Drug Addiction and Responsibility for the Health Care of Drug Addicts

Abstract

Taking care of those who are in need of health care is something that we, as a society, feel ourselves committed to insofar as public funds make that possible. Is this commitment in any way qualified by the fact that a person's medical maladies are the result of that person having voluntarily embarked on activities whose deleterious consequences for health were known and appreciated by that person beforehand? Specifically, is society's obligation to provide health-care services to those who have addicted themselves to illicit drugs attenuated by the fact of that addiction? Some argue that it is, whereas others consider this position morally untenable. This essay explores the question of who is right on this matter and why.

• Choice
• Fairness
• Justice
• Innocent victim
• Responsibility
• Sympathy
• Voluntary assumption of risk
• Voluntary victim

Notes

^aLetters to the Editor (1991).

^bIn the United States, for example, 40% of the costs of treating smoking-induced illness are borne by the public. (Breslow, 1982; Goodin, 1989).

^cIn the United States, most states do not criminalize the possession or use of syringe needles without a prescription. New York used to criminalize it, but no longer does. See Navarro (1993).

^dHistorically, efforts to combat sexually transmitted diseases through apprising potential victims of the facts, risks and prevalence of the disease have generally proven unsuccessful. See Brandt (1987).

^eSmith (1988). See also Navarro (1993).

^fInfluential religious, political, and ethnic leaders have often gone on record as opposing such programs for a variety of reasons, chief among them being their not wanting “to send the wrong message” to drug addicts. The argument is that distribution by a government agency of free sterile needles to be used for intravenous drug injection serves to undermine the law that makes the selling and buying of street drugs illegal. Others have objected that clean needle distribution programs “lead to the notion that we have a permanent disability of addiction that is intractable, and that is a shame” (Mitchell S. Rosenthal, president of Phoenix House, a drug rehabilitation center in New York City, as quoted in Navarro, 1993).

^gSee Baum and Nisselof (1988).

^hJarlais et al. (1986).

ⁱJarlais et al. (1986).

^jJarlais et al. (1986).

^kSee Navarro (1993).

^lSee Riese (1988).

^mThe term “subculture” is widely used within sociological writings on IV-drug use to describe the social network found among IV-drug users. See, for example, Jarlais et al. (1986); also Agar (1973) and Coombs et al. (1976).

ⁿFor a useful discussion of the notion of the standards of voluntariness, see Feinberg (1986).

^oJarlais et al. (1986).

^pSee, for example, Williams (1958).

^qFor a good discussion of this issue, see Finnis (1991).

^rI am grateful to Dahlia Dehri for this point, and as well for discussion of the paper generally.

^sI speak of “entitlements” here rather than “desert” because it is not clear that fairness in the distribution of health-care resources is fundamentally a question of moral merit. As I see it, the question before us is whether it is fair to demand that society draw on the public purse to subsidize the unfortunate fallout from freely chosen and dangerous pursuits. One may answer this question of fairness without appealing to the notions of moral merit and desert.

Additional information

Notes on contributors

Tziporah Kasachkoff

Tziporah Kasachkoff, Ph.D., (USA) is currently Professor of Philosophy at Ben Gurion University of the Negev in Be’er Sheva, Israel, where she teaches courses in theoretical and applied ethics, and political and social philosophy. She has been associated for more than 30 years with the City University of New York, where she has taught students at two ends of the educational spectrum: at the Borough of Manhattan Community College, where students begin their college career, and at the Graduate Center, where students take courses for their Masters and Doctorate degrees in Philosophy. Professor Kasachkoff is editor of the American Philosophical Association's Newsletter on Teaching Philosophy, has edited a collection of essays on the teaching of philosophy entitled In the Socratic Tradition: Essays on Teaching Philosophy, Rowman & Littlefield, 1998, and is now completing a revised version of that collection, which will be published under the title Teaching Philosophy: Theoretical Reflections & Practical Solutions (Rowman & Littlefield, 2004). She is also the editor with Steven Cahn of Morality and Public Policy (Prentice Hall, 2002) and the author of numerous articles on ethics, social policy, and ethics issues in health care. One of Professor Kasachkoff's chief professional interests is in the teaching of philosophy and the teaching of the teaching of philosophy. In 2000, she was the recipient of the American Association of Philosophy Teachers Award of Merit for Outstanding Leadership and Achievements in the Teaching of Philosophy.