Faden and Beauchamp 1986 p 6 emphasis added This definition implies that

Faden and beauchamp 1986 p 6 emphasis added this

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(Faden and Beauchamp 1986 , p. 6, emphasis added ). This definition implies that clinicians should only withhold decisional power from indi- viduals who suffer from either external control or personal limitations that prevent them from making adequate deci- sions that are consistent with personal values (Childress 1997 ). 250 N. HEATHER ET AL.
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The BDMA as proposed by Leshner ( 1997 ) and Volkow and colleagues (Volkow et al. 2016 ) has the basic tenet that repeated substance use leads to brain changes that render the individual incapable of making certain types of decisions and choices effectively. In essence, the BDMA suggests that addiction prevents addicts from making a variety of decisions about their lives, especially ones involving whether or not to use drugs at any given time. This view invites paternalism by treatment providers and others who view the addict as requiring treatment that he/she might not wish to undergo, but as incapable of effectively deciding to accept a treatment recommendation (Vandeveer 1986 ). This raises the question of the extent to which addicts are actually incapable of mak- ing decisions about their lives, the extent to which addiction actually prevents such decision-making, and how we are to ascertain when and whether addiction had rendered the individual incompetent in this way. It is clear from widely replicated research findings that most addicts clearly are not incompetent in this way that is, most ultimately make effective decisions about their substance use in the context of personal values that emerge at some point in time and outweigh the value of drug-taking (see Heyman 2009 ). Heyman notes the experience of William Burroughs who, when his family declined to further support him financially, and unwilling to work at a traditional job, stopped taking drugs (Heyman 2009 ). The BDMA also raises questions about whether an addict has the capacity to effectively make decisions about other aspects of life that might intersect with decisions about drug-taking, e.g. finances, entry into con- tracts, etc., further inviting a paternalism that risks becoming coercive and disrespectful of individual autonomy. Arguably, a fully-fledged acceptance of the BDMA could result in increased violation of addicts civil and human rights in the name of beneficence. Additionally, so doing may, given the toxicity of some treatments for some individ- uals, result in harm to the addict by virtue of creating a negative view of treatment that results in further reluctance to seek help for addiction. Such an outcome would clearly be in violation of the principle of nonmaleficence (Beauchamp and Childress 1989 ). Thus, in the author s view, the BDMA raises significant bioethical questions that need to be addressed going forward.
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