Cynthia’s dilemma: Consenting to heroin prescription

American Journal of Bioethics

Volumn 2, Issue 2, 2002, Pages 37-47

  Charland, Louis C ^a  

^a UNIVERSITY OF WESTERN ONTARIO   (Canada)

Author keywords

Decisional impairment; Geneva trials; Heroin addiction dependence; Heroin prescription; Heroin treatment; Theory of competence

Indexed keywords

ANALYTICAL APPROACH; ARTICLE; BIOMEDICAL AND BEHAVIORAL RESEARCH; CLINICAL TRIAL; DEPRESSION; ETHICS; HUMAN; INFORMED CONSENT; INTERNATIONAL COOPERATION; MENTAL CAPACITY; PRESCRIPTION; PSYCHOLOGICAL ASPECT; PSYCHOLOGICAL MODEL; RESEARCH ETHICS; VULNERABLE POPULATION;

ANALYTICAL APPROACH; BIOMEDICAL AND BEHAVIORAL RESEARCH;

CLINICAL TRIALS; DEPRESSIVE DISORDER; ETHICAL ANALYSIS; ETHICS, RESEARCH; HUMANS; INFORMED CONSENT; INTERNATIONALITY; MENTAL COMPETENCY; MODELS, PSYCHOLOGICAL; PRESCRIPTIONS, DRUG; THIRD-PARTY CONSENT; VULNERABLE POPULATIONS;

EID: 0036513881     PISSN: 15265161     EISSN: 15360075     Source Type: Journal    
DOI: 10.1162/152651602317533686     Document Type: Article

References (67)

1. American Psychiatric Association. 1994. Diagnostic and statistical manual of mental disorders, 4th ed. Washington: American Psychiatric Association.
2. Angell M., and J. P. Kassirer. 1994. Alcohol and other drugs: Toward a more rational and consistent policy. New England Journal of Medicine 331(8): 537-39.
3. Appelbaum, P. S. 1998. Ought we to require emotional capacity as part of decisional competence? The Kennedy Institute Journal of Ethics 8(4): 377-89.
4. Applebaum, P. S., and T. Grisso. 1995. The MacArthur Treatment Competence Study (I): Mental illness and competence to consent to treatment. Law and Human Behavior 19:105-26.
5. Applebaum, P. S. 1998. Assessing competence to consent to treatment: A guide for physicians and other health care professionals. Oxford, U.K.: Oxford University Press.
6. Appelbaum, P. S., T. Grisso, E. Frank, S. O’Donnel, and D. J. Kupfer. 1999. Competence of depressed patients to consent to research. American Journal of Psychiatry 156(9): 1380-84.
7. Bammer, G., and R. M. Douglas. 1996. The ACT heroin trial proposal: An overview. Medical Journal of Australia 164:690-92.
8. Bammer, G., A. Dobler-Mikota, P. M. Flemming, J. Strang, A. Uchtenagen. 1999a. The heroin prescribing debate: Integrating science and politics. Science 284(5418): 1277-79.
9. Bammer, G. 1999b. [Response.] Science 284(5418): 531.
10. Bayer, R. 1976. Heroin maintenance: An historical perspective on the exhaustion of liberal narcotics reform. Journal of Psychedelic Drugs 8(2): 157-65.
11. Brewer, C. 1995. Recent developments in maintenance prescribing and monitoring in the United Kingdom. Bulletin of the New York Academy of Medicine 72(2): 359-70.
12. Brock D., and A. Buchanan. 1987. Deciding for others: The ethics of surrogate decision-making. Cambridge, MA: Cambridge University Press.
13. Caltrider, W. 1999. Prescribing heroin [Letter]. Science 285(5418): 533.
14. Charland, L. C. 1998a. Appreciation and emotion: Theoretical reflections on the MacArthur treatment competence study. The Kennedy Institute Journal of Ethics 8(4): 359-76.
15. Charland, L. C. 1998b. Is Mr. Spock mentally competent? Competence to consent and emotion. With commentaries and replies. Philosophy, Psychiatry and Psychology 5(1): 67-86.
16. Ciment, J. 1998. Clash in U.S. over methadone treatment. British Medical Journal 317(7164): 968.
17. College of Physicians and Surgeons of British Columbia. 1995. No further harm: Report of the temporary advisory sub-committee on narcotics harm reduction. College of Physicians and Surgeons of British Columbia Policy Manual.
18. College on Problems of Drug Dependence. 1995. Special report: Human subjects issues in drug abuse research. Drug and Alcohol Dependence 37:167-75.
19. Damasio, A. 1994. Descartes’ error: Emotion, reason, and the human brain. New York: Putnam.
20. Dolinsky, Z. E., and T. F. Babor. 1997. Ethical, scientific, and clinical issues in ethanol administration research involving alcoholics as human subjects. Addiction 92(9): 1087-97.
21. Elliott, C. 1991. Competence as accountability. Journal of Clinical Ethics 2(3): 167-71.
22. Elliott, C. 1996. The rules of insanity: Moral responsibility and the mentally ill offender. Albany: State University of New York Press.
23. Elliott, C. 1997. Caring about risks: Are severely depressed patients competent to consent to research? Archives of General Psychiatry 54:113-16.
24. Elliott, C. 1999. Bioethics, culture, and identity: A philosophical disease. London: Routledge.
25. Elster, J. 1999. Strong feelings: Emotion, addiction, and human behavior. Cambridge, MA: MIT Press.
26. Erikson, P. G., D. M. Riley, Y. W. Cheung, and P. A. O’Hare, eds. 1997. Harm reduction: A new direction for drug policies and programs. Toronto: University of Toronto Press.
27. Fisher B., and J. Rehm. 1997. The case for a heroin substitution trial in Canada. Canadian Journal of Public Health 88(6): 367-70.
28. Gaughwin, M. D., and P. Ryan. 1999. Heroin addiction: The science and ethics of the new treatment pluralism. Medical Journal of Australia 170:129-30.
29. Gorelick, D. A., R. W. Pickens, and F. O. Bonkovsky. 1999. Clinical research in substance abuse: Human subject issues. In Ethics in psychiatric research: A resource manual for human subjects protection, ed. H. A. Pincus, J. A. Lieberman, and S. Ferris, 177-94. Washington: American Psychiatric Association
30. Grisso, T., and P. S. Appelbaum. 1995. The MacArthur treatment competence study, III: Abilities of patients to consent to psychiatric and medical treatment. Law and Human Behavior 19:149-74.
31. Grisso, T., P. S. Appelbaum, E. Mulvey, and K. Fletcher. 1995. The MacArthur treatment competence study, II: Measures of abilities related to consent to treatment. Law and Human Behavior 19:127-48.
32. Hartnoll, R., M. C. Mitcheson, A. Battersby, et al. 1980. Evaluation of heroin maintenance in controlled trial. Archives of General Psychiatry 37:877-81.
33. Higgins, S.T., A. J. Budney, W. K. Bickel, et al. 1993. Achieving abstinence with a behavioral approach. American Journal of Psychiatry 150:763-69.
34. James, W. 1929. The varieties of religious experience. New York: Modern Library.
35. Jurgen, R. 1997. Heroin substitution in Canada: A necessary public health intervention. Canadian Journal of Public Health 88(6): 365-66.
36. Kleber, H. D. 1994. Our current approach to drug abuseÐ Progress, problems, and proposals. New England Journal of Medicine 330(5): 361-65.
37. Koob, G. F., and F. C. Bloom 1988. Cellular and molecular mechanisms of drug dependence. Science 242:715-23.
38. Koob, G. F., and M. Le Moal. 1997. Drug abuse: Hedonic homeostatic dysregulation. Science 278(5335): 52-58.
39. Koob, G. F., P. P. Sanna, and F. E. Bloom. 1998. Neuroscience of addiction. Neuron 21:467-76.
40. Koocher, G. P. 1991. Questionable methods in alcohol research. Journal of Consulting and Clinical Psychology 59:246-48.
41. Koran, L. H. 1973. Heroin maintenance for heroin addicts: Issues and evidence. New England Journal of Medicine 288(13): 654-60.
42. LeDoux, J. 1996. The emotional brain. New York: Simon and Schuster. Leshner, A. 1997. Addiction is a brain disease, and it matters. Science 278(5335): 45-47.
43. LeDoux, J. 1999. Science-based views of drug addiction and its treatment. Journal of the American Association 282(14): 1314-16.
44. Leshner, A., and G. F. Koob. 1999. Drugs of abuse and the brain. Proceedings of the Association of American Physicians 111(2): 99-108.
45. Management of alcohol, tobacco, and other drugs: A physician’s manual. 2000. Toronto: Center for Addiction and Mental Health.
46. Marsden, J., M. Gossop, Michael, M. Farrell, and J. Strang. 1998. Opioid substitution: Critical issues and future directions. Journal of Drug Issues 27(1): 243-64.
47. Matas, R. 2001. Addicts to get heroin under research project. Toronto Globe and Mail, 8 November, A10.
48. Metrebian, N., W. Shanahan, B. Wells, and G. V. Stimson. 1998. Feasibility of prescribing injectable heroin and methadone to opiate-dependent users: Associated health and harm reductions. Medical Journal of Australia 168(12): 596-600.
49. Miller, J. S. 1998. Hepatitis and injection drug use in British Columbia: Pay now or pay later? Provincial Health Officer. Government of British Columbia, Canada.
50. Modell, J. G., F. B. Glaser, and J. J. M. Mountz. 1993. The ethics and safety of alcohol administration in the experimental setting to individuals who have chronic, severe alcohol problems. Alcohol and Alcoholism 28:189-97.
51. National Advisory Council on Alcohol Abuse and Alcoholism [Prepared for the National Institute on Alcohol Abuse and Alcoholism]. 1998. Recommended Council guidelines on ethyl alcohol administration in human experimentation. Bethesda: U.S. Department of Health and Human Services.
52. National Bioethics Advisory Commission. 1998. Research involving persons with mental disorders that may affect decisionmaking capacity, Vol. 1, Report and recommendations of the National Bioethics Advisory Commission. Rockville: National Institutes of Health.
53. Nestler, E. J., and G. K. Aghanjanian. 1997. Molecular and cellular basis of addiction. Science 278(5335): 58-63.
54. NIH Consensus Conference, National Consensus Development Panel on Effective Medical Treatment for Opiate Addiction. Effective treatment for opiate addiction. 1998. JAMA 280(22): 1936-43.
55. Ostini, R., G. Bammer, P. R. Dance, and R. E. Goodwin. 1993. The ethics of experimental heroin maintenance. Journal of Medical Ethics 19:175-82.
56. Panksepp, J. 1998. Affective neuroscience. Oxford, U.K.: Oxford University Press.
57. Perneger, T. V., F. Giner, M. del Rio, A. Mino. 1998. Randomized trial of heroin maintenance programme for addicts who fail in conventional drug treatments. British Medical Journal 317:13-18.
58. Powledge, T. M. 1999. Addiction and the brain. Bioscience 49(7): 513-19.
59. President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. 1982. Making health care decisions, vol. 1. Washington: U.S. Government Printing Office.
60. Rushe, S. 1999. Prescribing heroin [Letter]. Science 285(5418): 532-33.
61. Stimmel, B. 1997. Pain and its relief without addiction: Clinical issues in the use of opioids and other analgesics. New York: Haworth Medical Press.
62. Stricker, G. A. 1991. Ethical concerns in alcohol research. Journal of Consulting and Clinical Psychology 59:256-57.
63. ten Have, H., and P. Spoken. 1985. Heroin addiction, ethics, and the philosophy of medicine. Journal of Medical Ethics 11:173-77.
64. Uchtenhagen, A., F. Gutzwiller, and A. Dobler-Mikola. 1997. Programme for a medical prescription of narcotics: Final report of the research representatives. Berne: Swiss Federal Office of Public Health.
65. Van den Brink, W., V. M. Hendricks, and J. M. van Ree. 1999. Medical co-prescription of heroin to chronic, treatment resistant methadone patients in the Netherlands. Journal of Drug Issues 29(3): 587-607.
66. Wodak, A. D. 1997. Public health and politics: The demise of the ACT heroin trial. Medical Journal of Australia 167:348-49.
67. World Health Organization. Report of the external panel on the evaluation of the Swiss scientific studies of medically prescribed narcotics to drug addicts. 1999. Geneva: World Health Organization.