Emerging data indicates the prevalence and increased use of pharmaceutical enhancements by young medical professionals. As pharmaceutical enhancements advance and become more readily available, it is imperative to consider their impact on medical professionals. If pharmaceutical enhancements augment a person’s neurological capacities to higher functioning levels, and in some situations having higher functioning levels of focus and concentration could improve patient care, then might medical professionals have a responsibility to enhance? In this paper, I suggest medical professionals may have a (...) responsibility to use pharmaceutical enhancements. In some situations, having higher functioning levels of focus and concentration is conducive to providing the best possible care to a patient. In these circumstances medical professionals should use pharmaceutical cognitive enhancements. I conclude by examining the limitations and implications of this responsibility in the practice of medicine and areas for future research. (shrink)

Peterson, Karlawish, and Largent’s “Supported Decision Making with People at the Margins of Autonomy” not only elucidates the conceptual framework but also the practical importance of suppor...

Discussions about the permissibility of students using enhancements in education are often framed by the question, “Is a student who uses cognitive-enhancing drugs cheating?” While the question of cheating is interesting, it is but only one question concerning the permissibility of enhancement in education. Another interesting question is, “What kinds of students do we want in our academic institutions?” I suggest that one plausible answer to this question concerns the ideals of human excellence or virtues. The students we want in (...) our academic institutions are virtuous or, at least minimally, possess certain virtues. I argue that a virtuous student may choose to use cognitive-enhancing drugs for reasons of self-improvement. That a virtuous student may choose to use cognitive-enhancing drugs for reasons of self-improvement illustrates that under certain conditions motivation can determine the permissibility of using enhancements. Building upon this I suggest a virtues-based institutional rule for governing and guiding student-use of cognitive enhancers in an academic institution to be for the right reasons. This ideals of human excellence or virtues approach offers interesting and unique insights for issues of enhancement in education, as it might turn out, that uneasiness many people have about students using cognitive-enhancing drugs has less to do with issues of enhancement and more to do with the motivations and character of students. (shrink)

Conducting “difficult conversations” with patients and caregivers is one of the most difficult aspects of the medical profession. These conversations can involve communicating a terminal prognosis, advance care planning, or changing the goals of treatment. Although they are challenging, the need for these conversations is underwritten by the tenets of medical ethics. Unfortunately, medical professionals lack adequate training in communication skills and overestimate their abilities in conducting difficult conversations. I suggest that one way to improve that ability would be the (...) strategic use of pharmaceutical neuroenhancements. Pharmaceutically augmenting a professional’s capacity for recognizing masked emotional expressions might conduce to his or her development of open and responsive communication with patients and caregivers. I conclude by examining the limitations and objections to this use of a communication enhancement by illustrating that it would still require the development of, and indeed a greater emphasis on, communication skills in medical education and training. (shrink)

Bryan Frances’s recent argument is for the epistemic position called Live Skepticism. The Live Skepticism Argument (LSA) attempts to establish a restricted set of skeptical conclusions. The LSA’s “skeptical hypotheses” are scientific and philosophical positions that are “live actual possibilities” in an intellectual community. In order to “rule out” live hypotheses, an expert must know them to be false. However, since these are live hypotheses in this expert’s intellectual community—endorsed by others who have parallel levels of knowledge, intelligence, and understanding—this (...) expert is unable to rule them out. Consistent with the LSA is the outcome that people not exposed to these live hypotheses can know what these experts cannot. However, in this paper, I defeat the LSA by developing and defending a counterexample that focuses on the phenomenon of genius testimony. Everyone, including the LSA’s proponent, can and should allow that expertise comes in degrees. While in many cases a person’s intelligence, understanding, and knowledge are parallel to others in the field, there are some who are extraordinary in their intelligence, understanding, and knowledge (geniuses). If an expert meets with a genius, it is possible that the genius provides this individual with beliefs that can rule out a skeptical hypothesis. Therefore, an expert can have knowledge, even if the skeptical hypothesis is live and endorsed by others who have parallel levels of knowledge, intelligence, and understanding. After providing this counterexample, I present three potential objections, and show how people can know global warming exists and that smoking does not give someone cancer. I conclude by defending this counterexample from a likely reply by proponents of the LSA involving luck and knowledge. (shrink)

In end-of-life care discussions, I contend that the distinction between “having a life” vs. “being alive” is an underutilized distinction. This distinction is significant in separating different states of existence conflated by patients, families, and clinicians. In the clinical setting, applying this distinction in end-of-life care discussions aids patients’ and family members’ decision-making by helping them understand that being alive can differ from having a life. Moreover, this distinction helps them decide which state may be the most important to them. (...) After applying this distinction to three complex cases, I respond to the likely objection that “having a life” vs. “being alive” is less accurate and more controversial than other distinctions. I conclude by arguing that “having a life” vs. “being alive” is more accurate and less controversial than distinctions between medically indicated vs. medically inappropriate treatments, personhood, and quantity vs. quality of life. (shrink)