Philosophers and psychologists have been attracted to two differing accounts of addictive motivation. In this paper, we investigate these two accounts and challenge their mutual claim that addictions compromise a person’s self-control. First, we identify some incompatibilities between this claim of reduced self-control and the available evidence from various disciplines. A critical assessment of the evidence weakens the empirical argument for reduced autonomy. Second, we identify sources of unwarranted normative bias in the popular theories of addiction that introduce systematic errors (...) in interpreting the evidence. By eliminating these errors, we are able to generate a minimal, but correct account, of addiction that presumes addicts to be autonomous in their addictive behavior, absent further evidence to the contrary. Finally, we explore some of the implications of this minimal, correct view. (shrink)

Among medical researchers and clinicians the dominant view is that it is unethical to deceive patients by prescribing a placebo. This opinion is formalized in a recent policy issued by the American Medical Association (AMA [Chicago, IL]). Although placebos can be shown to be always safe, often effective, and sometimes necessary, doctors are now effectively prohibited from using them in clinical practice. I argue that the deceptive administration of placebos is not subject to the same moral objections that face other (...) forms of deception in clinical practice and medical research. Although deception is normally objectionable on the grounds that it limits autonomy and breaches trust, these grounds do not apply to placebos when they are prescribed within appropriate ethical limits. Patients have reason to prefer that doctors can prescribe placebos in ethically responsible ways. Hence, the AMA has an obligation to endorse and to promote the responsible use of deceptive placebos in clinical practice. (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)

abstract Criminal behaviour is but one behavioural tendency for which a genetic influence has been suggested. Whilst this research certainly raises difficult ethical questions and is subject to scientific criticism, one recent research project suggests that for some families, criminal tendency might be predicted by genetics. In this paper, supposing this research is valid, we consider whether intervening in the criminal tendency of future children is ethically justifiable. We argue that, if avoidance of harm is a paramount consideration, such an (...) intervention is acceptable when genetic selection is employed instead of genetic enhancement. Moreover, other moral problems in avoiding having children with a tendency to criminal behaviour, such as the prospect of social discrimination, can also be overcome. (shrink)

By nature we are all addicted to love... meaning we want it, seek it and have a hard time not thinking about it. We need attachment to survive and we instinctively seek connection, especially romantic connection. [But] there is nothing dysfunctional about wanting love.Throughout the ages, love has been rendered as an excruciating passion. Ovid was the first to proclaim: “I can’t live with or without you”—a locution made famous to modern ears by the Irish band U2. Contemporary film expresses (...) a similar sentiment: as Jake Gyllenhaal’s character famously says in Brokeback Mountain, “I wish I knew how to quit you.” And everyday speech, too, is rife with such expressions as “I need you” and “I’m addicted to you.”... (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)

Concepts We thank all three commentators for extremely constructive, insightful, and gracious commentaries. We cannot address all their valuable points. In this response, we elucidate and relate the concepts of addiction, disease, disability, autonomy, and well-being. We examine some of the implications of these relationships in the context of the helpful responses made by our commentators. We begin with the definitions of the relevant concepts which we employ: ¥? ? ? Addiction (Liberal Concept): An addiction is a strong appetite. ¥? (...) ? ? Appetites: An appetite is a disposition that generates desires that are urgent, oriented toward some rewarding behavior, periodically recurring, often in predictable circumstances, sated temporarily by their fulfillment, and generally provide pleasure. ¥? ? ? Disease (Naturalistic Concept): A disease is some biological or psychological state that results in subfunctioning of the organism in a given set of environmental and social circumstances, C. The reference class is a natural class of organisms of uniform functional design; specifically, an age group of a sex of a species. A normal function is a part or process within members of the reference class and is a statistically typical contribution by it to their individual survival and reproduction (Boorse 1977, 1997). ¥? ? ? Disability (Welfarist Concept): A disability is a relatively stable biological or psychological state that tends to reduce the amount of well-being that this person will enjoy in a given set of environmental and social circumstances (Savulescu and Kahane 2009; Kahane and Savulescu, 2009). ¥? ? ? Autonomy (Rationalist Concept): A person rationally desires or values some state of affairs if and only if he or she desires that state of affairs while (1) being in possession of all relevant. (shrink)

We thank Carrie Jenkins and Neil Levy for their thoughtful comments on our article about love and addiction. Although we do not have room for a comprehensive reply, we will touch on a few main issues.Jenkins points out, correctly in our view, that the word ‘addiction’ can trigger “connotations of reduced autonomy.” It may therefore be used, she argues, to “excuse” violent or otherwise harmful behaviors—disproportionately carried out by men—within the context of romantic relationships. Debates about love addiction, therefore, “are (...) best addressed with an eye to the more general issue of how we as a society apportion responsibility for things like date rape and intimate partner violence” (Jenkins... (shrink)

This month's issue of the Journal of Medical Ethics is a special issue devoted entirely to the ethics of infant male circumcision—an elective surgical practice that is currently performed on around a third of the world's male population.1The last time the Journal ran a symposium on this issue was in 2004, and there has been relatively scant discussion of the practice in the ethical literature since then. Three events that took place in the past year have brought the ethics of (...) infant male circumcision back into the global spotlight.First, in April of 2012, controversy erupted after it was reported that a baby had died in New York City after contracting Herpes Simplex virus during the Orthodox Jewish variant of circumcision known as metzitzah b'peh, which involves the oral suction of blood from the infant's penis following the circumcision procedure.2Later that year, the American Academy of Pediatrics released a policy statement which suggested that the health benefits of ordinary forms of male circumcision outweigh the risks and …. (shrink)

One argument which is frequently levelled against the enhancement of human biology is that we do not understand the evolved function of our bodies well enough to meddle in our biology without producing unintended and potentially catastrophic effects. In particular, this argument is levelled against attempts to slow or eliminate the processes of human ageing, or ‘senescence’, which cause us to grow decrepit before we die. In this article, I claim that even if this argument could usefully be applied against (...) attempts to enhance other human traits, it cannot be valid in the case of attempts to enhance the various processes that constitute senescence. I begin by reviewing the biology of ageing to show how it consists of a number of unrelated traits. Then, following the arguments of a number of evolutionary biologists, I explain that every one of these traits is a product of evolutionary ‘neglect’ rather than ‘intent’. Finally, I consider the strongest version of the argument against enhancing senescence, which acknowledges these facts about the evolution of ageing but insists that we have nevertheless have prudential reasons to avoid enhancement wherever there is some uncertainty about the genetics or evolutionary function of a trait. I provide two reasons for rejecting this version of the argument as well, even in the case of human senescence, where such uncertainty is currently significant. (shrink)

There is a growing consensus among neuroscientists that people can become addicted to food, and that at least some cases of obesity have addiction as their cause. By contrast, the rest of the world continues to see obesity as either a disease of the metabolism, or as a reckless case of self-harm. Among obesity researchers, there has been a lively debate on the issue of whether obesity ought to be considered a disease. Few researchers, however, have suggested that obesity is (...) a disease in the same sense as addiction is usually claimed to be a disease—that is, a disease of behaviour with a neurological cause. In this piece, I review what is now a compelling body of evidence for food addiction, to establish that many or most cases of obesity have addiction at their foundation. I then argue that in spite of this, obesity ought not to be considered a neurobehavioural disease in the sense usually attributed to drug addiction. Given the link between addiction and obesity, this implies that the disease conception of addiction must be abandoned. I conclude by assessing some of the implications this move has for policy and ethics, with regard to both obesity and drug addiction. (shrink)

A category of enhancement technologies target neural systems as a means of improving physical performance. The author calls these as neurophysical enhancements. This chapter demonstrates why neurophysical enhancements deserve an ethical assessment which is independent of those relating to physical and cognitive enhancements. It focuses almost exclusively on the use of neurophysical enhancements in the sporting arena, where they are for the most part prohibited. World Anti‐Doping Agency (WADA) does permit some drugs which are effective enhancements. Caffeine is permitted on (...) the rationale that it is ineffective at unsafe doses (and hence safe at an effective dose). It makes little sense to ban every performance enhancer from sporting competition, no matter what it is used for, and what the risks are, since sport is essentially a project of performance enhancement. If every form of enhancement is to be considered unethical, competitive sport must be abandoned. (shrink)

2007 will be remembered as the year in which the Tour de France died. Race leader and likely eventual winner, Michael Rasmussen, was eliminated near the end on an allegation of doping. Since the 1960s, the idealistic drug crusaders have been on a mission to reverse the course of history, and eliminate drugs from the sport. But this “zero tolerance” strategy to drugs has failed, as 2007's Tour spectacularly showed. Only around 10–15% of professional athletes are drug tested. Currently, it (...) is illegal to use erythropoietin (EPO) or blood doping to move your haematocrit from 48 to 49% even though some people will have a normal level of 49%. A regulated permissive policy would paradoxically reduce risk to athletes. The present system creates an environment of risk to the athlete. A rational policy on doping would allow safe performance‐enhancing interventions which are consistent with the spirit of a particular sport. (shrink)