Neurocognitive enhancement, or cosmetic neurology, offers the prospect of improving the learning, memory and attention skills of healthy individuals well beyond the normal human range. Much has been written about the ethics of such enhancement, but policy-makers in the USA, the UK and Europe have been reluctant to legislate in this rapidly developing field. However, the possibility of discrimination by employers and insurers against individuals who choose not to engage in such enhancement is a serious threat worthy of legislative intervention. (...) While lawmakers should not prevent individuals from freely pursuing neurocognitive enhancement, they should act to ensure that such enhancement is not coerced. This paper offers one model for such legislation, based upon a proposed US law, the Genetic Information Nondiscrimination Act of 2008, to address precisely this particular pitfall of the impending neuroscience revolution. (shrink)

Many drugs have therapeutic off-label uses for which they were not originally designed. Some drugs designed to treat neuropsychiatric and other disorders may enhance certain normal cognitive and affective functions. Because the long-term effects of cognitive and affective enhancement are not known and may be harmful, a precautionary principle limiting its use seems warranted. As an expression of autonomy, though, competent individuals should be permitted to take cognition- and mood-enhancing agents. But they need to be aware of the risks in (...) chronic use of these agents and to take responsibility for their effects. A reasonable middle ground between these positions is to warn those who choose to enhance that doing so entails risks. (shrink)

Entry on "Neuroenhancement" in the Routledge Encyclopedia of Philosophy Online.

This chapter addresses the claim that, as new types of neurointervention get developed allowing us to enhance various aspects of our mental functioning, we should work to prevent the use of such interventions from ever becoming the “new normal,” that is, a practice expected—even if not directly required—by employers. The author’s response to that claim is that, unlike compulsion or most cases of direct coercion, indirect coercion to use such neurointerventions is, per se, no more problematic than the pressure people (...) all find themselves under to use modern technological devices like computers or mobile phones. Few people seem to believe that special protections should be introduced to protect contemporary Neo-Luddites from such pressures. That being said, the author acknowledges that separate factors, when present, can indeed render indirect coercion to enhance problematic. The factors in question include lack of safety, fostering adaptation to oppressive circumstances, and having negative side effects that go beyond health. Nonetheless, the chapter stresses that these factors do not seem to be necessary correlates of neuroenhancement. (shrink)

Medizinethische Untersuchungen zum Thema Neuroenhancement (NE) wenden sich oft der Frage zu, inwiefern der Einzelne wie auch die Allgemeinheit durch NE zu Schaden kommen können. Gerechtigkeitsprobleme, ein befürchteter Wandel des Menschenbildes oder die Gefahr einer unerwünschten, schleichenden Veränderung der Gesellschaft werden problematisiert. Bezüglich individueller Risiken bleibt es aufgrund des vermeintlichen Zugewinns an Selbstbestimmung und Eigenverantwortung gerne beim Verweis auf die subjektive Kosten-Nutzen-Abwägung. Innerhalb der NE-Debatte gibt es bisher kaum Arbeiten, die die Aspekte der Motivation für die Nutzung von NE aus (...) tiefenpsychologischer Perspektive beleuchten. Das Ziel der vorliegenden Arbeit ist es, diese Aspekte zu analysieren. Die Arbeit soll einen Beitrag zu einem neuen Blickwinkel auf Selbstbestimmung und subjektive Einschätzung der Vor- und Nachteile von NE leisten. Es werden psychologische Aspekte thematisiert, welche die im Kontext von NE übliche Annahme, dass Konsumenten zur Selbstverantwortung fähig seien, problematisch erscheinen lassen, da sie die Wahrnehmung dieser Verantwortung erschweren oder gar unmöglich machen können. In diesem Zusammenhang wollen wir versuchen, für die psychologischen Gefahren und Folgen von NE zu sensibilisieren. Es wird beispielsweise darüber diskutiert, inwiefern der Gebrauch von NE-Technologien eine Persönlichkeit nachhaltig prägen und gerade deshalb das Erleben von Selbstwirksamkeit beeinträchtigen kann. Dies stellt die für die liberale Position zentrale Prämisse, wonach Individuen sich frei und vernünftig entscheiden können, infrage. (shrink)

The widespread use of stimulants among healthy individuals to improve cognition has received growing attention; however, public attitudes toward this practice are not well understood. We determined the effect of framing metaphors and context of use on public opinion toward cognitive enhancement. We recruited 3,727 participants from the United States to complete three surveys using Amazon’s Mechanical Turk between April and July 2017. Participants read vignettes describing an individual using cognitive enhancement, varying framing metaphors (fuel versus steroid), and context of (...) use (athletes versus students versus employees). The main outcome measure was the difference in respondent-assigned level of acceptability of the use of cognitive enhancement by others and by themselves between the contrasting vignettes. Participants were more likely to support the use of cognitive enhancement by others than by themselves and more when the use of enhancement by others was framed with a fuel metaphor than with a steroid metaphor. Metaphoric framing did not affect participants’ attitudes toward their own use. Participants supported the use of enhancement by employees more than by students or athletes. These results are discussed in relation to existing ethical and policy literature. (shrink)

In the March 2010 edition of Mayo Clinic Proceedings, Drs. Rose and Curry declared that resident physicians have an ethical duty to reduce error during periods of fatigue. Problematically, however, they argued this means ingesting a stimulant for performance enhancement and sleep avoidance during a shift when a resident physician is experiencing fatigue as the more ethical choice than forgoing ingesting a stimulant. Rather than accepting enhancement as an unstoppable technological imperative, this article will examine the underlying motivations for enhancement (...) embedded in our culture and the corresponding legal framework relating to stimulant drugs. Although our society seems to be engaged in a pharmacological arms race of efficiency, competition, and self “betterment,” the FDA has not approved stimulant drugs such as modafinil for PESA. As a result, the off-label use of modafinil for PESA means these individuals are part of a large-scale experiment that poses serious immediate and long-term side effects to the individual user as well as society. (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)

Direct brain intervention based mental capacity restoration techniques-for instance, psycho-active drugs-are sometimes used in criminal cases to promote the aims of justice. For instance, they might be used to restore a person's competence to stand trial in order to assess the degree of their responsibility for what they did, or to restore their competence for punishment so that we can hold them responsible for it. Some also suggest that such interventions might be used for therapy or reform in criminal legal (...) contexts-i.e. to make non-responsible and irresponsible people more responsible. However, I argue that such interventions may at least sometimes fail to promote these responsibility-related legal aims. This is because responsibility hinges on other factors than just what mental capacities a person has-in particular, it also hinges on such things as authenticity, personal identity, and mental capacity ownership-and some ways of restoring mental capacity may adversely affect these other factors. Put one way, my claim is that what might suffice for the restoration of competence need not necessarily suffice for the restoration of responsibility, or, put another way, that although responsibility indeed tracks mental capacity it may not always track restored mental capacities. (shrink)

Over the past few years the use of stimulants such as methylphenidate and modafinil among the student population has attracted considerable debate in the pages of bioethics journals. Under the rubric of cognitive enhancement, bioethicists have discussed this use of stimulants—along with future technologies of enhancement—and have launched a sometimes forceful debate of such practices. In the following paper, it is argued that even if we focus solely upon current practices, the term cognitive enhancement encompasses a wide range of ethical (...) considerations that can usefully be addressed without the need for speculation. In taking this position it is suggested that we divide cognitive enhancement into a series of empirically-constructed frameworks—medical risks and benefits, self-medication and under-prescription, prescription drug abuse and over-medication, and finally, the intention to cognitively enhance. These are not mutually exclusive frameworks, but provide a way in which to identify the scope of the issue at hand and particular ethical and medical questions that may be relevant to enhancement. By a process of elimination it is suggested that we can indeed talk of cognitive enhancement as an observable set of practices. However, in doing so we should be aware of how academic commentaries and discussion may be seen as both capturing reality and reifying cognitive enhancement as an entity. (shrink)

In this article, we analyse content from two recent reports to examine how a public health framework to cognitive enhancement is emerging. We find that, in several areas, these reports provide population-level arguments both for and against the use of cognitive enhancers. In discussing these arguments, we look at how these reports are indicative of potentially innovative frameworks—epidemiological, risk/benefit and socio-historical—by which to explore the public health impact of cognitive enhancement. Finally, we argue that these reports are suggestive of both (...) tensions between the bioethical and public health approaches and are also indicative of how these two frameworks can, in part, be seen as complementary. (shrink)

Clinical neuroethics and neuroskepticism are recent entrants to the vocabulary of neuroethics. Clinical neuroethics has been used to distinguish problems of clinical relevance arising from developments in brain science from problems arising in neuroscience research proper. Neuroskepticism has been proposed as a counterweight to claims about the value and likely implications of developments in neuroscience. These two emergent streams of thought intersect within the practice of neurology. Neurologists face many traditional problems in bioethics, like end of life care in the (...) persistent vegetative state, determination of capacity in progressive dementia, and requests for assisted suicide in cognition-preserving neurodegenerative disease (like amyotrophic lateral sclerosis). Neurologists also look to be at the forefront of downstream clinical applications of neuroscience, like pharmacological enhancement of mental life. At the same time, the practice of neurology, concerned primarily with the structure, function, and treatment of the nervous system, has historically fostered a kind of skeptical attitude toward its own subject matter. Not all problems that appear primarily neurological are primarily neurological. This disciplinary skepticism is generally clinical in orientation and limited in scope. The rise of interest in clinical neuroethics and in neuroskepticsim generally suggests a possible broader application. The clinical skepticism of neurology provides impetus for thinking about the appropriate role for skepticism in clinical areas of neuroethics. After a brief review of neuroskepticism and clinical neuroethics, a taxonomy of clinical neuroskepticism is offered and reasons why a stronger rather than weaker form of clinical neuroskepticism is currently warranted. (shrink)

Currently, there is a growing interest in combining genetic information with physiological data measured by functional neuroimaging to investigate the underpinnings of psychiatric disorders. The first part of this paper describes this trend and provides some reflections on its chances and limitations. In the second part, a thought experiment using a commonsense definition of psychiatric disorders is invoked in order to show how information from this kind of research could be used and potentially abused to invent new mental illnesses. It (...) is then argued why an inference to the best explanation could provide an antidote to such attempts. The conclusion emphasises why normative criteria, such as those used to define disorders, cannot be derived from descriptive empirical results alone. While the etiology of some psychiatric diseases may be purely organic, there are many other cases where the psychiatric symptoms and the associated genotypes and phenotypes have an essentially and irreducibly external meaning that is derived from social and political factors. A limited perspective on the genes and brain of man carries the risk that psychiatry may increasingly treat the effects of other domains, although social and political solutions would be more appropriate. (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)

There is mounting evidence that methylphenidate (MPH; Ritalin) is being used by healthy college students to improve concentration, alertness, and academic performance. One of the key concerns associated with such use of pharmaceuticals is the degree of freedom individuals have to engage in or abstain from cognitive enhancement (CE). From a pragmatic perspective, careful examination of the ethics of acts and contexts in which they arise includes considering coercion and social pressures to enhance cognition. We were interested in understanding how (...) university students, parents of university students, and healthcare providers viewed autonomy and coercion in CE using MPH. We found that perspectives converged on the belief that CE is a matter of personal and individual choice. Perspectives also converged on the existence of tremendous social pressures to perform and succeed. Parents emphasized personal responsibility and accountability for CE choices, and expressed feelings of worry, sadness and fear about CE. Students emphasized the importance of personal integrity in CE, expressed tolerance for personal choices of others, and highlighted the challenge that CE poses to maintaining one’s personal integrity. Healthcare providers emphasized the health consequences of CE. These results illustrate: (1) the importance of understanding how context is viewed in relation to perspectives on autonomous choice; (2) the limitations of individualistic libertarian approaches that do not consider social context; and (3) the ethical implications of public health interventions in a value-laden debate where perspectives diverge. (shrink)

Over the past decades, mood enhancement effects of various drugs and neuromodulation technologies have been proclaimed. If one day highly effective methods for significantly altering and elevating one’s mood are available, it is conceivable that the demand for them will be considerable. One urgent concern will then be what role physicians should play in providing such services. The concern can be extended from literature on controversial demands for aesthetic surgery. According to Margaret Little, physicians should be aware that certain aesthetic (...) enhancement requests reflect immoral social norms and ideals. By granting such requests, she argues, doctors render themselves complicit to a collective ‘evil’. In this paper, we wish to question the extent to which physicians, psychiatrists and/or neurosurgeons should play a role as ‘moral gatekeepers’ in dealing with suspect demands and norms underlying potential desires to alter one’s mood or character. We investigate and discuss the nature and limits of physician responsibilities in reference to various hypothetical and intuitively problematic mood enhancement requests. (shrink)

To date, ethics discussions about stem cell research overwhelmingly have centered on the morality and acceptability of using human embryonic stem cells. Governments in many jurisdictions have now answered these “first-level questions” and many have now begun to address ethical issues related to the donation of cells, gametes, or embryos for research. In this commentary, we move beyond these ethical concerns to discuss new themes that scientists on the forefront of NRM development anticipate, providing a preliminary framework for further discussion (...) between scientists and ethicists. Fostering strong partnerships between neuroscientists and ethicists that operate and collaborate within this evolving framework will maximize the translation of NRM discoveries on the brain into cures that are safe and address the needs of science and society. (shrink)

Public attitudes towards cognitive enhancement––e.g., using stimulants like Adderall and Ritalin to improve mental functioning––are mixed. Attitudes vary by context and prompt ethical concerns about fairness, obligation, and authenticity/character. While people may have strong views about the morality of cognitive enhancement, how these views are affected by the physical characteristics of enhancers is unknown. Visible facial anomalies (e.g., scars) bear negatively on perceptions of moral character. This pre-registered study (osf[dot]io/uaw6c/) tested the hypothesis that such negative biases against people with facial (...) anomalies extend to moral beliefs surrounding their use of cognitive enhancement. In an online survey, 941 participants made moral judgments in response to a vignette about a person who had to decide whether or not to enhance. The vignette was accompanied by a face photograph that ostensibly depicted the potential enhancer and either did or did not have visible anomalies. Participants then learned whether the person ultimately decided to enhance. Next, participants played a modified Trust Game with, they were told, the person from the photograph/vignette. Participants judged enhancement to be less fair and enhancers less authentic if they had facial anomalies, while effects on judgments of moral obligation and on behavior were not detected. These findings extend previous work showing that people with visible differences are subject to an “anomalous-is-bad” stereotype that has negative consequences for perceptions of their moral character. While anomalous faces were judged more harshly, these judgments did not appear to affect behavior. These results are discussed in relation to discrimination and policy. (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.

Donepezil, an acetylcholinesterase inhibitor used in the treatment of Alzheimer's disease, has been widely cited in media and bioethics literature on cognitive enhancement (CE) as having the potential to improve the cognitive ability of healthy individuals. In both literatures, this claim has been repeatedly supported by the results of a small study published by Yesavage et al. in 2002 on non-demented pilots (30-70 years old). The factors contributing to this specific interpretation of this study's results are unclear.

I survey some important semantical and axiomatic theories of self-referential truth. Kripke's fixed-point theory, the revision theory of truth and appraoches involving fuzzy logic are the main examples of semantical theories. I look at axiomatic theories devised by Cantini, Feferman, Freidman and Sheard. Finally some applications of the theory of self-referential truth are considered.

As our knowledge of the functional and pharmacological architecture of the nervous system increases, we are getting better at treating cognitive and affective disorders. Along with the ability to modify cognitive and affective systems in disease, we are also learning how to modify these systems in health. “Cosmetic neurology,” the practice of intervening to improve cognition and affect in healthy individuals, raises several ethical concerns. However, its advent seems inevitable. In this paper I examine this claim of inevitability by reviewing (...) the evolution of another medical practice, cosmetic surgery. Cosmetic surgery also enhances healthy people and, despite many critics, it is practiced widely. Can we expect the same of cosmetic neurology? The claim of inevitability poses a challenge for both physicians and bioethicists. How will physicians reconsider their professional role? Will bioethicists influence the shape of cosmetic neurology? But first, how did cosmetic surgery become common? (shrink)

Neurotechnologies that are currently applied to treat a range of neurological and psychiatric diseases were found to have a number of positive side effects on cognitive functioning in healthy individuals. Consequently, these neurotechnologies could in theory be used for cognitive enhancement purposes, for instance, the improvement of eyewitness memory. Improving the process of collecting eyewitness testimony would be of great value and is an example of cognitive enhancement for the common good. In this article, we discuss the epistemological and ethical (...) issues such use raises. These issues are not only critical to using neurotechnologies to improve eyewitness memory, but have a wider scope. By discussing enhancement for a purpose that is not primarily self-regarding or self-serving but potentially benefits the society as a whole, we reflect on the consequences of accepting enhancement for the common good for the acceptability of cognitive enhancement in general. (shrink)

ZusammenfassungMedizinethische Untersuchungen zum Thema Neuroenhancement (NE) wenden sich oft der Frage zu, inwiefern der Einzelne wie auch die Allgemeinheit durch NE zu Schaden kommen können. Gerechtigkeitsprobleme, ein befürchteter Wandel des Menschenbildes oder die Gefahr einer unerwünschten, schleichenden Veränderung der Gesellschaft werden problematisiert. Bezüglich individueller Risiken bleibt es aufgrund des vermeintlichen Zugewinns an Selbstbestimmung und Eigenverantwortung gerne beim Verweis auf die subjektive Kosten-Nutzen-Abwägung. Innerhalb der NE-Debatte gibt es bisher kaum Arbeiten, die die Aspekte der Motivation für die Nutzung von NE aus (...) tiefenpsychologischer Perspektive beleuchten. Das Ziel der vorliegenden Arbeit ist es, diese Aspekte zu analysieren. Die Arbeit soll einen Beitrag zu einem neuen Blickwinkel auf Selbstbestimmung und subjektive Einschätzung der Vor- und Nachteile von NE leisten. Es werden psychologische Aspekte thematisiert, welche die im Kontext von NE übliche Annahme, dass Konsumenten zur Selbstverantwortung fähig seien, problematisch erscheinen lassen, da sie die Wahrnehmung dieser Verantwortung erschweren oder gar unmöglich machen können. In diesem Zusammenhang wollen wir versuchen, für die psychologischen Gefahren und Folgen von NE zu sensibilisieren. Es wird beispielsweise darüber diskutiert, inwiefern der Gebrauch von NE-Technologien eine Persönlichkeit nachhaltig prägen und gerade deshalb das Erleben von Selbstwirksamkeit beeinträchtigen kann. Dies stellt die für die liberale Position zentrale Prämisse, wonach Individuen sich frei und vernünftig entscheiden können, infrage. (shrink)

During the past few years considerable debate has arisen within academic journals with respect to the use of smart drugs or cognitive enhancement pharmaceuticals. The following paper seeks to examine the foundations of this cognitive enhancement debate using the example of methylphenidate use among college students. The argument taken is that much of the enhancement debate rests upon inflated assumptions about the ability of such drugs to enhance and over-estimations of either the size of the current market for such drugs (...) or the rise in popularity as drugs for enhancing cognitive abilities. This article provides an overview of the empirical evidence that methylphenidate has the ability to significantly improve cognitive abilities in healthy individuals, and examines whether the presumed uptake of the drug is either as socially significant as implied or growing to the extent that it requires urgent regulatory attention. In addition, it reviews the evidence of side-effects for the use of methylphenidate which may be an influential factor in whether an individual decides to use such drugs. The primary conclusions are that neither drug efficacy, nor the benefit-to-risk balance, nor indicators of current or growing demand provide sufficient evidence that methylphenidate is a suitable example of a cognitive enhancer with mass appeal. In light of these empirically based conclusions, the article discusses why methylphenidate might have become seen as a smart drug or cognitive enhancer. (shrink)

Los avances de las últimas dos décadas en el estudio del sistema nervioso y en el desarrollo de neuro-tecnología parecen justificar las elevadas expectativas en lo que a este campo concierne. No obstante, cada vez son más los autores que advierten, desde dentro y fuera de la neurociencia, que es excesivo tal grado de optimismo así como perjudicial el neuro-esencialismo que genera. En el presente artículo analizamos el origen y el papel de las expectativas neurocientíficas. En las conclusiones defendemos, primero, (...) que las principales causas no son las evidencias y las teorías científicas, como suele pensarse y, segundo, que precisamente esta generalizada falsa creencia perjudica seriamente el avance científico y el progreso social. (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.

The current generation paving the path for new research marks a milestone to attain the ancient goal of improving our cognition. To date, increased prevalence of cognitive enhancers by healthy people has raised the scientific community’s attention as well as media coverage. In particular, nootropics such as piracetam promise to offer modest improvements in cognitive performance. The long-lasting impetus of this “holistic enhancer” convinced scientists as well as ethicists to discuss its potential ethical implications and future directions. Moreover, there are (...) discrepancies in the concept of a true nootropic between pharmacology and contemporary public culture. Here, I review the ethical aspects of nootropics raised by its potential use in cognition enhancement and substantiate the epistemological commentary on the concept of nootropic. (shrink)