Autonomy, power, and place: Ethical considerations at the intersections of substance use care, and the sex trade

Substance use disorder (SUD) care among women in the sex trade poses multiple ethical challenges. We propose a framework with three lenses-autonomy, power, and place-that can inform and help improve more ethical clinical care for people who trade sex seeking SUD treatment. A relational perspective on autonomy, an analysis of power relations in the clinic, and a geographical analysis can inform how we create space for people with experience in the sex trade in substance use treatment facilities and beyond. We conclude with some practical applications of this framework, all while integrating a composite clinical vignette throughout our analysis. This analysis addresses a clinical and ethical gap in ways to provide better care for women in the sex trade, an understudied and chronically marginalized population deserving of care that meets them where they are.

Automated summary

The care for women in the sex trade with substance use disorder (SUD) poses ethical challenges. The proposed framework, focusing on autonomy, power, and place, aims to improve ethical clinical care for these individuals seeking SUD treatment. By considering relational autonomy, power relations in clinical settings, and geographical analysis, this framework provides guidance on creating space for those with sex trade experience in substance use treatment facilities. The practical applications of this framework address the clinical and ethical gap in providing better care for marginalized women in the sex trade.