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Ethical and Legal Aspects of Interventions in Addiction Treatment

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Textbook of Addiction Treatment: International Perspectives

Abstract

The UN conventions present the international legal framework; they urge member states to provide treatment and rehabilitation but prohibit consumption and possession of scheduled drugs. This creates problems for providing treatment and harm reduction programs to patients who are not or not yet ready to stop illicit drug use. Other international documents, notably from the World Health Organization and the United Nations Office on Drugs and Crime, are strongly in favor of agonist substitution treatment and harm reduction measures. Within this framework, national legislation has much room for diverse preferences; the International Narcotic Control Board regularly comments the national practices, as well as the European Monitoring Centre for Drugs and Drug Addiction for the EU member states. An international trend gradually prefers therapeutic measures over criminal sanctions for drug users.

The international ethical framework is set by the universal declaration and European convention on human rights, striking a balance between individual rights and societal interests. Less ambiguous guidance comes from medical ethics claiming the full range of patient’s rights for addicted persons. The respective conduct codes for medical professions are regional or national and include procedures how to deal with ethical conflicts. Conflicting situations frequently occur, e.g., around the principles of autonomy or of confidentiality.

An essential ethical element of treatment is its effectiveness and avoidance of harm, asking for scientific evaluation of therapeutic approaches, services, and systems. The ethical acceptability of agonist substitution treatment and of harm reduction measures is based on rigorous evidence of their effectiveness. Other aspects concern the limits of social acceptability of addictive behavior and the limits of what can be attained for an individual patient by therapeutic interventions; avoidance of harm often is the more immediate objective than full recovery. In a public health perspective, effects at population level rather than at individual level are a priority, aiming at good coverage of treatment needs by good accessibility and affordability of services.

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Authors and Affiliations

  1. Research Foundation for Public Health and Addiction, Zurich University, Kirchgasse 30, CH-8001, Zurich, Switzerland

    Ambros Uchtenhagen

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  1. Ambros Uchtenhagen
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Correspondence to Ambros Uchtenhagen .

Editor information

Editors and Affiliations

  1. Department of Psychiatry, Alberta Gambling Research Institute University of Calgary, Calgary, Alberta, Canada

    Nady el-Guebaly

  2. Faculty of Brain Sciences UCL Division of Psychiatry, University College London, London, United Kingdom

    Giuseppe Carrà

  3. Division of Alcoholism & Drug Abuse, New York University School of Medicine, New York, New York, USA

    Marc Galanter

Additional information

Note: Some of the material is based on earlier work of the author about ethical aspects of treatment and care in addiction (Uchtenhagen & Guggenbühl 2000; Uchtenhagen et al. 2005; Uchtenhagen 2010a, b).

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Uchtenhagen, A. (2015). Ethical and Legal Aspects of Interventions in Addiction Treatment. In: el-Guebaly, N., Carrà, G., Galanter, M. (eds) Textbook of Addiction Treatment: International Perspectives. Springer, Milano. https://doi.org/10.1007/978-88-470-5322-9_65

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  • DOI: https://doi.org/10.1007/978-88-470-5322-9_65

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