The author examines whether Kantian ethics would condone the use of pharmaceutical drugs to enhance one’s moods and cognitive abilities. If key assumptions concerning safety and efficacy, non-addictiveness, non-coercion, and accessibility are not met, Kantian ethics would consider mood and cognitive enhancement to be impermissible. But what if these assumptions are granted? The arguments for the permissibility of neuroenhancement are stronger than those against it. After giving a general account of Kantian ethical principles, the author argues that, when these assumptions (...) are granted, Kantian ethics no longer justifies the prohibition of neuroenhancement, and responds to two objections. (shrink)

Z propozycją rekalibracji etyki i zastąpienia jej neuroetyką wystąpiła Patricia S. Churchland. Churchland twierdzi, że im bardziej rozumiemy szczegóły funkcjonowania naszego systemu nerwowego, tym bardziej jesteśmy przekonani co do tego, że przyjmowane przez nas standardy moralnego działania są uwarunkowane neurobiologicznie. Od roku 2002 termin „neuroetyka” funkcjonuje jako nazwa nowej subdyscypliny etyki. Wymienia się w niej dwa zasadnicze działy: etykę neuronauki i neuronaukę etyki. Pierwszy dotyczy zasadniczo moralnych problemów związanych z zastosowaniem osiągnięć neuronauk, przedmiotem drugiego: neuronauki etyki, jest wpływ, jaki wiedza (...) z zakresu neuronauk ma na nasze rozumienie etyki. Artykuł jest krytyczną prezentacją nowej subdyscypliny etycznej i próbą pokazania, że jakkolwiek neurobiologiczne procesy mają wpływ na nasze działanie, to nie decydują o jego moralnym wymiarze. (shrink)

One of the ethical issues that has been raised recently regarding emerging neurotherapies is that people will be coerced explicitly or implicitly in the workplace or in schools to take cognitive enhancing drugs. This article builds on this discussion by showing how the law may pressure people to adopt emerging neurotherapies. It focuses on a range of private law doctrines that, unlike the criminal law, do not come up very often in neuroethical discussions. Three doctrines—the doctrine of mitigation, the standard (...) of care in negligence, and child custody determinations in family law—are addressed to show how the law may pressure people to consent to treatment by offering a choice between accepting medical treatment and suffering a legal disadvantage. The doctrines considered in this article apply indirect pressure to submit to treatment, unlike court-ordered medical treatment, which applies direct pressure and is not addressed here. The outcome of this discussion is to show that there is a greater range of social pressures that may encourage the uptake of novel neurotherapies than one might initially think. Once treatments that were developed and offered with therapeutic benefits in mind become available, their existence gives rise to unintended legal consequences. This certainly does not mean we should cease developing new therapies that may be of tremendous benefit to patients, but it does raise some questions for physicians and for legal policy-makers. How should physicians, who are required by medical ethical principles to obtain valid consent to treatment, react to a patient’s reluctant consent that is driven by legal pressure? From the legal policy perspective, are our legal doctrines satisfactory or should they be changed because, for example, they unduly promote the collective interest over individual freedom to reject medical treatment or because they channel us toward economically efficient treatments to the detriment of more costly but potentially superior approaches of dealing with behavioural problems? (shrink)

Some libertarians tend to advocate the wide availability of cognition-enhancing drugs beyond their current prescription-only status. They suggest that certain kinds of drugs can be a component of a prudential conception of the ‘good life’—they enhance our opportunities and preferences; and therefore, if a person freely chooses to use them, then there is no justification for the kind of prejudicial, authoritative restrictions that are currently deployed in public policy. In particular, this libertarian idea signifies that if enhancements are a prudential (...) ‘good’ for the user, then this can also be construed as a moral good for all rational agents. If this argument is successful, there can be no substantial distinction between the categorical benefits of enhancement, and what is labeled as an enhancement technology. In this paper, I argue that the exclusivity of egotistical choice, and an uncritical deployment of enhancement as a prudential good, underplays the role of a social and political community when creating a procedurally just and effective public policy. Principally, the argument is devoid of any ethical system to permit the external—and therefore public–appreciation of the social context of moral decisions. In effect, libertarian arguments of this sort must disregard any ideas of public ethics, because the liberty to use whatever means available to gain a socio-economic advantage actually extinguishes any professed legitimation strategy. Escaping the procedural aspects of public policy, which are considered integral to authoritative coherence, results in the erosion of any moral obligations. Thus, in a libertarian society, disenfranchised individuals—such as those harmed through addiction—are the unlucky or superfluous product of a liberal and ‘progressive’ society. (shrink)

The debate over the propriety of cognitive enhancement evokes both enthusiasm and worry. To gain further insight into the reasons that people may have for endorsing or eschewing pharmacological enhancement, we used empirical tools to explore public attitudes towards PE of twelve cognitive, affective, and social domains. Participants from Canada and the United States were recruited using Mechanical Turk and were randomly assigned to read one vignette that described an individual who uses a pill to enhance a single domain. After (...) reading the vignette, participants were asked how comfortable they were with the individual using the enhancement. People were significantly more comfortable when they read about enhancement of certain CAS domains than others. We found a modest negative correlation between comfort level and the degree to which the PE was perceived as changing core features of the person. We also found a modest correlation between comfort level and the degree to which the PE was perceived as improving success in life. Finally, using a sequential mixed method technique, we found that participants who felt uncomfortable about PE use overwhelmingly focused on a lack of need and, to a lesser degree, expressed concerns about safety; those who felt comfortable about PE use most frequently mentioned the safety of the pill and its ability to provide a positive outcome. The data provide novel insights into public enthusiasms and concerns over the use of PE. (shrink)

In recent years, discussion around memory modification interventions has gained attention. However, discussion around the use of memory interventions in the criminal justice system has been mostly absent. In this paper we start by highlighting the importance memory has for human well-being and personal identity, as well as its role within the criminal forensic setting; in particular, for claiming and accepting legal responsibility, for moral learning, and for retribution. We provide examples of memory interventions that are currently available for medical (...) purposes, but that in the future could be used in the forensic setting to modify criminal offenders’ memories. In this section we contrast the cases of dampening and enhancing memories of criminal offenders. We then present from a pragmatic approach some pressing ethical issues associated with these types of memory interventions. The paper ends up highlighting how these pragmatic considerations can help establish ethically justified criteria regarding the possibility of interventions aimed at modifying criminal offenders’ memories. (shrink)

International institutions such as UNESCO are deliberating on a new standard setting instrument for neurotechnologies. This will likely lead to the adoption of a soft law document which will be the first global document specifically tailored to neurotechnologies, setting the tone for further international or domestic regulations. While some stakeholders have been consulted, these developments have so far evaded the broader attention of the neuroscience, neurotech, and neuroethics communities. To initiate a broader debate, this target article puts to discussion twenty-five (...) considerations and desiderata for recognition by a future instrument. They are formulated at different levels of abstraction, from the big picture to technical details, seek to widen the perspective of preparatory reports and transcend the narrow debate about “neurorights” which overshadows many richer and more relevant aspects. These desiderata are not an exhaustive enumeration but a starting point for discussions about what deserves and what requires protection by an international instrument. (shrink)

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)

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)

Current developments in the area of neuroenhancement pose multiple ethical and societal questions. Improvements in general cognitive capacities can have important positive effects. With the use of several interventions, ranging from pharmaceutics through microsurgery to non-invasive and invasive methods, new possibilities of enhancing human abilities can be achieved. Yet, they have to be critically evaluated from the point of view of both individual and societal consequences that are involved. The aim of this paper is to address societal benefits and challenges (...) that are related to these interventions. These new developments, especially in the specific area of their military application, pose important questions with regard to safety of their use, long-term results, coercion to use them, and issues of inequality. Often, these consequences are unforeseeable at the present moment and can greatly interfere with development of both individuals and societies. Therefore, as in both areas – civilian and military – the long-term consequences are still difficult to predict, prudency is prescribed. Consequently, any use of the methods of enhancement should be under exceptional scrutiny from the ethical as well as legal and social point of view. (shrink)

The Ethical, Legal, and Social Implications (ELSI) program of the Human Genome Project stands as a model for how to organize bioethical inquiry for a rapidly changing field. Neuroscience has experienced significant growth in recent years and there is increasing interest in organizing critical reflection on this field, as evidenced by the creation of “neuroethics.” A nascent framework for reflection on the implications of neuroscience is emerging but significant work remains, given the pace and scope of neuroscientific developments. The adoption (...) of an ELSI program, modeled on that of the ELSI program of the Human Genome Project, promises a way for neuroscience to meet important organizational, educational, and policy objectives. Review of recent criticisms of the HGP ELSI program suggests that an ELSI program for neuroscience would face certain obstacles. Those interested in a neuroscience ELSI program will need to develop appropriate resources to overcome these obstacles. (shrink)

There are a number of premises underlying much of the vigorous debate on pharmacological cognitive enhancement. Among these are claims in the enhancement literature that such drugs exist and are effective among the cognitively normal. These drugs are deemed to enhance cognition specifically, as opposed to other non-cognitive facets of our psychology, such as mood and motivation. The focus on these drugs as cognitive enhancers also suggests that they raise particular ethical questions, or perhaps more pressing ones, compared to those (...) raised by other kinds of neuroenhancement. Finally, the use of these drugs is often claimed to be significant and increasing. Taken together, these premises are at the heart of the flurry of debate on pharmacological cognitive enhancement. In this article, it is argued that these are presumptions for which the evidence does not hold up. Respectively, the evidence for the efficacy of these drugs is inconsistent; neurologically it makes little sense to distinguish the cognitive from non-cognitive as separate targets of pharmacological intervention; ethically, the questions raised by cognitive enhancement are in fact no different from those raised by other kinds of neuroenhancement; and finally the prevalence rates of these drugs are far from clear, with the bulk of the claims resting on poor or misrepresented data. Greater conceptual clarity along with a more tempered appreciation of the evidence can serve to deflate some of the hype in the associated literature, leading to a more realistic and sober assessment of these prospective technologies. (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)

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)

This paper focuses on the ethical justifiability of patents on Genetically Modified (GM) crops. I argue that there are three distinguishing features of GM crops that make it unethical to grant patents on GM crops, even if we assume that the patent system is in general justified. The first half of the paper critiques David Resnik’s recent arguments in favor of patents on GM crops. Resnik argues that we should take a consequentialist approach to the issue, and that the best (...) way to do so is to apply the Precautionary Principle, and that the Precautionary Principle, in this case, supports patents on GM crops. I argue that his argument in favor of a consequentialist treatment is invalid; his Precautionary Principle in any case appears to be incompatible with consequentialism; and his conception of reasonable precautions is too ill-defined to have any argumentative purchase. In the second half of the paper, I argue against GM crop patents, on three grounds. First, there is insufficient evidence to say whether allowing patents on GM crops will make research go faster than not having patents, whilst there is a good reason to think that, other things being equal, a society that allows patents on GM crops will be less just than one that does not. Second, even assuming that patents on GM crops will increase the pace of GM crop research, there is no social need to do so. Third, patents on GM crops will frequently have ethically unacceptable side effects. (shrink)

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.

The 2015 Varsity Medical Ethics debate convened upon the motion: “This house believes nootropic drugs should be available under prescription”. This annual debate between students from the Universities of Oxford and Cambridge, now in its seventh year, provided the starting point for arguments on the subject. The present article brings together and extends many of the arguments put forward during the debate. We explore the current usage of nootropic drugs, their safety and whether it would be beneficial to individuals and (...) society as a whole for them to be available under prescription. The Varsity Medical Debate was first held in 2008 with the aim of allowing students to engage in discussion about ethics and policy within healthcare. The event is held annually and it is hoped that this will allow future leaders to voice a perspective on the arguments behind topics that will feature heavily in future healthcare and science policy. This year the Oxford University Medical Society at the Oxford Union hosted the debate. (shrink)

It is an imperative within health care, medicine, and public health to restore, preserve, and enhance health. Therefore, it is important to determine what kinds of enhancement are increases in health and what kinds are not. Taking as its point of departure two conceptions of health, namely, “manifest health” and “fundamental health,” the paper discusses various means used to enhance ability and well-being, and if those means, such as wheelchairs, implants, medicines, stimulants, or narcotics, enhance health. The fact that some (...) means that enhance ability or well-being are not usually considered health enhancing, for example, narcotics, constitutes a problem. The paper ends with a discussion of some suggestions about how to distinguish between those enhancements that are health related and those that are not. One plausible idea holds that an enhancement is health related when the substance, or aid, increases ability or well-being, is integrated into the body, and does not harm the individual’s fundamental health. (shrink)

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)

The availability of a range of new psychotropic agents raises the possibility that these will be used for enhancement purposes (smart pills, happy pills, and pep pills). The enhancement debate soon raises questions in philosophy of medicine and psychiatry (eg, what is a disorder?), and this debate in turn raises fundament questions in philosophy of language, science, and ethics. In this paper, a naturalistic conceptual framework is proposed for addressing these issues. This framework begins by contrasting classical and critical concepts (...) of categories, and then puts forward an integrative position that is based on cognitive-affective research. This position can in turn be used to consider the debate between pharmacological Calvinism (which may adopt a moral metaphor of disorder) and psychotropic utopianism (which may emphasize a medical metaphor of disorder). I argue that psychiatric treatment of serious psychiatric disorders is justified, and that psychotropics are an acceptable kind of intervention. The use of psychotropics for sub-threshold phenomena requires a judicious weighing of the relevant facts (which are often sparse) and values. (shrink)

One of the most fascinating issues in the emerging field of neuroethics is pharmaceutical cognitive enhancement (CE). The three main ethical concerns around CE were identified in a Nature commentary in 2008 as safety, coercion and fairness; debate has largely focused on the potential to help those who are cognitively disabled, and on the issue of “cosmetic neurology”, where people enhance not because of a medical need, but because they want to (as many as 25% of American students already use (...) nootropic cognitive enhancers such as ritalin). However, the potential for CE to improve public health has been neglected. This paper examines the prospect of improving health outcomes through cognitive enhancement among sections of the population where health inequalities are particularly pronounced. I term this enhancement of the public's health through CE “neuroenhancing health”. It holds great promise, but raises several ethical issues. This paper provides an outline of these issues and related philosophical problems. These include the potential effectiveness of CE in reducing health inequalities; issues concerning autonomy and free will; whether moral enhancement might be more effective than cognitive enhancement in reducing health inequalities; and the problem of how to provide such CE, including the issue of whether to provide targeted and universal coverage. (shrink)

One of the most fascinating issues in the emerging field of neuroethics is pharmaceutical cognitive enhancement. The three main ethical concerns around CE were identified in a Nature commentary in 2008 as safety, coercion and fairness; debate has largely focused on the potential to help those who are cognitively disabled, and on the issue of ‘cosmetic neurology’, where people enhance not because of a medical need, but because they want to. However, the potential for CE to improve public health has (...) been neglected. This paper examines the prospect of improving health outcomes through CE among sections of the population where health inequalities are particularly pronounced. I term this enhancement of the public’s health through CE ‘neuroenhancing health’. It holds great promise, but raises several ethical issues. This paper provides an outline of these issues and related philosophical problems. These include the potential effectiveness of CE in reducing health inequalities; issues concerning autonomy and free will; whether moral enhancement might be more effective than CE in reducing health inequalities; and the problem of how to provide such CE, including the issue of whether to provide targeted or universal coverage. (shrink)

In their recent paper in this journal, Heinz and colleagues accuse proponents of cognitive enhancement of making two unjustified assumptions. The first of these is the assumption that neuroenhancing drugs will be safe; the second is that research into cognitive enhancement does not pose particular ethical problems. Heinz and colleagues argue that both these assumptions are false. Here, I argue that these assumptions are in fact correct, and that Heinz and colleagues themselves make several assumptions that undermine their argument. Neuroenhancement (...) does raise several ethical concerns, but safety and research in this area pose no unique difficulties. (shrink)

Abstract Under the realm of neurocultures the concept of the cerebral subject emerges as the central category to define the self, socio-cultural interaction and behaviour. The brain is the reference for explaining cognitive processes and behaviour but at the same time the plastic brain is situated in current paradigms of (self)optimization on the market of meritocracy by means of neurotechnologies. This paper explores whether neurotechnological apparatuses may—due to their hybridity and malleability—bear potentials for a change in gender based attributions that (...) have been historically legitimized by apparently natural differences between women and men. Or, in contrast, which gendered ascriptions are (again) produced in theories and applications according to the normative demands for the bio-techno-social cerebral subject situated in neoliberal power relations. An exploration of three main fields of current developments, the neurotechnological apparatus of brain-computer-interfaces, the technologies for brain tuning and the discourses in neuroeconomics, reveals first insights on these gender aspects in reliance with the ethical/political debate. Moreover, this paper concretizes questions for further research on gender and ethical aspects in the field of neurotechnologies. Content Type Journal Article Category Original Paper Pages 1-14 DOI 10.1007/s12152-011-9129-1 Authors Sigrid Schmitz, Faculty of Social Sciences, Institute of Cultural and Social Anthropology, University of Vienna, Alserstraße 23/22, 1080 Vienna, Austria Journal Neuroethics Online ISSN 1874-5504 Print ISSN 1874-5490. (shrink)

The hopes and fears expressed in the debate on human enhancement are not always based on a realistic assessment of the expected possibilities. Discussions about extreme scenarios may at times obscure the ethical and policy issues that are relevant today. This paper aims to contribute to an adequate and ethically sound societal response to actual current developments. After a brief outline of the ethical debate concerning neuro-enhancement, it describes the current state of the art in psychopharmacological science and current uses (...) of psychopharmacological enhancement, as well as the prospects for the near future. It then identifies ethical issues regarding psychopharmacological enhancements that require attention from policymakers, both on the professional and on the governmental level. These concern enhancement research, the gradual expansion of medical categories, off-label prescription and responsibility of doctors, and accessibility of enhancers on the Internet. It is concluded that further discussion on the advantages and drawbacks of enhancers on a collective social level is still needed. (shrink)