360P
ETHICS AND HEROIN PRESCRIPTION TRIALS
TK Christie
BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia
Objective: To conduct an ethical analysis of the argument that heroin prescription trials are unethical because heroin addicts cannot give a free and voluntary informed consent.
Methods: Ethical analysis and literature review.
Results: Louis Charland, a critic of heroin trials, argues that since heroin addicts are addicted to heroin, they are incapable of saying no to heroin and, thus, cannot provide a voluntary informed consent to participating in heroin prescription trials. This analysis will show, however, that Charland addresses the wrong question. The real question is not about whether to use heroin (which would require consideration of Charland's argument), but where subjects are going to use heroin, under supervision or on the street; and secondly, whether to substitute heroin with methadone.
Conclusions: Charland's argument gives undue weight to the principle of autonomy while violating the principle of Justice, namely to help the worst off. As a result of Charland's argument, a vulnerable population would be denied the benefits of research that is "minimal risk," simply because they are vulnerable. The standards for research involving vulnerable subjects must seek to balance the vulnerability that arises from their incompetence with the injustice that would arise from their exclusion from the benefits of research. Because heroin prescription trials are "minimal risk", more injustice would result from prohibiting the trials than allowing a compromised informed consent standard.