Formalism and Narrative in Law and Medicine: The Debate over Medical Marijuana Use

ABSTRACT

The 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.

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."

REFERENCES

Alliance for Cannabis Therapeutics v. DEA, et al., 15 F.3d. 1131 (D.C. Cir. 1994).

Arendt, H.
1958 The Human Condition. Chicago: University of Chicago Press.

Aristotle
1967 The Politics. Harmondsworth: Penguin.

Becker, H.
1963 Outsiders: Studies in the Sociology of Deviance. New York: Free Press.

Blomley, N. K.
1994 Law, Space, and the Geographies of Power New York: The Guilford Press.

Bonnie, R. and C. Whitebread.
1970 The Forbidden Fruit and the Tree of Knowledge. Virginia Law Review 56:971.

Boreham, P. (ed.)
1986 The Professions in Australia. St. Lucia: University of Queensland Press.

Bourdieu, P.
1990 In Other Words: Essays Towards a Reflexive Sociology. Cambridge: Polity.

Carr-Saunders, A. M.
1928 Professions. Oxford: Clarendon Press.

Clifford
1983 THC for Tremor in Multiple Sclerosis. Ann. Neurology 18: 669.

Consroe, Wood, and Buchsbaum
1975 Anticonvulsant Nature of Marijuana Smoking. JAMA 234: 306. Controlled Substances Act (U.S.) 21 U.S.C. ' 812(b)

Dickson, D.
1968 Bureaucracy and Morality: An Organization Perspective on a Moral Crusade. Social Problems 16:143.

Fitzpatrick, P.
1992 The Mythology of Modern Law. London: Routledge.

Foucault, M.
1973 The Order of Things. New York: Vintage Books.

Friedson, E.
1970 Professional Dominance. New York: Aldine.

Goodrich, P.
1983 The Rise of Legal Formalism Or the Defences of Legal Faith. Legal Studies 3:248.

Grinspoon, L. and Bakalar.
1993 Marihuana: The Forbidden Medicine. New Haven: Yale University Press.

Gusfield, J.
1963 Symbolic Crusade. Urbana: University of Illinous Press.

Habermas, J.
1971 Toward a Rational Society. London: Heinemann.

Habermas, J.
1996 Paradigms of Law. Cardozo Law Review 17:771-84.

Hart, H. L. A.
1961 The Concept of Law. Oxford: Clarendon Press.

Helmer, J.
1975 Drugs and Minority Oppression. New York: Seabury Press.

Hepler and Frank
1971 Marijuana Smoking and Intraocular Pressure. JAMA 217:1392.

Himmelstein, J.
1978 Drug Politics Theory. Journal of Drug Issues 8:3 7.

Himmelstein, J.
1983 From Killer Weed to Drop-out Drug. Contemporary Crises 13-38.

Hobbes, T.
1928 The elements of the law, natural and politic. Cambridge: Cambridge University Press.

Hobbes, T
1946(165 1) Leviathan. Oxford: Blackwells.

Inglis, B.
1975 The Forbidden Game: A Social History of Drugs London: Routledge.

In the matter of Marijuana Rescheduling Petition
1988 Docket No. 86-22, http:www.calyx.com/olsen/MEDICAL/YOUNG/young.html. In the matter of Petition of Carl Eric Olsen, on remand from the U.S. Court of Appeals (D.C. Cir. 93-1109).

Kelsen, H.
1934-5 The Pure Theory of Law. Law Quarterly Review 50,51.

King, R.
1978 The drug problem and the idioms of war. Journal of Drug Issues 8: 221-31.

Kuhn, T.
1962 The Structure of Scientific Revolutions. Chicago: Chicago University Press.

Kymlicka, W.
1991 Liberalism Community and Culture. Oxford: Clarendon Press.

Manderson, D.
1995 Metamorphoses: Clashing Symbols in the Social Construction of Drugs. Journal of Drug Issues 25: 799-816.

Marijuana Rescheduling Petition, 57 Fed. Reg. 10499 (1992).

Mill, J. S.
1857 On Liberty.

Musto, D.
1973 The American Disease. New Haven: Yale University Press.

Nahas, G. and N. Pace
1994 Marijuana Smoking as Medicine: A Cruel Hoax. www.drctalk@drcnet.org.

New South Wales Parliamentary Debates

1976 25, 26, 27 (1976-1978) Eliz. 11 Ser. 3 Vol. 133, 7779-80.

Peele, S.
1985 The Meaning of Addiction. Lexington, Mass.: Lexington Books.

Peele, S.
1989 Diseasing of America: Addiction Treatment Out of Control. Boston: Houghton Mifflin Co. San Jose Mercury News, May 14 1995.

Sandel, M.
1997 Democracy's Discontent: America in Search of a Public Philosophy. Cambridge, Mass.: Belknap Press.

Scarry, E.
1985 The Body in Pain: The Making and Unmaking of the World. New York: Oxford University Press.

Starr, P.
1982 The Social Transformation of American Medicine. New York: Basic Books. The Economist, March 28-April 4 1992.

Vinciguerra, Moore and Brennan
1988 Inhalation Marijuana as an Anti-emetic for Cancer Chemotherapy. New York State Journal of Medicine 88:525.

Weber, M.
1954 Law in Economy and Society, trans. M. Rheinstein. Cambridge, MA: Harvard University Press.

Willis, E.
1983 Medical Dominance. Sydney: Allen and Unwin.