Putting ethics in its place – right at the heart of drug policy debates
Dr Gregory K Pike, PhD

Abstract:

Making decisions of an ethical and moral nature is part of the everyday business of human existence. It is not possible to be value free or to act without making a moral or ethical decision of one sort or another, for good or ill. Personal decisions about taking mind-altering drugs have ethical dimensions, and these frequently have particular reference to pleasure.Pleasure needs to be understood with nuance and distinctions made between pleasures which are in keeping with human fulfillment and those that are not. Ethics can also be valuable in understanding the roots of overarching policies like harm minimization. Harm minimization has its basis in the ethical theory of utilitarianism which judges actions by considering the balance between pleasure and pain. It is argued that this is a flawed approach and that harm minimization not only promotes unethical practices, but ultimately ends up failing the very people it seeks to assist.

Keywords: ethics, morality, utilitarianism, harm minimization, pleasure, autonomy, policy

Introduction
Debates about drug policies are confounded by a wide variety of quite complex matters. Whilst these include law, treatment, education, international relations and scientific evidence, to name a few, more basic is the philosophical framework from which these are derived. And foundational differences in that framework can lead to very different perspectives on policy. The area of philosophy in which many of the basic questions lie is the field of morals and ethics (1), and while it has been forcefully put at times that morals and ethics should be left out of the drug debate, it is impossible to do so, since morals and ethics are unavoidable. That drug policies contain profound ethical questions cannot be denied, but perhaps the desire to do so comes from the quite basic differences in perspective coming from voices in the debate. More controversial still is the proposition that substance abuse itself is primarily a moral problem. This is not to say that drug abuse is ‘simply a moral problem’ and therefore the hard work of assisting someone to become drug-free does not require detailed and dedicated attention to the mental, physical, spiritual and financial devastation often caused by drug abuse, but rather that an ethical perspective informs how that work is to be done.
Debates about ethics and about the drug policies which arise from ethics can be hard going, and one of the reasons for this is ethical subjectivism or moral relativism. As Budziszewski so starkly puts it,

Once upon a time it was possible for a philosopher to write that the foundational moral principles are the same for all … Today all that has changed. A thinker … can no longer expect most people to agree. In fact he must expect most people to disagree. He will be told that the foundational moral principles are not the same for all … They might not even be right for all, and they are certainly not known to all. (2)

About moral knowledge, he goes on to say,

… not only was moral knowledge universal, but the determination to play tricks on moral knowledge was universal, too. A law was written on the heart of man, but it was everywhere entangled with the evasions and subterfuges of men. (3)

Ethical reasoning is now much harder work because of competing moral philosophies that ultimately lead to very different decisions being made in a wide range of fields from drug policy to end-of-life to biotechnology and genetics. Consensus is harder to reach, and therefore clear policy-making can be stymied. Reminiscent of De Quincey’s nineteenth century ‘opium-eating’, during which he described his experience of “ … mighty and equal antagonisms ... ” (4), the various sides of the drug policy debate cannot agree because of foundational differences in their basic ethic.

Nevertheless, despite competing moral philosophies, it is possible to find agreement on many of the basic virtues and values that promote human fulfilment, and in the modern era, much of that agreement can be found in human rights instruments like the International Declaration of Human Rights. This human rights document, and many others like it, is committed to providing a framework within which human beings can flourish. It promotes values like freedom, respect, courage, social interaction, good health and so on that can be used to inform appropriate policies not only in the drugs field, but in every field.

Whilst it is an oversimplification, within the drug debate one side holds the basic conviction that mature individuals should be legally permitted to use currently illicit mind-altering drugs, much like they may choose to use tobacco, caffeine or alcohol, and the other side holds the basic conviction that the currently illicit mind-altering drugs should remain illegal. Another oversimplification, but useful for the purposes of beginning a discussion, is that it is reasonable to say that the first group either consider such use morally acceptable or at least an individual’s choice even if morally unacceptable, and the second group consider such use morally unacceptable. And there are a variety of reasons why each would conclude so. It is important to note that something that is generally agreed to be wrong may not necessarily be the subject of legislation (5). This is the difference between ethics and law. However, in a democracy something that is the subject of proscriptive legislation is always generally agreed to be wrong. If the community consensus shifted and the general agreement changed, the law would then change to reflect that shift in ethical perspective. If this happened, it might sound like the community is being relativistic about ethics, and that would be because it is.

For those who consider drug use morally unacceptable, the decision about whether to apply restrictive legislation or not is based upon the extent to which drug use is considered a private matter that harms self but not others as well as the extent to which personal liberty to carry out self-harming behaviour can be justified. On the first count, a strong case can be made that harm as well as the risk of harm does extend to others from ‘personal’ drug use, and therefore John Stuart Mill’s famously enunciated principle in On Liberty cannot be fairly applied.

The only purpose for which power may be rightly exercised over any member of a civilised community, against his will, is to prevent harm to others. His own good, either physical or moral, is not sufficient warrant. (6)

On the second count, one might appeal to legal paternalism to argue that there are times when the state should protect people from themselves. Indeed, there are numerous examples where the state does just that, for example, seatbelt laws or helmets for cyclists. Moreover, international law proscribes selling oneself into slavery, even if that were, bizarrely, an expression of liberty. Another take on this is that a law based upon pure paternalism is rare and that, in reality, there are other factors that are taken into consideration. For example, the community, through the state, must bear the not inconsiderable cost of rescuing people from the consequences of their risky or outright self-harming behaviour, and therefore some form of paternalism is justified. Furthermore, where there are obvious benefits that arise from risky behaviour, as is the case with certain sports, it is much easier to justify not applying legal paternalism than when the benefits are few, misrepresented, counterfeit, or absent.

Much more could be said about the complex relationship between ethics and law in relation to drug abuse, but it will not be explored further here.

Instead, because ethics and morality pervade numerous other private and collective aspects of the field of substance abuse, two of these will now be addressed. They include the moral legitimacy or otherwise of recreational (7) use and the ethical underpinnings of harm minimization. Ethics does, of course, have much more to say in a wide range of areas within the field of substance abuse, for example about modes of addiction treatment, truth-telling in drug policy debates, conflicts of interest and hidden agendas, formal and material cooperation by individuals or the state in harmful practices, and the ethics of including in research addicted individuals or those otherwise vulnerable because of their drug abuse. (6) In addition, modern neuroscience is now beginning to uncover interesting details about the brain and decision-making in general and moral decision-making in particular. Some of these findings and how they accord with studies that have explored decision-making impairments resulting from drug abuse are important, but they are beyond the scope of this paper.

‘Recreational’ Drug Use
The reasons why people initiate drug use are complex; however, there can be little doubt that the feeling that is derived, or at least sought, is often pleasurable or otherwise an adventure into unreality and therefore desirable. Several explanations can be found; the following is from Nick Stafford who posted his view online:

I believe it is my human right to use opiates or any other drug I feel like using, for whatever reasons I may have. I feel my life has been enriched by the use of heroin, marijuana, speed, acid and other drugs. I believe that drugs should all be legally available, and I will continue to use these drugs, if I so desire, for the rest of my life. (8)

For Stafford, all other ethical considerations have been subjugated to personal desire and the right to choose, both of which are premised on the pursuit of pleasure as an end in itself. Of course, autonomy and choice are valid ingredients in ethical decision-making. But the failure to take into account any other ethical consideration, including a consideration of what it is that promotes human flourishing, leads to a perverse individualism in which the common good of all is substantially undermined.

… strong emphasis on autonomy … has led ethicists and others to ignore or discount to different degrees the fact that individuals make decisions as social beings - that is, as persons with many characteristics closely tied to their social, cultural, ethnic, and family contexts and that these social aspects of the person impact relevantly and often crucially on their actions and certainly on their beliefs. (9)

One could go further and argue that not only is there a requirement for individual action not to undermine the common good of the community, but that there is a requirement for individuals to promote the common good by positive contributions to the community. Such a sentiment has a long and rich history, particularly in the various religious traditions. (10)

The justification for personal drug use also comes from far more notable figures than Nick Stafford. In his recent book, Romancing Opiates, English writer and retired physician Theodore Dalrymple charges Samuel Taylor Coleridge and Thomas De Quincey, amongst others, with producing,

Romantic claptrap [that] invests intoxication by opiates with a philosophical significance beyond mere indulgence. (11)

In a chapter appropriately titled, The literature of exaggeration and self-dramatization, Dalrymple ruthlessly exposes Coleridge and De Quincey for their self-indulgent and dishonest accounts of their supposed mind and consciousness expansion whilst under the influence.

Gosh! Opium not only calms you down while sharpening your faculties and honing your intelligence, but makes you a better, kinder person. No pharmaceutical purveyor of an antidepressant ever bid up his product higher than that. Take but a little heroin, therefore, and your intellect will be majestic.Your thoughts will be coherent, your powers of mental synthesis unparalleled. You will recover the pristine, pre-social beauty of the human character of which Rousseau speaks so eloquently. A drunk is a drunk, but a heroin addict is a philosopher. (12)

This ‘wisdom of intoxication’ was taken up by 60s gurus like O’Leary to the detriment of a generation, and in Dalrymple’s opinion remains, along with boredom and meaninglessness, the root causes of modern society’s problem with drug addiction. It may take some years to exorcise the influence.

Apart from the deceit of consciousness expansion, the appeal of pleasure in its various forms remains a key factor in drug use. In a recent article, Cameron Duff chides policy makers for ignoring this primary purpose of drug taking, enlisting the work of Michel Foucault on ethics and the use of pleasure:

Indeed, Foucault’s work on ethics and the use of pleasure gives rise to a series of critiques of contemporary drug policy and the ways in which it tends to privilege the ‘problem’ of harms whilst eliding the consideration of pleasure. (13)

Duff wants pleasure to be incorporated into the drug policy equation, and as it turns out, perhaps not unexpectedly, he recommends easier access to drugs that induce pleasure. Perhaps he is braver than others so far who have advocated liberalisation on the grounds of harm minimization, but in reality see pleasure as a desirable goal that is factored into the pleasure/pain calculus. The fact that pleasure doesn’t get that much of a mention may be because the promotion of pleasure is a risky business because many others would see it as counterfeit pleasure; after all, perhaps the pleasures attributed to drugs like cocaine, heroin or ecstasy can be achieved by other more authentic means that have a richness, depth and enduring wholeness unattainable with drugs. At least this is the thesis of writers like A. Ernest Wilder-Smith. (14)

The importance of pleasures and pains and their relationship to the human condition, as well as to good and evil, have their roots in Greek philosophy. Writing circa 300 BC, Epicurus noted that:

we always act to avoid pain and fear

and that:

pleasure is the first good innate in us, and from pleasure we begin every act of choice and avoidance, and to pleasure we return again, using the feeling as the standard by which we judge every good. (15)

In the seventeenth century Thomas Hobbes consolidated this view:

… if I derive pleasure from something, it is good, whereas if it causes me pain, it is evil. (16)

Thus what is subjectively experienced as pleasure or pain Hobbes objectively defines as good or evil. If there is something that gives me pleasure, then it can be called good, and if there is something that causes me pain, then it can be called bad. This is not only a relatively simple way to determine good from evil, but it is also centered upon my judgment and perspective and mine alone. This reliance on my judgment or perspective might be satisfying for me and bring me some pleasure or avoidance of pain, but to say that good has been served and evil averted requires something more.

Another obvious corollary of this mode of thinking is the problem that arises when my particular pleasure happens to contribute directly or indirectly to someone else’s pain. How then can what I call good as a consequence of the pleasure I derive be at one and the same time evil for another because of the pain they experience? Furthermore, pain and pleasure can be intricately connected, occurring in the context of one event, for example in childbirth or during a marathon run.

This leads to the conclusion that pleasure in and of itself cannot be equated with good. Pleasure is an experience that can be derived from that which is good as well as from that which is evil. As Thomas Aquinas has said:

In the moral order, there is a good pleasure, whereby the higher or lower appetite rests in that which is in accord with reason; and an evil pleasure, whereby the appetite rests in that which is discordant from reason and the law of God. (17)

Aquinas identifies good pleasures as those which are in keeping with objective goods as appraised by reason and evil pleasures which are contrary to reason and not aligned with objective goods. It is another way of saying that pleasure can be derived from acts which cause human beings to flourish, but it can also be derived from inherently harmful acts that diminish humanity and lay waste to human lives. Pleasure alone cannot define what is good, just as pain alone cannot define what is bad.

To more clearly distinguish ‘good’ from ‘bad’ requires understanding that the badness of what is bad is what Germain Grisez describes as “the distorting, damaging, or corrupting factor. This factor is a privation, a real lack of something which should be present and perfect.” (18) The converse of this is that goodness is fullness of being. Just as badness is privation, so goodness lies in the fulfillment of our potentialities. (19) Both good and bad are real, and their effects are really experienced by human beings. To be taught the whole truth about something is liberating and fulfilling. To be given a partial truth, a half-truth, leaves us still to some degree in the slavery of ignorance and therefore unfulfilled.

But there is a secondary sense in which the terms ‘good’ and ‘bad’ are used. Humans are sensible beings as well as intelligent beings. As intelligent beings, we make choices. We can choose between that which is good (fulfilling) and that which is bad (ultimately unfulfilling). As sentient beings, we respond emotionally to things around us which are suited to us or unsuited to us. Our emotions arouse within us possibilities for action while our intelligence considers the reasons for and against acting on the possibilities proposed to us by our emotions.

When emotion and intelligence work together in harmony, what is brought about is “both pleasant (the sensible good is experienced) and fulfilling (the intelligible good is served).” (20) Grisez gives some examples. Eating a good meal provides the person not only with pleasure but also the objective/intelligible goods of health and sociability.

So there are both intelligible goods and bads/evils and sensible goods and bads/evils. An intelligible good is one which is objective, fulfilling and fundamental such as knowledge, health, well-being, sociability and so on. Intelligible evils are the real deprivation of those goods, such as ignorance, sickness, disability, alienation from others and so on.

Sensible goods and evils are the feelings of pleasure and pain experienced at an emotional level, either of attraction or repugnance.

Grisez gives an example of the distinction between sensible and intelligible goods and evils:

The distinction between sensible and intelligible goods is most obvious when a choice for an intelligible good overrides emotional repugnance to a sensible evil which will be experienced by the act itself. For example, one chooses to undergo painful dental treatment for the sake of the intelligible good of healthy functioning teeth. But in undergoing the treatment one experiences pain. Unlike the intelligible evil of the loss of one’s teeth, the sensible evil of pain is a positive reality. Thus sensible evils are not privations, and sensible goods are only partial aspects of the intelligible goods which fulfill a human person as a whole. (21)

The point here is that a sensible evil, such as pain, is not necessarily a ‘bad’. Human beings need to be able to experience pleasure and pain for reasons of survival. Pain is as real as pleasure and is as beneficial to the human being as pleasure.

The long shot of all this is that equating pleasure with good and pain with evil simply cannot be made. Later, in the discussion of harm minimization and its association with the ethical theory of utilitarianism, it will hopefully become clearer that it is the failure to fully appreciate these relationships between good and evil, pain and pleasure that contribute to the adoption of harm minimization as a solution to substance abuse.

With all this talk about pleasure from drug use, it is worth noting that this is really a rather limited picture. Just as Dalrymple exposed the exaggeration and self-dramatization of Coleridge and De Quincey, perhaps a more realistic account of the ‘pleasure’ of drug use will reveal rather more decidedly unpleasant experiences than advocates would like to admit. The following account was the result for a 41 year old of using a hallucinogen, but bad trips of different types can result from any mind-altering substance.

My entire being - my soul, I suppose - began to scream in anguish, in terror, in horror. This, surely, was the worst place in the universe for a human soul to be. I can’t say why or how or what this was; it doesn’t translate to our consensus reality. I just know that it took me utterly and horribly. I wanted to get out of there with every fiber of my being. After what was maybe two or three minutes of this, I came to believe that I was, in fact, in hell: Hell, the real place - no red demons with pitchforks, no fire, no frozen lakes - just pure, non-stop, overwhelming, spiritual torment. And it seemed to be eternal. I believed, not in the way we think normally or have a notion, but rather as an indisputable, immutable truth in the core of my small, small self, that I had made some huge mistake in my life … (22)

Besides the bad trips, the reality is that when recreational drug use turns to addiction, someone is no longer seeking pleasure or any other-worldly experience or is likely to get one. Rather, the real experience will instead be to avoid the unpleasantries of withdrawal, both physical and psychological. If there had been some pleasure in the early stages, this new reality must come as a cruel joke, a mean, seductive trick where getting back can be like climbing Everest.

Harm Minimization and Utilitarianism
For ethics to be able to assist in understanding what has become the most prevalent yet controversial approach to drug policy, it is essential to obtain some clear definitions.

Lacking a clear definition, the concept of harm-reduction or harm-minimization is in danger of being co-opted by persons who have very different conceptions of what harm-reduction means in terms of policies and programs. (23)

There are several problems that one initially encounters when considering what has variously been called harm minimization or harm reduction in relation to drug policies. The first is that at face value, while both terms have general appeal, they have been applied in a variety of ways and in differing contexts so that their meaning is confused, primarily because their application in the real world has led to the implementation of practices which arguably have not always reduced or minimized harm. Indeed, it could and has been argued that overall harm has never been reduced or minimized where these policies have been implemented.

Furthermore, minimizing harm is conceptually quite different to merely reducing harm. If harm is reduced by a fraction of a percent, assuming such measurements can in fact reasonably be made, then one can claim to have achieved harm reduction, but, in practice, next to nothing has changed. On the other hand, harm minimization at least sets a goal which is bringing harm to a minimum, the least it can be, whereas harm reduction is relatively meaningless, setting no articulated goals.

To confuse matters further, while the two terms have often been used interchangeably, there are also policy statements in which harm reduction has been assigned as a subset of harm minimization. Thus harm minimization has been adopted as an overall policy and harm reduction used in reference to particular treatment strategies applied only to those who are serious drug users and for whom, it is argued, there is no chance they will ever stop using drugs. Ethically this begs the question as to why we would accept merely reducing harm as sufficient for the most seriously affected people, whereas minimizing harm, a much more rigorous standard, is applied to everyone else. Could it be that lurking behind this kind of distinction is a eugenic impulse to regard some people as simply being beyond the pale, irrecoverable, and not worth the candle? Whatever the case, definitions of either harm minimization or harm reduction are difficult to construct but have nevertheless been attempted. One attempt by the Drugs and Crime Prevention Committee of the Parliament of Victoria takes the following form:

A policy or practice or strategy is harm-minimizing if it is fully reasonable to expect that it will reduce existing or future harm to the greatest degree allowable by the resources and conditions that prevail in the particular context of its application, without necessarily requiring the reduction or elimination of drug use. (24)

The last phrase of this definition appears oddly attached and unnecessary for the definition to function. One wonders whether it being there unmasks part of the meaning of harm minimization, which may be to sanction continued drug use.

It is at this point that the identification of harm minimization with the utilitarian theory of ethics can be made. Just as harm minimization is predicated upon the task of measuring outcomes rather than being based upon primary principles or long-held ethical norms or the goods constitutive of human fulfillment, utilitarianism, also known as consequentialism, likewise focuses on consequences or outcomes in its determination of the moral good. Utilitarianism is based upon Mill’s observation that human beings strive to be happy by seeking pleasure and avoiding pain. As the name implies, utility or usefulness to achieve a chosen end is the key. Outcomes or consequences are what counts, not so much how one gets there. Another way of saying this is that the means are justified by the ends.

The philosopher Peter Singer describes utilitarianism/consequentialism thus:

Consequentialists start not with moral rules but with goals. They assess actions by the extent to which they further these goals. The best known, though not the only, consequentialist theory is utilitarianism. The classical utilitarian regards an action as right if it produces as much or more of an increase in the happiness of all affected by it than any other alternative action. (25)

From a public policy point of view (as well as from the individual’s point of view when making a moral choice) such utilitarian calculations are not possible unless one can objectively identify all of the relevant pleasures and pains, apply weight to each, and then perform the necessary calculations to reach the desired goal of the greatest happiness for the greatest number. For example, for heroin use this would involve identifying, weighing and appropriately balancing all of the consequences in the pleasure/pain calculus for all individuals affected.

For utilitarianism nothing is inherently wrong in and of itself, and therefore acts, which traditional ethical theories have determined to be unethical, may be justified as part of a process to achieve a good outcome.

Even if one could identify all the pleasures and pains of all individuals affected by heroin addiction (an impossible task), the fact is that they cannot be weighed up because we have no scales by which pleasures and pains can be commensurated. This attempt to commensurate the incommensurable, somewhat like adding the weight of the page to the number of words on the page and dividing that figure by the area of the page, is incoherent.

Others have contended that, in reality, utilitarianism as a modern moral philosophy is a form of justification for arbitrarily chosen acts. As one bioethicist puts it:

Indeed it will be argued that partisan attachments to particular moral philosophies is no basis for public policy because modern moral philosophy is in disarray, that modern moral philosophers “offer a rhetoric which serves to conceal behind the masks of morality what are in fact the preferences of arbitrary will and desire.” (26)

When it comes to drug policies that are founded upon utilitarianism as expressed in harm minimization, the argument is that since drug use is pleasurable and not inherently harmful, some sort of pleasure versus pain calculus can be carried out that allows the development of policies that minimize the overall harms, the majority of which arise, it is argued, from the policies of prohibition. More precisely, as noted earlier, harm minimization in practice takes the pleasure or benefit component of drug use for granted and weighs harms against each other in the belief that the overall outcome will be better. But no such calculation can be undertaken, especially since many harms simply cannot be measured in a way that allows them to be balanced one against another.

In the scientific era there is a particular risk when it comes to measuring outcomes. That risk has arisen in the context of applying the scientific method to fields in which there are complex human behaviours and complex causes. Scientific analysis in the field of substance abuse needs both very careful structuring and implementation and even greater care when it comes to interpreting the results, for there are many filters applied to the data, including ideological ones:

The humanist trust in reason and science allows the abstraction of moral problems from their full human context. The solving of moral problems becomes a technical construct in which full credibility is given to the pretence that all relevant factors may be identified and in some way scientifically quantified. (27)

This trust in the application of the scientific method to complex drug policy questions which have important ethical aspects is associated with an attraction to utilitarianism.

Utilitarianism is attractive to those minds which reflect these assumptions because it appears to be ‘scientific’, ‘rational’, and ‘certain’. It appears to offer a scientifically safe method of computing morally good acts while at the same time appealing to the pragmatism of scientific elites who identify the public interest with the successful outcomes of their scientific protocols. (28)

Thus many of the studies that assess the efficacy of needle exchange facilities, for example, do so by measuring certain parameters in abstraction from the complex human behaviours that result from their implementation. Some of those behaviours may include practices that contribute to the use of drugs by others who may previously have avoided them, but an analysis of such a possibility would be extremely difficult to carry out. In a recent US Surgeon General’s Review on needle exchange facilities it was categorically stated that “syringe exchange programs … do not encourage the use of illegal drugs”. (29) One wonders whether this refers to participants or the wider community, whether it was a conclusion based on lack of evidence, how diligently the researchers went looking for evidence and how in practice the data was collected, compiled, analyzed and interpreted.

Likewise, a medically supervised safe injecting facility might claim to be successful by calculating the number of overdose emergencies it has successfully managed which might be claimed to have otherwise resulted in death, but it cannot effectively measure the impact the safe injecting room has had on the ability of individuals to seek treatment to be free from their addiction.
So whilst harm minimization purports to take into account, within reason, all factors that might contribute to harm, in reality the process is very selective and leaves out of policy deliberations important and potentially serious harm that can come to individuals and the community. One example would be where the harm of addiction itself remains or even increases in severity in treatments like methadone or heroin maintenance.

Conclusion
All deliberations about drug policies are founded upon one ethic or another, claims to the contrary notwithstanding. While little has been said here about what ethic they should be established upon, it can be argued that much better can be done than harm minimization founded upon utilitarianism.

What utilitarianism really fails to do is to provide either an account of humanity’s desires to promote its best and highest ideals or to provide a solid touchstone that will not shift with the tides of arbitrary preference and desire. It fails to acknowledge that humans dream of the best they can be and then strive for it. Harm minimisation, by being grounded upon utilitarianism, suffers the same basic shortcoming. It cannot provide an account of what is really the best for human beings who have been trapped in the conundrum of addiction, nor can it provide a vision for a way out to a much better existence. In some respects it amounts to a council of despair inasmuch as many of its policies represent an abandonment of people to their addiction.

The best drug policies need to be built upon the basic values that contribute to the circumstances in which human beings can truly flourish. These basic values include things like social interaction, knowledge, trust, health, safety, play, freedom, reason, integrity, courage, wisdom, authenticity, equity and substantive fairness. These values are real, never mutually exclusive and, to varying degrees, attainable. They are really worth aiming for. And while reality is messy, complicated and imperfect, the best that can be done should be the best that can be done. Harm minimization fails on many grounds, but perhaps its primary failure is the failure to recognise that aiming for less guarantees less.

Dr Pike is the Director of the Southern Cross Bioethics Institute in Adelaide, South Australia. He has a doctorate in Physiology and undertook postdoctoral studies in the USA in biophysics and in Australia in neurobiology. He also worked on clinical trials in laparoscopic surgery at the Royal Adelaide Hospital before being attracted to Bioethics. He has a particular interest in the interface between bioethics and public policy development in the areas of illicit drugs, stem cells, cloning, abortion, reproductive technology, genetics, and end-of-life decision making. He is a member of the Australian Health Ethics Committee, and is married with three children.

References
1. The terms ethics and morals will be used approximately interchangeably.

2. Budziszewski J. What we can’t not know: a guide. Dallas: Spence; 2003, 3.

3. Ibid. 4.

4. De Quincey T. Confessions of an English opium-eater and other writings. Ward, A, editor. New York: Signet; 1966, 71.

5. Obvious examples arise in personal sexual ethics; for example, adultery is generally morally proscribed by the majority of the community, but in modern societies the law has retreated almost entirely.

6. Mill J S. On liberty. New York: Rowman and Littlefield; 2005. Mill can also be quoted thus: “No person is an entirely isolated being; it is impossible for a person to do anything seriously or permanently hurtful to himself without mischief reaching at least to his near connections, and often far beyond them.” And, “if he deteriorates his bodily or mental faculties, he not only brings evil upon all who depended upon him for any portion of their happiness, but disqualifies himself for rendering the services which he owes to his fellow creatures generally, perhaps becomes a burden on their affection or benevolence; and if such conduct were very frequent hardly any offense that is committed would detract more from the general sum of good.”

7. The term ‘recreational’ is used here with caution and only in deference to its popularity in public debates about drug abuse. In fact, the term is quite inappropriate in reference to abusing drugs. The Collins dictionary defines recreation as “refreshment of health or spirits by relaxation or enjoyment” which, by linking recreation to health, excludes drugs of abuse.

8. Stafford N. Available from: www.drugaid.com.au; 2001.

9. Kegley J A K. Genetic information and genetic essentialism: will we betray science, the individual and the community? Kegley, J A K, editor. Genetic knowledge: human values & responsibility. ICUS; 1998, 55.

10. For example, the Golden Rule – “Do unto others as you would have them do unto you”, Jesus, Matthew 7:12.

11. Dalrymple T. Romancing Opiates: pharmacological lies and the addiction bureaucracy. New York: Encounter; 2006, 61.

12. Ibid. 65.

13. Duff C. Drug use as a ‘practice of the self’: is there any place for an ‘ethics of moderation’ in contemporary drug policy? Int J Drug Policy 15:385-393.

14. Wilder-Smith A E. The causes and cure of the drug epidemic. Stuttgart-Neuhausen: TELOS-International; 1974.

15. Epicurus to Menoeceus. In: Epicurus: extant remains. Bailey C, translator. Oxford: Clarendon Press; 1926, 84-91.

16. May L. Hobbes. In: Ethics in the history of western philosophy, Cavalier R J, Gouinlock J and Sterba, J P, editors. New York: St. Martin’s Press; 1989, 125.

17. Summa Theologiae, la liae. 34 a. 1.

18. Grisez, G. Christian moral principles. Chicago: Franciscan Herald Press; 1983, 116.

19. Ibid. 117.

20. Ibid. 119.

21. Ibid. 120.

22. Available from: www.erowid.org/experiences/exp.php?ID=19319.

23. Single, E. The concept of harm reduction and its application to alcohol: the 6th Dorothy Black lecture. Drugs: Education, Prevention and Policy 4(1): 10, 1997.

24. Drugs and Crime Prevention Committee, Parliament of Victoria. Harm minimization: principles & policy frameworks, Occasional paper no. 1. Available from: www.parliament.vic.gov.au/dcpc/Reports%20in%20PDF/Harm%20Minimisation.pdf.

25. Singer, P. Practical ethics. Cambridge: Cambridge University Press; 1979, 3.

26. Fleming, J I. Natural rights and natural law: an analysis of the Consensus Gentium and its implications for bioethics (PhD thesis). Queensland, Australia: Griffith University; 1992, 68. Included in quotation marks is a quote from Alasdair Macintyre, After Virtue, Duckworth, London, 1987, 71.

27. Fleming, J I. Op. Cit., 1992, 139.

28. Ibid.

29. Evidence-based findings on the efficacy of syringe exchange programs: an analysis from the Assistant Secretary for Health and Surgeon General of the scientific research completed since April 1998. Surgeon General’s NEX review. Available from: www.harmreduction.org/issues/surgeongenrev/surgreview.html.