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CONTENTS
ABSTRACT
T he debate over the medical use of
marijuana, recently played out in California and of topical
significance elsewhere, is often portrayed - by both sides -
as a conflict between the forces of rationality against those
of emotion. The fact that proponents and opponents are both
able to characterize themselves as on the 'right' side of
this equation should suggest to us that what is at stake is
precisely the meaning of rationality. The author presents the
debate on this subject as an ideological struggle about the
nature of our society's core values. At the heart of the
dispute is a disagreement about what counts as science, as
evidence, and as truth. After demonstrating that in the
debate over medical marijuana, there are two versions of
these concepts being played out, the author goes on to argue
that the conflict can be resolved by exploring deeper those
philosophical elements which are common to both sides.
Characterizing the philosophical disagreement as one between
those who value 'public good' and those who, on the contrary,
value 'private freedom,' Manderson concludes by focusing on
the pain which the medical use of marijuana is said to
relieve. The control of pain is both a public benefit and a
private advantage and, therefore, is an aspect which, the
author believes, makes a case for the use of the drug
persuasive to both sides.
(Top)
INTRODUCING DICHOTOMIES
The '30s, saw films like "Marihuana: Weed of Madness." In
the'50s, the U.S. Congress was told it was a drug that
incited "many of our most sadistic, terrible crimes ... such
as sex slayings" (Inglis 1975: 183; see also Bonnie and
Whitebread 1970; Himmelstein 1983: 19-26; Helmer 1975). In
the'70s, the New South Wales parliament heard that it was to
blame for "a yielding to homosexual advance" (N.S.W.
1976-77-78: 7779-80). So much, apparently, has marijuana
wrought.
In the '90s, the debate has been fought on slightly
different grounds. Proposition 215¹ amended the
Californian Constitution to permit the use of cannabis as a
medicine, in particular in cases of glaucoma, and to combat
wasting syndrome and as an anti-nausea agent in the treatment
of some cancers, AIDS, and MS (Grinspoon and Bakalar 1993;
Vinciguerra, Moore and Brennan 1988; Hepler and Frank 1971;
Clifford 1983; Consroe, Wood, and Buchsbaum 1975). But to
give full effect to this would require the rescheduling of
cannabis under the federal Controlled Substances Act, 21
U.S.C. ° 812(b). As a Schedule II drug it would no
longer be prohibited in absolute terms. Like a host of
substances including morphine, the barbiturates, and so on,
it would finally be capable of medical prescription in
appropriate cases.
This step has provoked astonishing resistance and
hostility. Although such a proposal does not envisage
decriminalization of personal or recreational use, let alone
legalization, the issue serves as a proxy war for the drug
reform debate as a whole. The fear of floodgates and
dangerous precedents undergirds the debate. It may be,
therefore, that it will be impossible to understand this
small skirmish except by reference to the cold war on drugs
and its political imperatives. In 1992, the head of the
United States Public Health Service, James Masin, declared
that we ought not prescribe marijuana to AIDS patients
because, "crazed" by the high, they "would be more likely to
practise unsafe sex" (The Economist 1992). If this is what
counts as reasoned argument from an alleged expert, then it
may be futile to take the opposition to the medical use of
marijuana as anything other than a strategic opposition to
the forces of drug law reform in general.
Questions of politics have been well documented in this
area. We are familiar with the ways in which a continuing
atmosphere of drug crisis serves the political aspirations of
politicians and protects the budgets and power of
institutions (Himmelstein 1978; Dickson 1968; Musto 1973;
King 1978). We are also familiar with analyses that focus on
the ways in which drug laws come to symbolize a broad range
of social fears and insecurities (Helmer 1975; Gusfield 1963;
Becker 1963; Manderson 1995). These critiques, as important
as they are, can give the impression that "drug politics" is
corrupting rational public policy. On this reasoning, drug
policy will change if only people begin to look at 'the
facts' objectively. But we all understand our facts and
develop our politics from a particular, and often deeply
held, philosophical position. Knowledge of the 'real facts'
will not change people's minds. At the heart of the debate
over drug policy lies a philosophical disagreement which must
also be confronted.
The debate over the medical use of marijuana reflects a
conflict between private and public, individual and society.
According to this argument, the free choice of individual
drug users is to be overridden because of the unacceptable
social costs of use. This is an argument to which I return in
the last section of this essay. But there is a remarkable
paradox here. Those who come out in support of public virtue
here are typically the same people who elsewhere support the
hegemony of the private sphere. They are, in most other
respects, philosophical 'liberals' in the grand tradition of
John Locke, Adam Smith, and John Stuart Mill. In most Western
countries, including the United States and Australia, this
liberalism entails an established commitment to the free
market and individual autonomy. Why, then, does this
ideological orthodoxy not extend to questions like the use of
drugs? Why in particular does a belief in the free market in
medicines and the individual's right to the relief of pain -
or the "pursuit of happiness" - not extend to the use of
cannabis?
Individualism is an important philosophical commitment of
modem liberalism. But there is another philosophical
framework which operates here - that of formalism. In the
following section, the concept of formalism is explained and
explored as a fundamental tenet of "liberal" law and
"liberal" medicine alike.
FORMALISM OR NARRATIVE
Formalism is the philosophy which expresses the orthodox
understanding of law. Hans Kelsen's Pure Theory of Law is
perhaps the manifesto of this doctrine. He aims to make of
the craft of law a "legal science," "objectivist and
universalistic." "The law is an order," he writes, "and
therefore all legal problems must be set and solved as order
problems" (Kelsen 1934, in Goodrich 1983:248). The key
element of legal formalism is a judicial system committed to
results whose objectivity is conclusively determined by a
process uncontaminated by external forces. This is what the
'rule of law' means. It is an ideal which makes sense the
moment one understands law as a logical system whose
operations are designed to produce not true judgments but
valid ones (Hart 1961). From axiom to conclusion, formalism
shows no particular interest in the truth or otherwise of any
legal system's basic principles, and every interest in
ensuring the logical validity of its conclusions. As Pierre
Bourdieu explains (1990:83)
[F]ormalization, understood both in the sense of logic
or mathematics as well as in the juridical sense, is what
enables you to go from a logic which is immersed in the
particular case to a logic independent of the individual
case.
The 'purity' of the process is guaranteed by the invariant
structure which produces each and every result and by the
specialists who administer it. Provenance and expertise,
therefore, are the twin essences of formalism.
In the late 19th century, Max Weber described the
development of a formal legal order according to which
(Goodrich 1983:248)
"abstract" legal propositions are organized
systematically ... ; judges are to apply the code using
specific modes of professional logic; not only is all human
action "ordered by law," but what law allows no other
social force can deny.
For law this means: specific criteria for legal enactment;
procedural safeguards; and a specialist judiciary and legal
profession to interpret the law. Let us imagine that law is a
sausage factory, transforming conflict into justice by the
operation of some great mill. According to the broad
understanding which I am terming formalism, the quality of
its sweetmeats is not assured by inspecting the sausages it
produces, but rather by the regular machine that grinds the
meat, and the white-coated technicians who keep it oiled.
This idea of law is far more relevant to the judiciary
than the legislature. Policy-making has never claimed to be
removed from substantive values. But there too, we place
increasing emphasis on democracy as a process, in parliament
and at elections, without inquiring as to the quality of our
participation in it. Likewise, the 'free press' is judged
according to whether there are formal constraints on speech
without regard to what is actually said and by whom. Weber's
insight was to perceive elements of this trend towards a
process-oriented understanding of truth, throughout the
social world. He characterized ours as a society advancing in
every sphere towards a system of "formal rationality" in
which provenance and expertise would be the sole criteria by
which to judge the truth or justice of a result (Weber 1954).
This has been true in medicine no less than in law. The
professionalization of health care has been a striking and
relentless development this century (Friedson 1970;
Carr-Saunders 1928; Boreham 1986; Willis 1983; Starr 1982).
This trend towards the science of medicine has been
accompanied by an emphasis on medical research as a product
of experimental laboratories. Increasingly, unless medical
results are obtained in this way, they do not constitute
proof of "good science." It is the process by which medical
science advances - the provenance of its techniques, and the
professional expertise of its practitioners - that guarantees
the objectivity and validity of its results.
Nevertheless, there are alternatives to this formalism.
Experiment can be distinguished from discovery: experiments
are designed to achieve a result, while discoveries emerge
from experience. Indeed, until the very recent past, this was
the nature, at least in the first instance, of most medical
knowledge. One observed the result of taking, say, arrowroot
or willowbark, opium or cod-liver oil, and from the rough
conjunction of these experiences, began to detect a pattern.
The essence of this model of medical discovery is a respect
for the narratives of people's lives. Medical learning
derives directly from the stories of how the sick and the
healthy felt and what they did about it.
In law too, formalism can be contrasted with narrative. A
formal process, as Kelsen put it, subjects "individual
phenomena" to an overriding "systemic context." A narrative
approach is instead interested in clients' own ways of
describing their problems, in their own words. Without
finding a space in law to hear and accommodate individuals'
own experiences of their lives, we may end up exchanging
substantive justice for an empty form. The idea of narrative
in law, like that in medicine, values experience over
abstraction, and results over process.
Philosophical liberalism reveals a strong commitment to
formalism. It is scepticism about the idea of objective truth
which drives it in this direction. Unsure as to what an
objective or truly rational result might be, this philosophy
puts its faith instead in the procedure to answer the
question for them (Mill 1857; Habermas 1971; Weinrib 1993).
In short, liberal philosophy gives up on defining substantive
justice and hopes to provide it as a by-product of the
process of law; it gives up on defining substantive health
and hopes to provide it as a by-product of the process of
medicine.
Paradoxically, this move subjugates individualism to a
system (Habermas 1996). There is a tension here within the
philosophy of liberalism which the debate on the medical use
of marijuana highlights well. The next section illustrates
how the contrasting frameworks of formalism and narrative
underlie the conflicting medical and legal approaches in this
area. To demonstrate these differences, I analyze two
important and contradictory decisions that form the
background to the current debate on the medical use of
marijuana. On the one hand, the 1988 Opinion by Judge Francis
Young, Chief Administrative Law Judge of the Drug Enforcement
Administration (DEA), categorically recommended that
marijuana be transferred to Schedule II (In the matter of
Marijuana Rescheduling Petition 1988: 67); on the other hand,
the 1992 Final Order by the Administrator of the DEA,
determined that "marijuana does not have a currently accepted
medical use in treatment in the United States" and
consequently refused to remove it from Schedule I (Marijuana
Rescheduling Petition 1992; Alliance for Cannabis
Therapeutics v. DEA, et al. 1 1994).
TWO FRAMEWORKS OF LIBERALISM
A FORMAL ORDER
Neither the Final Order of 1992 by Administrator Bonner,
nor the Final Order by the Deputy Administrator the following
year (In the matter of Petition of Carl Eric Olsen 1993)
betray even the slightest acknowledgment of Judge Young's
earlier ruling, although the hearing he conducted had been
specifically requested by the DEA as part of a tortuously
protracted series of proceedings lasting twenty years in the
effort by the National Association for the Reform of
Marijuana Laws (NORML) to remove marijuana to Schedule
II.
Legal formalism is a framework of exclusion. It aims to
treat legal rules as "an internally coherent whole ... a
single justification that coherently pervades the entire
relationship" (Weinrib 1993). The "gapless," ordered law is
fundamental to the formalist ideal (Goodrich 1983). Internal
consistency, then, is the prime value of legal formalism. The
DEA's Final Orders reflect this in their very silences: that
which is incommensurable must be ignored, for the law as a
structure cannot concede its incompleteness or imperfection.
So the Administrator of the DEA acknowledges the existence of
no dissent.
Along with the Order's tacit commitment to legal formalism
goes an explicit commitment to medical formalism. The
Administrator concluded that marijuana had no "currently
accepted medical use in treatment" (Controlled Substances
Act, 21 U.S.C. ° 812 (b)(2)(B)). He used the
following criteria (Marijuana Rescheduling Petition
1992):
a. the drug's chemistry must be known and reproducible;
b. there must be adequate safety studies;
c. there must be adequate and well-controlled studies
proving
efficacy;
d. the drug must be accepted by qualified experts; and
(and!)
e. the scientific evidence must be widely available.
These criteria clearly do not determine the "currently
accepted medical use" of a drug. Rather, they determine
whether that medical use is in fact able to be 'proved'
effective.
Provenance, as we have seen, is integral to the formalist
idea of proof. Dr Gabriel Nahas, a prominent foe of drug law
reform, contrasts "anecdotal claims" for the therapeutic
properties of marijuana smoking with "scientific scrutiny."
Here too, Nahas emphasizes the need to "verify" the evidence
of marijuana treatment by "clinical investigations," and
concludes that the results of those studies have been
inconclusive (Nahas and Pace 1994). In this framework, then,
as in that of the Administrator, 'proof' requires expertise
and clinical process, while the experiences of those who have
used the drug as an anti-nausea treatment while undergoing
chemotherapy, for example, are dismissed as "hearsay"
(ibid.). 'Hearsay' is the heresy against which the faith of
formalism sets itself: it condemns all truth-claims untested
by a formal procedure, such as a scientific experiment or the
legal oath.
The language of expertise is justified by the formalists'
understanding of a drug as a collection of dangerous
chemicals. Nahas' emphasis on this point is again typical
(ibid.):
Indeed, marijuana contains in addition to THC 60 other
cannabinoids which modify absorption, availability and
transformation of THC in the body, and which are also
biologically active. Besides cannabinoids, 360 other
compounds have been identified in the plant material...
In legal and medical formalism alike, the role of the
expert is to corral and protect an unwitting public from
phenomena which would, if left in the state of nature, run
wild. According to this Hobbesian world-view (1928; 1946) we
need laws because without regulation our natural morals drive
us to anarchy; we need medicine because without regulation
our natural chemicals would drive us to pathology.
The Final Order of the Administrator emphasizes both
expertise and provenance. According to the Administrator,
medical use is only "accepted" if it is constituted by
scientific processes of analysis (a) and experimentation (b
and c), and carried out by scientific experts (d and e). The
Administrator here confirms that medical science is
legitimate not because it is substantively true but because
it is formally valid. Like a law, medicine claims our
allegiance because of the authority that supports it, and the
process that brings it forth. Like a law, medicine tames our
wild experience.
A NARRATIVE OPINION
The 1988 Opinion rendered by Judge Young took a different
tack. He ascertained whether a drug is "used in medical
treatment" not by the use of expert studies and clinical
trials, but rather by investigating the experiences of
doctors and their patients (In the matter of marijuana
Rescheduling Petition 1988:3 1). Here he specifically
criticized the earlier work of the DEA:
By considering little else but scientific test results
and reports the Administrator was making a determination as
to whether or not, in his opinion, [it] ought to be
accepted for medical use in treatment... It is not for this
Agency to tell doctors whether they should or should not
accept a drug or substance for medical use. The statute
directs the Administrator merely to ascertain whether, in
fact, doctors have done so.
Young's reasoning focuses on the many doctors who in fact
accept marijuana as a useful treatment, rather than the
process or expertise behind that acceptance. The word
'acceptance' implies that medical treatment is grounded in a
social practice tested by long experience and empirical
observation. Judge Young quotes, for example, the mother of a
cancer-riddled child in San Diego (ibid.: 22):
When your kid is riding a tricycle while his other
hospital buddies are hooked up to IV needles, their heads
hung over vomiting buckets, you don't need a federal agency
to tell you marijuana is effective. The evidence is in
front of you, so stark it cannot be ignored.
The very evidence which a formalist approach dismisses as
mere "hearsay" is treated here, as the judge frequently
insists, as "uncontroverted" (ibid.:9). It could hardly be
otherwise: in a study of oncologists undertaken in 1992,
almost half had recommended marijuana to their patients
despite the risk of prosecution (The Economist 1992). The
disjunction between the decisions of Young and Bonner
therefore lies in what counts as medical proof.
The medical anti-formalism of the judge is at one with his
legal structure. For the evidence discussed by Young is, and
is presented as, a sequence of personal and subjective
narratives (In the matter of marijuana Rescheduling Petition
1988: 17-18):
The patient's doctor, when asked about it later, stated
that many of his younger patients were smoking marijuana.
Those who did so seemed to have less trouble with nausea
and vomiting .... The marijuana was completely successful
with this patient, who accepted it as effective in
controlling his nausea and vomiting... The patient resumed
eating regular meals and regained lost weight, his mood
improved markedly, he became more active and outgoing and
began doing things together with his wife that he had not
done since beginning chemotherapy.
Listen to this language: "seemed to have less trouble";
"accepted it as effective" - not provenance but history
governs what counts as evidence. He "resumed eating regular
meals"; he "regained lost weight"; he revived in outlook and
activity - not objective expertise but subjective experience
governs why the evidence matters. Medical evidence is
understood as the collection of personal experience; legal
evidence is a way of giving respect to the stories of other
people's lives.
Behind formalism we saw at work a fear of the state of
nature, and its subjection to the control of expert systems.
It is a liberalism with its roots in Hobbes. Behind
anti-formalism there is a faith in nature and a corresponding
fear of experts. Theirs is a liberalism which echoes
Jean-Jacques Rousseau. Here the individualism of liberalism
is most evident. The narrativists put their trust in the
natural, the personal and the subjective, and distrust the
institutional, the systemic, and the objective. As Robert
Randall says, "The question is: who is going to control
individual's biology - large corporations, doctors and
governments, or people themselves" (ibid.).
BEYOND DICHOTOMIES
FORMALISM AND NARRATIVE
The debate on the use of marijuana in the treatment of
illness is not just a political struggle or a dispute about
facts; it is also a conflict between two kinds of liberal
values, formalism and narrative. This explains the paradox by
which the rhetoric of individualism succumbs in this case to
the demand for social control. Nevertheless, the dichotomy
between formalism and narrative, between public and private,
individual and community, is a false one. Both aspects are
already present within the discourse of liberal philosophy.
It is the movement from an either/or absolutism in relation
to these paradigms that suggests, within the realm of
philosophy as well as of politics, how to couch the logic of
drug law reform.
Law and medicine, no matter how formalist the theory which
sustains them, are actually valued only because of the power
of certain narratives as to their origins and development
(Berman 1975; Cover 1983; Fitzpatrick 1992). Formalism is not
just a theory which derives from nowhere and for no good
purpose. It takes its place as part of a story of 'progress'
and 'civilization'. If legal process is thought to be more
valuable than what Weber calls "kadi justice" (Weber 1954),
in which each case is considered on its individual merits
without reference to abstract principles, that is only
because we understand formalism within a larger narrative
about the development of our society.
Formalism in both law and medicine claims the mantle of a
tradition stretching back to Aristotle and Hippocrates,
Justinian and Galen, Sir Edward Coke and Sir Isaac Newton:
rationalize, order, neutralize, objectify (Kuhn 1962;
Foucault 1973; Blomley 1994). Its legitimacy stems not just
from its logic, but because the legal and scientific method
it represents has grown as a process over two and a half
thousand years in response to on-going questions of how we
are to test and enforce propositions about the nature of the
physical world on the one hand, and the social world on the
other. Formalism, if nothing else, is about proof -
scientific truth and legal truth, what counts as reality and
what counts as justice - but the justification of its truth
is actually a reading of history: the history of struggle and
contention through which our society has endeavoured to come
to terms with how best to understand and structure our social
interactions.
Formalism is embedded in a narrative, which actually
provides it with its values. This is a fundamental point to
make. In consequence, empirical and experiential claims about
pain and treatment made by those who support the medical use
of marijuana, ought to be addressed in their own terms.
PUBLIC AND PRIVATE
At the very heart of this narrative about social
development, at the very heart of orthodox Western values,
lies not one but two related philosophical traditions. The
analysis I have undertaken of the workings of liberal theory,
therefore, brings us back finally to consider how to balance
these two traditions. On the one hand, the liberalism of
Locke and Mill, with its commitment to individual freedom
established through autonomous private action; on the other
hand, a theory of 'republicanism,' which, going back to
Aristotle and most recently articulated by Hannah Arendt and
Michael Sandel, is committed to the idea of citizenship in
which members of a democracy actively participate in a
distinct "public sphere" (Sandel 1996; Arendt 1958; Kymlicka
1991; Aristotle 1967). Liberalism says we ought to be free to
make individual decisions about how we want to give meaning
and pleasure to our lives. Republicanism says we are entitled
to decide, as a society, what kinds of personal behaviour
ought to be encouraged or not. Our role as a citizen is to
participate in this debate as to values and to abide by its
outcome. This is what it is to be a member of "the
community." And it is clear that there is a strong belief
that drug use, no matter its purpose, destroys the public
sphere by creating users who, through hedonism or addiction,
are no longer able to be citizens in this strong sense.
The medical prescription of marijuana is not about
pleasure; it is about pain. Those who support medical use
emphasize not only its efficacy in reducing pain, but that
those who take it obtain no pleasure from it (Marijuana
Rescheduling Petition 1988:47):
At college in Florida, Rosenfeld was introduced to
marijuana by classmates. He experimented with it
recreationally. He never experienced a "high" or "buzz" or
"floating sensation" from it. ... It had been very
difficult for him to sit for more than five or ten minutes
at a time because of tumors in the backs of his legs. ...He
experimented further and found that his pain was reduced
whenever he smoked marijuana.
Notice the construction of parallel experiments, the
recreational one which fails and the medical one which
succeeds. Proposition 215 defends the use of marijuana as a
response to pain and not as a desire for pleasure.
For those who oppose medical use, however, public values
trump private use, and the distinction between pain and
pleasure is ultimately irrelevant. The danger of marijuana
use - of any kind - is typically seen to be the way in which
it undermines the public sphere, encouraging hedonism and
alienation, or creating a so-called "amotivational syndrome"
(Himmelstein 1983). There is, indeed, a similar symbolism in
play in all social attitudes to drug use. The fear of
addiction is that the user will withdraw from the public
realm into a world of private self-absorption (Peele 1989;
1985). Utopia or dystopia, hell or paradise, no matter.
Marijuana encourages an atomised community: liberalism
without republicanism to balance it. Whether their drug use
stems from pain or pleasure is, it turns out, of no account;
both must be sacrificed to a greater social good.
Neither can this dichotomy between 'public' and 'private'
- between, perhaps, republican citizenship and liberal
autonomy - be long sustained. 'Public' welfare and 'private'
autonomy are symbiotic. The philosopher Jurgen Habermas
writes about the role of public discourse in securing private
freedom, since our personal identity is formed not in
abstract isolation but out of the community in which we live
(Habermas 1996:784). But the opposite is equally true. The
efficacy of public life depends on the ability of private
individuals to act with freedom and autonomy in their own
lives. The public sphere constructs private identity and vice
versa. The desire to make of our society not just an
agglomeration but a community is admirable and familiar. But
without respecting individual autonomy, such a community will
be fictitious.
The specific context of the medical use of marijuana
directly shows us how private freedom is necessary for the
public sphere. The experience of pain and suffering denies in
a very physical sense any personal autonomy, while
simultaneously precluding the possibility of public
participation. Citizenship asks us to look outside of
ourselves and ahead to the future. Be in pain, feel weak,
throw up every time you eat: such abstractions cease to
matter. Chronic or acute pain is an intensely isolating
experience (Scarry 1985). Between the sick and the well lies
a gauze screen. To have no relief from pain is to feel
yourself removed, step by step, from the world of others
whose concerns and interests, even whose conversation, seems
to recede. Your life becomes a constant cycle of anticipation
and recovery. Wait for the next jolt of pain, the next wave
of nausea to come upon you. Recoil, pause, wait. Illness is a
completely individual battle. The hospital ward knows no
wider public than itself: it is a sphere bounded by physical
existence, debilitated by physical exertion.
Pain is the point at which the two traditions unite.
Freedom from pain is both essential to individual autonomy
and the very precondition for public participation. It is
only by the relief of pain that the sick can be released into
the public realm again. Bill Shanteau, living with the final
stages of colon cancer, articulates the social as well as the
personal importance of effective pain management (San Jose
Mercury News 1995):
The point is marijuana is a major agent in keeping me
interested in life. Besides restoring my appetite, it's
like a hot tub for the brain.... It keeps me focused in the
moment instead of sitting here thinking I'm dying
tomorrow.
Prohibiting the medical use of marijuana militates against
precisely the 'republican' values which would, in any
philosophical sense, underlie such a policy.
Beyond the dichotomy between formalism and narrative, one
can at last hear the stories of those who suffer and those
who have been helped. Beyond the dichotomy between public and
private, the control of pain becomes not just a private
benefit, but a public advantage. "Amotivational syndrome"
articulates a genuine fear as to the development of a
dysfunctional community. But pain is the greatest
amotivational syndrome of all.
ACKNOWLEDGEMENTS
This paper was first presented to the 8th International
Conference on the Reduction of Drug-Related Harm. My thanks
to the Lindesmith Center, New York, and the Macquarie
University Research Grants Scheme, which financed my
attendance; and to all my friends and colleagues who attended
the conference and provided invaluable criticism and
commentary. My thanks also to an unnamed airline which kindly
delayed my flight for just long enough to enable me to
prepare this paper en route; and to Scott Veitch and Colin
Perrin, who read and commented on the paper at a later stage,
thus ensuring that my flights were not those of fancy.
NOTES
¹Proposition 215 added section 11362.5 to the
State of California Health and Safety Code, "(A) To ensure
that seriously ill Californians have the right to obtain and
use marijuana for medical purposes where that medical use is
deemed appropriate and has been recommended by a physician
who has determined that the person's health would benefit
from the use of marijuana in the treatment of cancer,
anorexia, AIDS, chronic pain, spasticity, glaucoma,
arthritis, migraine, or any other illness for which marijuana
provides relief. (B) To ensure that patients and their
primary caregivers who obtain and use marijuana for medical
purposes upon the recommendation of a physician are not
subject to criminal prosecution or sanction."
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