a possible sexual assault that she might otherwise have been rendered powerless to avoid.

In cases real or hypothetical, the facts, explicit or implicit, are important. In this case the young woman is an adult, not an adolescent or a child. That she is a professional implies that she is functionally competent, even perhaps with a sophisticated grasp of the implications of using the new medication. We must make a few additional assumptions about her—for example, that she is not incapacitated with mental illness, nor does she have a cognitive disability that would make questionable her capacity to understand and appreciate the consequences of her choices. That she is free to attend weekend parties implies that she is free in a more general sense—she is neither incarcerated nor institutionalized. Nor for that matter is she likely to be under the active surveillance of the criminal justice system, as might be the case with someone on probation after being convicted of illegal drug use. There is no reason to suppose that she is addicted to the date-rape drug whose effect she wishes to avoid, so we do not have to consider whether addiction impairs her ability to give free, voluntary, and informed consent. And she is making this decision by and for herself. Neither is she the object of some other person’s would-be benevolence nor is she choosing on someone else’s behalf. Finally, the purpose for which she is using the new medication seems an entirely worthy one. In short, this hypothetical case includes a set of facts that incline us to approve of her decision. In the messier world in which these new medications might be used, the facts will often be murkier and the ethical judgments more complex.

  • Suppose she was an adolescent or child rather than an adult.

  • Suppose she had a mental illness or mental disability that interfered with her ability to understand or appreciate what using the new intervention would mean for her.

  • Suppose she was in prison or a residential drug treatment facility.

  • Suppose undergoing this treatment was a condition of her parole for substance abuse and she accepted it grudgingly.

  • Suppose she was powerfully addicted to the drug that the intervention was meant to counteract. Would her consent to treatment mean the same?

  • Suppose the drug itself was not illegal—that it was alcohol or nicotine rather than some banned substance.

  • Suppose the intervention was imposed on her by another party: her parents, her employer, the government.

  • Suppose the intervention was being marketed aggressively, perhaps directly to consumers, by its manufacturer.

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