The client in question could be suffering from heroin addiction. In this case, there may be need to provide her with medically prescribed heroin to treat her addiction. The ethical dilemma in this case is whether she is sufficiently competent to make a decision regarding this type of treatment. This kind of treatment raises complex ethical problems. One major ethical issue is whether a heroin addict is capable of assenting to prescription of heroin.
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Heroin is a drug associated with degeneration of the mind. This raises doubts as to whether a heroin-dependent individual has the mental ability to make such choices. When these questions were put forward to Cynthia, a recovering heroin addict at a local clinic, her reaction was disbelief and amazement. “That’s crazy,” she said, “if you’re addicted to heroin, then by dentition you can’t say ‘No’ to the stuff.” Cynthia’s response can be expressed in the form of a dilemma (Charland, 2002, p. 37).
This essay is about ethical dilemma posed by heroin prescription. The problems raised by the dilemma are serious. The basis of the dilemma lies in the nature of heroin addiction. Heroin addicts suffer from an uncontrollable want to search for and use heroin. As a consequence, they have damaged decisional ability to make choices about heroin.
Ethical debates about heroin prescription seem to have overlooked this point completely. Heroin prescription presents a remarkable angle from which to observe the function of value in mental competence. This also point up why accountability is paramount in any form of competency. There are also interesting similarities between addiction and depression that are important. It has been argued that severely depressed patients may not be competent to consent to research because they care too little about risks.
The problem with heroin addiction is just the opposite. Heroin addicts care too much about benefits that accrue from their use of heroin. Clinical tests of the competency of depressed subjects to consent to research have recently been carried out. We should not assume that heroin addicts are competent to sanction prescription of heroin. Actually, we should assume they are incompetent unless proven otherwise (Charland, 2002).
There are other important ethical issues regarding prescription of heroin. They include the quarrel that pits harm reduction against abstinence; the debate over whether addiction should be viewed as a social or a medical problem; the argument that existing resources are better spent elsewhere; and the worry that there is a risk of promoting the message that heroin addiction is acceptable.
These are just a few scattered themes and examples. Evidently, there is an interesting literature on the ethics of heroin prescription. No resolution of those issues will be attempted here.
For present purposes, what deserves mention is what those discussions omit. Nothing is said about whether the subjects targeted for heroin prescription are capable of competent voluntary consent to heroin. Consent is mentioned, but usually only to say it is important to seek it and to stress those subjects must be properly informed. Everybody seems to assume that it is possible to give a competent voluntary consent to heroin use (Charland, 2002).
In conclusion, it will suffice to give the client be the drug. This is because there is no evidence that she might suffer from decisional impairments that compromise her ability to consent. However, the ability to give competent voluntary consent should not be presumed in the debate of ethics of heroin prescription. The vulnerability of the client to free and legal heroin should be taken into consideration.
Charland, L. (2002). Cynthia’s Dilemma: Consenting to Heroin Prescription. The American Journal of Bioethics, 2 (2), 37-47.