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- Eric Racine & Cynthia Forlini (2010). Cognitive Enhancement, Lifestyle Choice or Misuse of Prescription Drugs? Neuroethics 3 (1).The prospects of enhancing cognitive or motor functions using neuroscience in otherwise healthy individuals has attracted considerable attention and interest in neuroethics (Farah et al., Nature Reviews Neuroscience 5:421–425, 2004; Glannon Journal of Medical Ethics 32:74–78, 2006). The use of stimulants is one of the areas which has propelled the discussion on the potential for neuroscience to yield cognition-enhancing products. However, we have found in our review of the literature that the paradigms used to discuss the non-medical use of stimulant drugs prescribed for attention deficit/hyperactivity disorder (ADHD) vary considerably. In this brief communication, we identify three common paradigms—prescription drug abuse, cognitive enhancement, and lifestyle use of pharmaceuticals—and briefly highlight how divergences between paradigms create important “ethics blind spots”.
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Cognitive enhancement takes many and diverse forms. Various methods of cognitive enhancement have implications for the near future. At the same time, these technologies raise a range of ethical issues. For example, they interact with notions of authenticity, the good life, and the role of medicine in our lives. Present and anticipated methods for cognitive enhancement also create challenges for public policy and regulation.
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.
This article challenges recent assumptions that physicians may ethically and legally prescribe psychopharmacological enhancement drugs to patients and the counterintuitive notion that in some cases ingesting an enhancement drug constitutes the more ethical choice than forgoing this option. Enhancement proponents have touted modafinil as an ideal mechanism to improve concentration, alertness, and forgo sleep and keep pace with our society's demands. However, patients who use modafinil for these reasons risk potentially severe side effects and addiction, and face unintended consequences related to their cognitive, emotive, and physiological functioning. Importantly, prescribing a controlled substance such as modafinil for performance enhancement and sleep avoidance runs contrary to a physician's ethical duty to the patient and the standard of practice set forth in legal requirements governing the prescription of controlled substances.
abstract As history shows, some human beings are capable of acting very immorally. 1 Technological advance and consequent exponential growth in cognitive power means that even rare evil individuals can act with catastrophic effect. The advance of science makes biological, nuclear and other weapons of mass destruction easier and easier to fabricate and, thus, increases the probability that they will come into the hands of small terrorist groups and deranged individuals. Cognitive enhancement by means of drugs, implants and biological (including genetic) interventions could thus accelerate the advance of science, or its application, and so increase the risk of the development or misuse of weapons of mass destruction. We argue that this is a reason which speaks against the desirability of cognitive enhancement, and the consequent speedier growth of knowledge, if it is not accompanied by an extensive moral enhancement of humankind. We review the possibilities for moral enhancement by biomedical and genetic means and conclude that, though it should be possible in principle, it is in practice probably distant. There is thus a reason not to support cognitive enhancement in the foreseeable future. However, we grant that there are also reasons in its favour, but we do not attempt to settle the balance between these reasons for and against. Rather, we conclude that if research into cognitive enhancement continues, as it is likely to, it must be accompanied by research into moral enhancement.
The purpose of this commentary is to address an ethical issue introduced by Walter Glannon regarding whether responsibility can be affected by the use of performance enhancing drugs. Glannon uses the example of a surgeon taking drugs to enhance her capacities. I explore whether conducting surgeries while under the influence of performance enhancing drugs will affect the surgeon’s responsibility for performing more surgeries ‘and’ the surgeon’s responsibility for assuming the consequences of performing these surgeries. Here, the ‘and’ is cumulative: one is responsible for performing ‘and’ one is responsible for having taken performance enhancing drugs. Given that such accumulation could be interpreted as “more responsible”, this might challenge Glannon’s conclusion and impact the normative practices associated with enhancement drugs.
In an essay on performance-enhancing drugs, author Chuck Klosterman (2007) argues that the category of enhancers extends from hallucinogens used to inspire music to steroids used to strengthen athletes—and he criticizes those who would excuse one means of enhancement while railing against the other as a form of cheating: After the summer of 1964, the Beatles started taking serious drugs, and those drugs altered their musical performance. Though it may not have been their overt intent, the Beatles took performance-enhancing drugs. And . . . absolutely no one holds it against them. No one views “Rubber Soul” and “Revolver” as “less authentic” albums, despite the fact that they would not (and probably could ..
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.
This thesis argues that the neuroethical debate regarding cognitive enhancement drugs, as it stands, expounds arguments that fail as a result of the success of the Extended Cognition thesis. Instead this thesis suggets that arguments that support the ethically problemtatic nature of cognitive enhancement drugs focus on the metaphorical influence they have on the self.
Abstract 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. Content Type Journal Article Category Original Paper Pages 1-12 DOI 10.1007/s12152-011-9131-7 Authors Simon M. Outram, Novel Tech Ethics, Dalhousie University, 1234 Le Marchant Street, Halifax, Nova Scotia B3H 3P7, Canada Journal Neuroethics Online ISSN 1874-5504 Print ISSN 1874-5490.
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