Drunkenness and Personal Responsibility

This evening my wife posed an excellent puzzle regarding American society's treatment of drunkenness and personal responsibility. In her capacity as an ER physician she regularly treats people who are absolutely tanked. Common medical practice, backed up by legal precedent, is to treat legally intoxicated individuals as incapable of making decisions regarding their medical care. And yet, she pointed out, we apply a different standard to drunk drivers, holding them personally responsible for their actions while under the influence. On casual observation she would seem to have a point, but I want to follow this idea out in detail to make sure there's not a subtle difference. First, is this really a conflict, or is it just confusion brought on by imprecise language? In the case of the medical patient the standard seems pretty clear: drunk people will have their care dictated by a physician; their personal wishes as to their treatment carry little or no weight. Contrast this with a sober person who has, at least in theory, the right to refuse treatment etc. The reason seemingly implicated by this state of affairs is that intoxication renders you incapable of making decisions, necessitating a health-care proxy in the form of a medical professional. Now, how about a drunk driver? My first thought when I was trying to sort this out was that they weren't actually being punished for drinking and driving per se, but for some decision made while still sober. But that's line of reasoning appears to be a blind alley. Drunkenness, by itself, is generally not a crime. Crimes associated with drunkenness usually have a second component i.e. drunk and disorderly, or being intoxicated in public. Drunk driving would appear to follow this pattern; its not a crime to be drunk... the crime is only committed when you actually operate a motor vehicle. Here's where it gets interesting: On what grounds can we hold the driver culpable for the ensuing carnage? There's two prongs to the definition of "culpability" here, a legal one and a moral one. Legally (IANAL, so my apologies if I mess this analysis up), intent is important. Did the person intend to commit the crime? If intoxication makes it impossible for a person to make decisions then can they be said to be capable of forming intent? Morally, a person must know that what they are doing is wrong and have the ability to choose another course of action. Drunkenness would seem to interfere with both halves of the moral predicate. It impairs judgment so, arguably, the person may not realize that what they are doing is wrong. Also, because drunkenness removes the ability to make decisions, its not clear that the person is capable of choosing another course of action. So, on fairly close examination, it would appear that the two standards are in conflict. However, I can come up with two counterarguments to the above:

1. The medical standard is a legal fiction applicable only to the practice of medicine. It has a different problem domain, so the conflict is illusory.
2. In the case of drunken driving the person is being held responsible for the drinking itself under the theory that drunken driving is a foreseeable consequence of said drinking. The individual is thus being punished for a decision made while sober, in which case the conflict is illusory.

In order to disprove the above two contentions it is sufficient to show that:

1. The idea of the limited capacity of a drunken individual is not limited solely to medical practice.
2. The "foreseeable consequence" standard is arbitrary/arbitrarily applied.

This is what makes this topic so interesting, because there's a very salient, very "real world" counter example which demonstrates both points. Exhibit A: A 30-something bar-hopper who gets drunk and subsequently gets raped. We, as a modern society, do not:

1. Accept the rapist's assertion that the sex was consensual. It seems to be long-settled dogma that an intoxicated individual cannot consent to sex.
2. Chastise the victim for not "knowing better", even though such an encounter is a foreseeable consequence of getting drunk.

Point 1 demonstrates that the concept of the limited capacity of an intoxicated individual is not limited simply to medical practice. Point 2 demonstrates that the "foreseeable consequence" standard is arbitrarily applied. So there you have it, there definitely seems to be a conflict. It would seem that we either have to rethink our approach to drunken driving, or we have to change our treatment of rape victims. Neither seems to be particularity desirable, but I don't see any way around the issue that is logically consistent. If anyone has any ideas I'd love to hear them.