Factors predicting outcome among opiate addicts after treatment. Br J Clin Psychology 1990; 29: 209–16.
10 Bratman, M. Intention, Plans, and Practical Reason. Harvard University Press, 1987.
11 Perneger, TV, Giner, F, del Rio, M, Mino, A. Randomised trial of heroin maintenance programme for addicts who fail in conventional drug treatment. BMJ 1998; 317: 13–8.
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BJPsych Bulletin
  • ISSN: 2056-4694
  • EISSN: 2056-4708
  • URL: /core/journals/bjpsych-bulletin
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Providing free heroin to addicts participating in research – ethical concerns and the question of voluntariness

  • Edmund Henden (a1) and Kristine Bærøe (a2)
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