The use of psychopharmaceuticals to enhance human mental functioning such as cognition and mood has raised a debate on questions regarding identity and authenticity. While some hold that psychopharmaceutical substances can help users to ‘become who they really are’ and thus strengthen their identity and authenticity, others believe that the substances will lead to inauthenticity, normalization, and socially-enforced adaptation of behaviour and personality. In light of this debate, we studied how persons who actually have experience with the use of psychopharmaceutical (...) medication would view their ‘self’ or their authentic personal identity in relation to the use of medication. We have interviewed a number of adults diagnosed with ADHD and discussed their experiences with medication use in relation to their conceptions of self and identity. In the first part of this paper we illustrate that the concepts of identity and authenticity play an important and sometimes problematic role in experiences of ADHD adults. This shows that the question about identity and psychopharmacology is not merely an ‘academic’ issue, but one that influences everyday lives of real people. In order to answer the question whether psychopharmaceuticals threaten personal identity and authenticity, more than empirical research is needed. We also need to analyse the concepts of personal identity, authenticity and self: what do we mean when we are using statements as ‘a way of living that is uniquely our own’, ‘our true self’, or ‘who we really are’? In the second part of this paper we discuss two important philosophical views on personal identity, authenticity and self: the self-control view as elaborated by Frankfurt, and the self-expression view as proposed by Schechtman. We compare these with the experiences of our respondents to see which view can help us to understand the diverse and often conflicting experiences that people have with medication for ADHD. This will contribute to a better understanding of whether and in which cases personal identity and authenticity are threatened by psychopharmacology. (shrink)

Stimulant drugs, transcranial magnetic stimulation, brain-computer interfaces, and even genetic modifications are all discussed as forms of potential cognitive enhancement. Cognitive enhancement can be conceived as a benefit-seeking strategy used by healthy individuals to enhance cognitive abilities such as learning, memory, attention, or vigilance. This phenomenon is hotly debated in the public, professional, and scientific literature. Many of the statements favoring cognitive enhancement (e.g., related to greater productivity and autonomy) or opposing it (e.g., related to health-risks and social expectations) rely (...) on claims about human welfare and human flourishing. But with real-world evidence from the social and psychological sciences often missing to support (or invalidate) these claims, the debate about cognitive enhancement is stalled. In this paper, we describe a set of crucial debated questions about psychological and social aspects of cognitive enhancement (e.g., intrinsic motivation, well-being) and explain why they are of fundamental importance to address in the cognitive enhancement debate and in future research. We propose studies targeting social and psychological outcomes associated with cognitive enhancers (e.g., stigmatization, burnout, mental well-being, work motivation). We also voice a call for scientific evidence, inclusive of but not limited to biological health outcomes, to thoroughly assess the impact of enhancement. This evidence is needed to engage in empirically informed policymaking, as well as to promote the mental and physical health of users and non-users of enhancement. (shrink)

This article seeks to situate pharmacological cognitive enhancement as part of a broader relationship between cultural understandings of the body-brain and the political economy. It is the body of the worker that forms the intersection of this relationship and through which it comes to be enacted and experienced. In this article, we investigate the imaginaries that both inform and are reproduced by representations of pharmacological cognitive enhancement, drawing on cultural sources such as newspaper articles and films, policy documents, and pharmaceutical (...) marketing material to illustrate our argument. Through analysis of these diverse cultural sources, we argue that the use of pharmaceuticals has come to be seen not only as a way to manage our brains, but through this as a means to manage our productive selves, and thereby to better manage the economy. We develop three analytical themes. First, we consider the cultural representations of the brain in connection with the idea of plasticity – captured most graphically in images of morphing – and the representation of enhancement as a desirable, inevitable, and almost painless process in which the mind-brain realizes its full potential and asserts its will over matter. Following this, we explore the social value accorded to productive employment and the contemporary ethos of working on or managing oneself, particularly in respect of improving one’s productive performance through cognitive enhancement. Developing this, we elaborate a third theme by looking at the moulding of the worker’s productive body-brain in relation to the demands of the economic system. (shrink)

The use of medical stimulants to sustain attention, augment memory and enhance intellectual capacity is increasing in society. The use of Methylphenidate for cognitive enhancement is a subject that has received much attention in the literature and academic circles in recent times globally. Medical doctors and medical students appear to be equally involved in the off-label use of Methylphenidate. This presents a potential harm to society and the individual as the long-term side effect profile of this medication is unknown.

A key aspect of transhumanist thought involves the modification or augmentation of human physical and mental capabilities—a form of intervention often encapsulated under the term "enhancement." This article provides an overview of the concept of enhancement, focusing on six major areas in which usages of the term become slippery and controversial: normal or species-typical functioning, therapeutics or healing, natural functioning, human nature, authenticity, and the ambiguity between "more" and "better." I argue that we need to be aware of the tendency (...) to embed the concept of enhancement within stark binary oppositions that seem perfectly reasonable at first glance, but that in fact yield little more than conceptual muddles if they are not handled carefully. (shrink)

Developments in neuroscience have raised the possibility that pharmaceuticals may be used to enhance memory, mood, and attention in people who do not have an illness or disorder, a practice known as “cognitive enhancement.” We describe historical experiences with two medicinal drugs for which similar enhancement claims were made, cocaine in the late 19th and early 20th centuries, and amphetamines in the mid 20th century. These drugs were initially introduced as medicinal agents in Europe and North America before becoming more (...) widely used for a variety of purposes, including what would nowadays be considered cognitive enhancement. Their trajectory of use conformed to the typical use cycle of psychotropic drugs. There was an initial steep rise in prescribing for medical use, followed by expanded nonmedical use that was fueled by enthusiasm for the drugs’ effects. As the number of regular users increased, problems related to use (such as addiction) became apparent, societal concern increased, and laws were passed banning nonmedical use and eventually, medical use. This historical experience draws attention to the adverse side effects of enhancement use that only become apparent with regular, wide-scale use of a drug. We highlight the similarities between the enthusiasms for cocaine and amphetamines and the current enthusiasms for using prescription stimulants for cognitive enhancement. We argue bioethicists should not encourage the cognitive enhancement use of drugs such as methylphenidate in the absence of evidence on the efficacy and safety of their use for cognitive enhancement purposes. (shrink)

There is currently little empirical information about attitudes towards cognitive enhancement - the use of pharmaceutical drugs to enhance normal brain functioning. It is claimed this behaviour most commonly occurs in students to aid studying. We undertook a qualitative assessment of attitudes towards cognitive enhancement by conducting 19 semi-structured interviews with Australian university students. Most students considered cognitive enhancement to be unacceptable, in part because they believed it to be unethical but there was a lack of consensus on whether it (...) was similar or different to steroid use in sport. There was support for awareness campaigns and monitoring of cognitive enhancement use of pharmaceutical drugs. An understanding of student attitudes towards cognitive enhancement is important in formulating future policy. (shrink)

Objectives To understand the ethical principles guiding college students’ abstention from pharmacological cognitive enhancement, and to determine the correlates associated with endorsing different principles. Design One-stage cluster sampling was used to implement a paper-based survey among undergraduate students attending one university in the U.S. Thematic analysis was used to explore the ethical principles guiding PCE abstention. Multivariate logistic regression analyses were used to examine sociodemographic correlates associated with endorsed ethical principles. Participants Of the 499 eligible students who completed the survey, (...) 259 students had a negative attitude towards PCE, did not engage in PCE, and provided reasons for abstention. Results The thematic analysis resulted in the identification of eight themes, with respondents often endorsing more than one theme per response. The three themes most endorsed were non-malfeasance, disapproval of drugs and dosage beneficence. The sociodemographic correlates associated with endorsing each theme varied across themes. Conclusions Students abstain from PCE for a multitude of reasons, many of which are guided by ethical principles. These findings may be incorporated into future prevention programming messages. (shrink)

ObjectivesTo understand the ethical principles guiding college students’ abstention from pharmacological cognitive enhancement, and to determine the correlates associated with endorsing different principles.DesignOne-stage cluster sampling was used to implement a paper-based survey among undergraduate students attending one university in the U.S. Thematic analysis was used to explore the ethical principles guiding PCE abstention. Multivariate logistic regression analyses were used to examine sociodemographic correlates associated with endorsed ethical principles.ParticipantsOf the 499 eligible students who completed the survey, 259 students had a negative (...) attitude towards PCE, did not engage in PCE, and provided reasons for abstention.ResultsThe thematic analysis resulted in the identification of eight themes, with respondents often endorsing more than one theme per response. The three themes most endorsed were non-malfeasance, disapproval of drugs and dosage beneficence. The sociodemographic correlates associated with endorsing each theme varied across themes.ConclusionsStudents abstain from PCE for a multitude of reasons, many of which are guided by ethical principles. These findings may be incorporated into future prevention programming messages. (shrink)

Various kinds of alcohol and drug testing, such as preemployment, routine, and for-cause testing, are commonly performed by employers. While healthcare organizations usually require preemployment drug testing, they vary on whether personnel will be subjected to further testing. Recently, a call has gone out for postincident testing among physicians who are involved in serious, preventable events, especially ones leading to a patient's death. This article will offer a number of counterarguments to that proposal and discuss an alternate approach: that health (...) institutions can better improve patient safety and employees’ well-being by implementing an organizational policy of “speaking up” when system operators notice work behaviors or environmental factors that threaten harm or peril. The article will conclude with a description of various strategies that facilitate speaking up, and why the practice constitutes a superior alternative to mandatory alcohol and drug testing in the wake of serious, harm-causing m.. (shrink)

So-called cognitive enhancing drugs are relatively common in higher education, especially among students who are white, male, and attend highly selective institutions. Using qualitative data from a diverse sample of 32 students at an elite university, the present study aims to examine whether students perceive CED use to be advantageous, equitable, and fair. Participants were either medical or nonmedical users of CEDs—primarily ADHD stimulant medications such as Adderall. Data were first coded openly, then axially into themes, and finally arranged to (...) respond to research aims around social and ethical concerns. Ethical perceptions and behavioral justifications varied by participants’ personal use frequency, class standing, and perceived social norms surrounding CEDs. Among the salient themes to emerge was the belief that CED use is a lesser or more tenable form of cheating, that the vagueness and prevalence of ADHD justifies nonmedical use, and that above all, CEDs are advantageous. Some participants expressed concern about the advantageousness of CEDs when coupled with a perceived imbalance of their use among students from traditionally underrepresented backgrounds, with one calling it “the white version of cheating.” Implications for cheating and drug use prevention are discussed, situating cognitive enhancement as an emerging ethical and social equity concern in higher education. (shrink)

Academic integrity policies at 200 institutions of higher education were examined for the presence of academic prohibitions against the nonmedical use of prescription stimulants or any other cognitive enhancing drug. Researchers used online search tools to locate policy handbooks in a stratified random sample of IHE’s drawn from the Integrated Postsecondary Education Data System database, searching for NMUPS/CED use as violations of either academic integrity or alcohol and other drug policies. Of 191 academic integrity policies found online, NMUPS/CED prohibitions were (...) present in only one. However, NMUPS was addressed in all but two of the 200 IHE AOD policies, often with language referencing IHE adherence to federal or state law. NMUPS/CED prohibitions are predominantly absent in IHE academic integrity policies, raising questions about whether colleges and universities are concerned about the use of enhancement drugs as a form of cheating. Implications for fairness, health promotion, and future research are discussed. (shrink)

Bioethics has changed considerably over the years, the increasing diversity of topics of bioethical interest having led to specialisation if not fragmentation. In this context the term “neuroethics" emerged, and it soon became clear that it could be understood in two ways. The “ethics of neuroscience” assesses the ethical and philosophical implications of research in neuroscience and of the application of these discoveries, especially as regards enhancement of “normal” human faculties or new challenges to privacy. The “neuroscience of ethics” basically (...) turns the tables on ethics: it is ethical reasoning itself that becomes the object of neuroscience research. This provides a “behind the scenes” glance into moral reasoning, challenging aspects of moral philoso-phy and of the conventional philosophical interpretation of human action and free will. On the more practical side, neuroethics increases the level of awareness of the relatively neglected area of diseases of the brain-mind. (shrink)

In this chapter, I propose the mechanism of cognitive enhancement based on studies of cognitive-enhancing drugs and behavioral training. I argue that there are mechanistic differences between cognitive-enhancing drugs and behavioral training due to their different enhancing effects. I also suggest possible mechanisms for cognitive-enhancing drugs and behavioral training and for the synergistic effects of their simultaneous application.

Psychopharmacological cognitive enhancements could lead to a higher quality of life of healthy individuals with lower cognitive capacities, but the current regulatory framework does not seem to enable access to this group. This article discusses why Sen’s Capability Approach could open up such access, while two other modern social justice theories – utilitarianism and Rawls’ Justice as Fairness – could not. In short, the utilitarian approach is proven to be inadequate, due to practical reasons and having a low chance of (...) real-world success. Rawls’ Justice as Fairness seems to be problematic because of conflicting stances that follow from his First Principle of Justice. The Capability Approach has the greatest chance of success in the context of these substances, because of arguments that can be identified under the banners of agency/self-respect and the way the public views those who take the capability path out of their poor situation. The article also discusses general and practical problems with psychopharmacological cognitive enhancement that should be addressed when writing new policy on this topic. (shrink)