4 ms·

Addiction is a sickness. Saying that the person “wants” to drink (or do heroin) is missing a huge part of the problem.

paulcole 7y ago
I have diabetes and if I decide I don't want to take my insulin because I'm fed up with the hassle, I shouldn't have to go to court over it. It's my choice and my life.
- DanBC 7y ago
  Sure, if you have capacity to make a choice you should be allowed to make an unwise choice. People are asking how much capacity a person has if they are addicted.
  - fsloth 7y ago
    The thing is - this is impossible to quantify. So basically, you are left with a binary decision - is it okay to overturn peoples civil liberties over arbitrary quotas or not. Personally - having suffered the devastation an addiction of a close relative causes in everyone around them - i would still prefer the current model where people are not forced to things against their will just because they drink too much alcohol.
    - DanBC 7y ago
      (I'm in England so all of this is somewhat from an English perspective) There are roughly two camps when we talk about a human rights approach to mental health law, and they're not compatible with each other. The more mainstream version is to look at the UN Declaration of Human Rights, which flows into the EU Convention on Human Rights, which flows into national law. Under this system we can still have detention under mental health law, forced medication, and substituted decision making. But you do need some protections in place to prevent arbitrary detention and to give people a right of appeal. The less mainstream view is to look at the UN Convention on the Rights of Persons with Disabilities. Under this approach you cannot detain people under mental health laws, you can force them to take medication against their will, and you can only have supported decision making, you cannot have substituted decision making. There's some discussion on the CRPD here: https://www.nationalelfservice.net/mental-health/disability-rights-mental-health-treatment-and-the-united-nations-ronr2019/ https://www.nationalelfservice.net/mental-health/disability-... https://www.un.org/development/desa/disabilities/convention-on-the-rights-of-persons-with-disabilities.html https://www.un.org/development/desa/disabilities/convention-...
      - whiddershins 7y ago
        Wait, in the second case you can or can not force them to take medication against their will?
        DanBC 7y ago
        In the second case you can not force people to take medication against their will.
- smileysteve 7y ago
  If this is strictly a patient's choice; then health insurance providers, especially the government (medicare, medicaid) or future government programs should also have a similar choice of requiring pre-consent for DNRs and to some extent bypass quality of life considerations (amputations for diabetes complications) for costs. It's also arguable that state regulated or state run health insurance should require some degree of self insurance for people making these detrimental choices.
  - pkaye 7y ago
    You can fill out what's called an Advance Care Directive. My health care provider gave us a form to fill out and they will keep on record. Its a series of questions you have to answer to help make the decision when you no longer are able.
deleted 7y ago
[deleted]
DanBC 7y ago
Addiction is a sickness, and society needs to treat it as the public health problem it is and effective treatment needs to be made easily and cheaply available to all who need it. However, incarcerating people against their will, forcing them to take medication against their will, possibly for months, is problematic. We might tolerate that if it worked, but from the evidence we have we don't think it will work for many people with substance misuse. Addiction treatment is hard. I don't know many people working in addiction treatment who are asking for more legal powers to detain people. In England I sometimes speak to people with substance misuse disorders (comorbid with mental illness, or learning disability, or autism, or a mix). Many of them will have been detained for mental illness (they were not detained because of substance misuse). It's fair to say they have mixed views about compulsory treatment. Some of them hate it and think it caused them harm. Some of them think it was transformative. It is complicated.

I have diabetes and if I decide I don't want to take my insulin because I'm fed up with the hassle, I shouldn't have to go to court over it. It's my choice and my life.

DanBC 7y ago
Sure, if you have capacity to make a choice you should be allowed to make an unwise choice. People are asking how much capacity a person has if they are addicted.
- fsloth 7y ago
  The thing is - this is impossible to quantify. So basically, you are left with a binary decision - is it okay to overturn peoples civil liberties over arbitrary quotas or not. Personally - having suffered the devastation an addiction of a close relative causes in everyone around them - i would still prefer the current model where people are not forced to things against their will just because they drink too much alcohol.
  - DanBC 7y ago
    (I'm in England so all of this is somewhat from an English perspective) There are roughly two camps when we talk about a human rights approach to mental health law, and they're not compatible with each other. The more mainstream version is to look at the UN Declaration of Human Rights, which flows into the EU Convention on Human Rights, which flows into national law. Under this system we can still have detention under mental health law, forced medication, and substituted decision making. But you do need some protections in place to prevent arbitrary detention and to give people a right of appeal. The less mainstream view is to look at the UN Convention on the Rights of Persons with Disabilities. Under this approach you cannot detain people under mental health laws, you can force them to take medication against their will, and you can only have supported decision making, you cannot have substituted decision making. There's some discussion on the CRPD here: https://www.nationalelfservice.net/mental-health/disability-rights-mental-health-treatment-and-the-united-nations-ronr2019/ https://www.nationalelfservice.net/mental-health/disability-... https://www.un.org/development/desa/disabilities/convention-on-the-rights-of-persons-with-disabilities.html https://www.un.org/development/desa/disabilities/convention-...
    - whiddershins 7y ago
      Wait, in the second case you can or can not force them to take medication against their will?
      - DanBC 7y ago
        In the second case you can not force people to take medication against their will.
smileysteve 7y ago
If this is strictly a patient's choice; then health insurance providers, especially the government (medicare, medicaid) or future government programs should also have a similar choice of requiring pre-consent for DNRs and to some extent bypass quality of life considerations (amputations for diabetes complications) for costs. It's also arguable that state regulated or state run health insurance should require some degree of self insurance for people making these detrimental choices.
- pkaye 7y ago
  You can fill out what's called an Advance Care Directive. My health care provider gave us a form to fill out and they will keep on record. Its a series of questions you have to answer to help make the decision when you no longer are able.

deleted 7y ago

[deleted]

DanBC 7y ago

Addiction is a sickness, and society needs to treat it as the public health problem it is and effective treatment needs to be made easily and cheaply available to all who need it. However, incarcerating people against their will, forcing them to take medication against their will, possibly for months, is problematic. We might tolerate that if it worked, but from the evidence we have we don't think it will work for many people with substance misuse. Addiction treatment is hard. I don't know many people working in addiction treatment who are asking for more legal powers to detain people. In England I sometimes speak to people with substance misuse disorders (comorbid with mental illness, or learning disability, or autism, or a mix). Many of them will have been detained for mental illness (they were not detained because of substance misuse). It's fair to say they have mixed views about compulsory treatment. Some of them hate it and think it caused them harm. Some of them think it was transformative. It is complicated.