"This is the pre-peer reviewed version of the following article: AUTONOMY, ADDICTION AND THE DRIVE TO PLEASURE:DESIGNING DRUGS AND OUR BIOLOGY: A REPLY TO NEIL LEVY in Bioethics ISSN 0269-9702 (print); 1467-8519 (online) Volume 20 Number 1 2006 pp 21–23, which has been published in final form at http://onlinelibrary.wiley.com/doi/10.1111/j.1467- 8519.2006.00472.x/abstract This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving." AUTONOMY, ADDICTION AND THE DRIVE TO PLEASURE: DESIGNING DRUGS AND OUR BIOLOGY: A REPLY TO NEIL LEVY BENNETT FODDY AND JULIAN SAVULESCU We argued that the desire for heroin or other drugs of addiction is a normal appetitive desire, albeit a strong one. 1 We argued that heroin addicts are: (1) competent, acting freely and that their desires are not compulsive; (2) sufficiently autonomous to consent to take part in heroin trials. We employed a thin concept of autonomy: a competent person, in possession of the relevant facts making a free decision about what to do with his or her life. Levy claims that addicts have impaired autonomy. This is no doubt true on a richer conception of autonomy. We did not claim that all addicts have unimpaired autonomy. We all have impaired autonomy, to some degree, on such a conception of autonomy. Levy seems to be operating a hierarchical account of autonomy after Harry Frankfurt. Frankfurt argued that we have first order desires, such as the desire to take heroin. But as persons, we have second order desires – desires about our first order desires – which should be our will. The addict is unfree because he desires not to desire to take heroin, but the desire to take heroin is so strong that it determines his actions 2 . Although the desire to take heroin may be the addiĐts stroŶgest desire, he also desires to not desire to take heroin. One of us has argued for a related rational desire account of autonomy 3 . What distinguishes us as persons is not having second order desires, but our rationality and capacity to act on the basis of normative reasons. We are autonomous when we act according to relevant normative considerations. On the thick conception of autonomy Levy uses, there will be two kinds of addict: the willing and the unwilling. The unwilling addict is the addict who believes he has most reason to not take heroin, but finds himself acting on the strong desire to take it nonetheless. The willing addict believes he has most reason to take heroin and acts on it. Levy seems to saddle us with the claim that all addicts are willing. That is not true. 1 Bennett Foddy & Julian Savulescu. Addiction and Autonomy: Can Addicted People Consent to the Prescription of Their Drug of Addiction? Bioethics 2006; 20(1): 1–15. 2 H. Frankfurt. Freedom of the Will and the Concept of a Person. J Philos 1971; 68(1): 5–20. 3 J. Savulescu. Desire-based and Value-based Normative Reasons. Bioethics 1999; 13(5): 405–413.