n South African Psychiatry Review - A moral deliberation on the tragic standoff between the substance dependent client and the therapist : original article

Volume 8, Issue 1
  • ISSN : 1811-7805



Substance dependent patients are trapped within their addictive behavior. They must deny, minimize, rationalize, intellectualize and project to keep going. Therapists see this as poor motivation in 'difficult' patients with a chronic relapsing disorder. Patients 'avoid' therapists and therapists 'avoid' patients. The problem for patients, love-ones and society lingers on. Society (patients) must trust caregivers in order to seek help. Caregivers must be committed to caring for substance dependent patients. This gap can only be bridged if the caregiver accepts this 'chronic relapsing illness', is skilled in motivational interviewing, and is able to balance duty of care and beneficence with the respect for autonomy (self determination) and the right to refuse treatment. The essence of the moral dilemma lies within the concept of patient competency to make informed decisions in the face of being 'trapped within his/her illness. The argument that the patient, at some stage of his/her illness, is not competent to make a rational treatment decision will be discussed. The paper will focus on motivational interviewing, autonomy, virtue, human rights, duty to care, justice and common good, and the need to induce sound moral arguments in the treatment strategies of patients with substance dependence.

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