Mitchel L. Galishoff, MD
Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L15-0356.
Galishoff M.; Pain, Opioids, and Addiction. Ann Intern Med. 2015;163:565. doi: 10.7326/L15-5142
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Published: Ann Intern Med. 2015;163(7):565.
TO THE EDITOR:
I applaud Gregg (1) for her frank analysis of the problem of pain and addiction. However, I am concerned that the neurobiological explanation for chemical dependence and abuse has led to an errant conclusion about the patient's moral agency. I have attended 3 conferences last year wherein speakers instructed us to inform patients that their addiction "is not their fault."
It is not logically necessary that a scientific explanation and moral responsibility be mutually exclusive. Both may be true and not violate the law of noncontradiction. Indeed, the diagnostic criteria for these disorders include behaviors that are fundamentally moral.
Mitchel L Galishoff
Valley Medical & Surgical Clinic, MC
October 6, 2015
I wish to thank Dr. Gregg For her thoughtful reply. I find it interesting that "secular humanism" is applied to groups such as AA and NA which often appeal to a "higher power." The appeal recognizes that the issues surrounding addiction transcend the patient's natural ability to overcome the illness. Whether we call this "higher power" God or leave it at some vague idea, the appeal is transcendental. Strictly, at least from our literature, secular humanism grew out of two main factors: Unitarianism and Modernism (Gordon H. Clark, contributing to Baker’s Dictionary of Christian Ethics, ed. Carl F. H. Henry, p. 302).* My reference to secular humanism was in the strictest sense of rejecting the idea that biological science alone can solve, much less answer the "why" of problems such as addiction. I believe we are in agreement but using the terms in a different manner.Again, many thanks for an important insight and for your great work.*Alan Cairns, Dictionary of Theological Terms (Belfast; Greenville, SC: Ambassador Emerald International, 2002), 165.
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