Advances in psychopharmacology raise the prospects of enhancing neurocognitive functions of humans by improving attention, memory, or mood. While general ethical reflections on psychopharmacological enhancement have been increasingly published in the last years, ethical criteria characterizing physicians’ role in neurocognitive enhancement and guiding their decision-making still remain highly unclear. Here it will be argued that also in the medical domain the use of cognition-enhancing drugs is not intrinsically unethical and that, in fact, physicians should assume an important role in gating (...) their usage. For finding normative orientation, concepts of disease, normality or medicine will not be helpful since—due to their cryptonormative nature—they rather hamper than allow targeted discussion and decision-making. As an alternative, the common and widely accepted bioethical criteria of beneficence, non-maleficence, autonomy and distributive justice allow a clinically applicable, highly differentiated context- and case-sensitive approach. By embedding decision-making in a participative physician–patient relationship extrinsic objections against neurocognitive enhancement (e.g. invalid perceptions about efficacy, benefit or risk; questionable voluntariness; restrained decision-making capacity) can be curtailed. (shrink)

Many find it intuitive that those who use enhancements like steroids and Adderall in Olympic weightlifting and education are due less praise than those who perform equally well without using these enhancements. Nonetheless, it is not easy to coherently explain why one might be justifiably due less praise for using these technologies to enhance one’s performance. Justifications for this intuition which rely on concerns regarding authenticity, cheating, or shifts in who is responsible for the performance face serious problems. Santoni de (...) Sio et al., however, have recently defended a justification for this intuition which avoids the problems competing justifications face; the nature-of-activities justification. This justification relies on a conceptual analysis of the nature of activities and does not require the defense of any particular ethical stance concerning the use of enhancements. Santoni de Sio et al. claim that the success of the nature-of-activities account requires distinguishing between practice-oriented activities and goal-directed activities. I, however, show that this distinction is both deeply problematic and unnecessary. After exposing the weaknesses of Santoni de Sio et al.’s original account, I defend a simpler and less problematic version of the nature-of-activities account. The revised account is capable of both justifying this intuition of less praise and allowing one to determine when enhancements should be deemed permissible, impermissible, or obligatory for a given activity. (shrink)

One frequently used argument in the discussion on human enhancement is that enhancement is a form of cheating. This argument is well-known in relation to doping in sports, but recently it has also been used with regard to cognitive enhancement in the context of education and exams. This paper analyses the enhancement-is-cheating argument by comparing sports and education, and by evaluating how the argument can be interpreted in both contexts. If cheating is understood as breaking the rules in order to (...) gain an unfair advantage over others, it can be argued that some enhancements are a form of cheating. This problem of cheating is, however, relatively easy to remedy by either changing the rules, or by instituting controls and sanctions. This does not, therefore, constitute a categorical objection to enhancement. A further analysis of the intuitions behind the enhancement-is-cheating argument, however, shows that if sports and education are understood as “practices”, with their own internal goods and standards of excellence, some potential problems of enhancement can be articulated. These concern the internal goods and standards of excellence that are characteristic of specific practices. Seen from this perspective, the important question is how enhancement technologies might be embedded in specific practices—or how they might corrode them. (shrink)

This paper investigates cognitive enhancement, specifically biological cognitive enhancement (BCE), as a converging technology, and its implications for public policy. With an increasing rate of technological advancements, the legal, social, and economic frameworks lag behind the scientific advancements that they support. This lag poses significant challenges for policymakers if it is not dealt with sufficiently within the right analytical context. Therefore, the driving question behind this paper is, “What contingencies inform the advancement of biological cognitive enhancement, and what would society (...) look like under this set of assumptions?” The paper is divided into five components: (1) defining the current policy context for BCEs, (2) analyzing the current social and economic outcomes to BCEs, (3) investigating the context of cost-benefit arguments in relation to BCEs, (4) proposing an analytical model for evaluating contingencies for BCE development, and (5) evaluating a simulated policy, social, technological, and economic context given the contingencies. In order to manage the risk and uncertainty inherent in technological change, BCEs’ drivers must be scrutinized and evaluated. (shrink)

Ingmar Persson and Julian Savulescu argue that non-traditional forms of cognitive enhancement (those involving genetic engineering or pharmaceuticals) present a serious threat to humanity, since the fruits of such enhancement, accelerated scientific progress, will give the morally corrupt minority of humanity new and more effective ways to cause great harm. And yet it is scientific progress, accelerated by non-traditional cognitive enhancement, which could allow us to dramatically morally enhance human beings, thereby eliminating, or at least reducing, the threat from the (...) morally corrupt minority. I argue that this apparently intractable dilemma is less difficult to resolve than Persson and Savulescu suppose. Their analysis of non-traditional cognitive enhancement overstates the risks and undervalues the benefits that such enhancement might provide. Once the benefits are better described, it is clear that non-traditional cognitive enhancement could be the means of our survival, not of our destruction. (shrink)

We ask why pharmacological cognitive enhancement (PCE) is generally deemed morally unacceptable by lay people. Our approach to this question has two core elements. First, we employ an interdisciplinary perspective, using philosophical rationales as base for generating psychological models. Second, by testing these models we investigate how different normative judgments on PCE are related to each other. Based on an analysis of the relevant philosophical literature, we derive two psychological models that can potentially explain the judgment that PCE is unacceptable: (...) the “Unfairness-Undeservingness Model” and the “Hollowness-Undeservingness Model.” The Unfairness-Undeservingness Model holds that people judge PCE to be unacceptable because they take it to produce unfairness and to undermine the degree to which PCE-users deserve reward. The Hollowness-Undeservingness Model assumes that people judge PCE to be unacceptable because they find achievements realized while using PCE hollow and undeserved. We empirically test both models against each other using a regression-based approach. When trying to predict judgments regarding the unacceptability of PCE using judgments regarding unfairness, hollowness, and undeservingness, we found that unfairness judgments were the only significant predictor of the perceived unacceptability of PCE, explaining about 36% of variance. As neither hollowness nor undeservingness had explanatory power above and beyond unfairness, the Unfairness-Undeservingness Model proved superior to the Hollowness-Undeservingness Model. This finding also has implications for the Unfairness-Undeservingness Model itself: either a more parsimonious single-factor “Fairness Model” should replace the Unfairness-Undeservingness-Model or fairness fully mediates the relationship between undeservingness and unacceptability. Both explanations imply that participants deemed PCE unacceptable because they judged it to be unfair. We conclude that concerns about unfairness play a crucial role in the subjective unacceptability of PCE and discuss the implications of our approach for the further investigation of the psychology of PCE. (shrink)

It is sometimes claimed that those who succeed with the aid of enhancement technologies deserve the rewards associated with their success less, other things being equal, than those who succeed without the aid of such technologies. This claim captures some widely held intuitions, has been implicitly endorsed by participants in social–psychological research and helps to undergird some otherwise puzzling philosophical objections to the use of enhancement technologies. I consider whether it can be provided with a rational basis. I examine three (...) arguments that might be offered in its favour and argue that each either shows only that enhancements undermine desert in special circumstances or succeeds only under assumptions that deprive the appeal to desert of much of its dialectic interest. (shrink)

In this paper we analyse some ethical and philosophical questions related to the development of memory enhancing drugs (MEDs) and anti-dementia drugs. The world of memory enhancement is coloured by utopian thinking and by the desire for quicker, sharper, and more reliable memories. Dementia is characterized by decline, fragility, vulnerability, a loss of the most important cognitive functions and even a loss of self. While MEDs are being developed for self-improvement, in Alzheimer’s Disease (AD) the self is being lost. Despite (...) this it is precisely those patients with AD and other forms of dementia that provide the subjects for scientific research on memory improvement. Biomedical research in the field of MEDs and anti-dementia drugs appears to provide a strong impetus for rethinking what we mean by ‘memory’, ‘enhancement’, ‘therapy’, and ‘self’. We conclude (1) that the enhancement of memory is still in its infancy, (2) that current MEDs and anti-dementia drugs are at best partially and minimally effective under specific conditions, (3) that ‘memory᾿and ‘enhancement᾿are ambiguous terms, (4) that there is no clear-cut distinction between enhancement and therapy, and (5) that the research into MEDs and anti-dementia drugs encourages a reductionistic view of the human mind and of the self. (shrink)

There is substantial evidence that methylphenidate (MPH; Ritalin), is being used by healthy university students for non-medical motives such as the improvement of concentration, alertness, and academic performance. The scope and potential consequences of the non-medical use of MPH upon healthcare and society bring about many points of view.

Advances in cognitive neuroscience make cosmetic neurology in some form inevitable and will give rise to extremely difficult ethical issuesConsider the following hypothetical case study. A well heeled executive walks into my cognitive neurology clinic because he is concerned that he is becoming forgetful. It turns out that he is going through a difficult divorce and my clinical impression is that his memory problems stem from the stress he is experiencing. I place him on a selective seratonin reuptake inhibitor, sertraline, (...) and in a few weeks he feels better. Around this time his 13 year old daughter has difficulty at school and is diagnosed by the school psychologist as having attention deficit disorder. I place her on adderall, a stimulant combination drug, which seems to help with her behaviour in school. My patient then comes to me because he is experiencing the “tip of the tongue” phenomena more frequently. He is concerned that his word finding difficulty interferes with his ability to function in high level meetings. I suggest we try a cholinesterase inhibitor to see if this helps. I am careful to explain that the Food and Drug Administration does not approve such a use for this medication. He wants to try it and is pleased with the results.A few months later, this patient visits me with his 16 year old son, a talented middle distance runner. His father thinks if he were just a bit better, among the elite high school runners in the state, he would be far more competitive as an applicant for selective colleges. We discuss various options. Because of a recent report that sildenafil, which is used conventionally for male impotence, may improve oxygen carrying capacity, I prescribe this medication. The son does not object.Encouraged by these pharmacologic successes, my patient …. (shrink)

Reports in the popular press suggest that smart drugs or “nootropics” such as methylphenidate, modafinil and piracetam are increasingly being used by the healthy to augment cognitive ability. Although current nootropics offer only modest improvements in cognitive performance, it appears likely that more effective compounds will be developed in the future and that their off-label use will increase. One sphere in which the use of these drugs may be commonplace is by healthy students within academia. This article reviews the ethical (...) and pragmatic implications of nootropic use in academia by drawing parallels with issues relevant to the drugs in sport debate. It is often argued that performance-enhancing drugs should be prohibited because they create an uneven playing field. However, this appears dubious given that “unfair” advantages are already ubiquitous and generally tolerated by society. There are concerns that widespread use will indirectly coerce non-users also to employ nootropics in order to remain competitive. However, to restrict the autonomy of all people for fear that it may influence the actions of some is untenable. The use of potentially harmful drugs for the purposes of enhancement rather than treatment is often seen as unjustified, and libertarian approaches generally champion the rights of the individual in deciding if these risks are acceptable. Finally, whether the prohibition of nootropics can be effectively enforced is doubtful. As nootropics use becomes widespread among students in the future, discussion of this issue will become more pressing in the years to come. (shrink)

When should humans enhance themselves? We try to answer this question by engaging in a conceptual analysis of the nature of different activities. We think that cognitive enhancement is morally impermissible in some practice-oriented activities, such as some educational activities, when it is the case both that cognitive enhancement would negatively affect the point of those activities and that we have good reasons to value that point. We then argue that cognitive enhancement should be allowed in two groups of cases, (...) namely in practice-oriented activities, such as recreational activities on which little moral value or social import hangs, and in some prominently goal-directed activities, such as high-responsibility professions, the goal of which has significant moral or social value. Finally, we argue that the use of efficacious and relatively safe cognitive enhancers may even be obligatory in those high-responsibility professions under certain special circumstances. (shrink)