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J Med Ethics. 1985 Dec;11(4):173-7.

Heroin addiction, ethics and philosophy of medicine.


This article discusses various ethical and philosophical aspects of heroin addiction. It arose as a result of the plan by the Amsterdam city council to supply free heroin to drug addicts. The objective of treatment of heroin addicts is ambivalent because what is in fact a socio-cultural problem is transformed into a medical problem. The characteristics of this treatment are made explicit through a philosophical analysis which sees the medical intervention as part of a strategy aimed at achieving social normalisation. The reason why such a social control function is practised by physicians is discussed, as well as the reason why heroin users in particular are the object of such a process. In this paper, heroin addiction is considered primarily as a cultural problem. The consequences of this for treatment and ethics form the conclusion.


The ethical and philosophical aspects of society's attitude toward heroin addiction are discussed in the context of a proposed experiment to supply the drug free to some of Amsterdam's addicts. Ten Have and Sporken question the assumptions that addiction is a medical problem and that medicine has a role to play in finding a solution. They see heroin abuse as a social problem and the heroin user as one who rejects basic cultural values. It would be wrong to supply free heroin to addicts, they argue, because to do so would be against the addicts' best interests and would reinforce their addiction for the sake of preventing crime and preserving the social order. Physicians' cooperation in this experiment would be unethical because they would be involved actively in damaging individual health for the sake of society.

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