Let's be honest, both of those are fairly spurious analogies. The addict in this case is being asked to give up something quite ephemeral - the ability to have kids in the future, something which they may not ever do anyway - not something concrete like an organ or a member of their family.
The point I come back to is this is a very contrary thing for people of liberal bent to assimilate. The addict is making a conscious choice about their future. This to the libertarian mind is A Very Good Thing. However the consequences of this act are essentially aesetic - it is an act of denial. This, to a libertarian mind is A Very Bad Thing. So you end up with a huge level of cognitive dissonance and the only way the libertarian mind can rationalise it is to conclude that the addict isn't really making the choice
properly. They're making
the wrong choice, so they must be doing so for the wrong reasons or in the wrong way... But a true libertarian would say they have an equal right to make the wrong choices, because nobody has the right to tell people whether their choices are good or bad, as long nobody else gets hurt. And thus you get the kind of reaction here, were people talk about 'mutilation' and accuse them of not being of sound mind.
As a psychologist, it's fascinating. It's a classic example of cognitive dissonance in action.
The first fact is this - nobody has the right to tell any other adult what they can or can not do with their bodies, provided no other person is immediately harmed. That is the basis of many laws, from abortion through to assisted suicide, from getting a tattoo to what clothes you can wear. The law recognises being under the influence of drugs as being enough to cause a person to lose the right to freedom of choice but not the state of addiction per se. As long as the addict is rational in the eyes of law when they sign the papers agreeing to the deal, nobody else has any right to judge it. This is the essence of personal choice under the law.
The second fact is this - the addicts could do what the charity is paying them to do without being paid, and nobody would
or indeed could object. In fact, many people would find it laudible, a sign that the addict had recognised the depth of their condition and was at least taking some steps - however drastic -to limit the harm that might do. But because some bunch of yank inspired neocon nutjobs actually want to reward them in cash for doing it, suddenly it's the next worst thing to The Final Solution.
There is nothing so funny as libertarians faced with something that makes them want to act in a very conservative way. Especially when what's doing it is a bunch of conservatives doing something which is essentially libertarian.
They can do this if they want to. Nobody has the right to stop them. This is not facism, it's the very opposite of it.
Jon