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Autonomy and Coercion in Academic “Cognitive Enhancement” Using Methylphenidate: Perspectives of Key Stakeholders

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Abstract

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.

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Notes

  1. Studies on the non-medical use of prescription stimulants by university students show that prevalence rates range from 6.9% to 35.3% [33] [34] and up to 11% for cognitive enhancement specifically [23].

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Acknowledgments

The authors would like to acknowledge the support of the International Institute for Research and Ethics in Biomedicine, the Canadian Institutes of Health Research, the Social Sciences and Humanities Research Council of Canada and the Institut de recherches cliniques de Montréal. Thanks to Nicole Palmour, Dr. Emily Bell and William Affleck. We also thank the anonymous reviewer who helped us make significant changes to this paper including focusing on the group-level differences between stakeholders.The authors report no conflicts of interest.

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Authors and Affiliations

  1. Neuroethics Research Unit, Institut de recherches cliniques de Montréal, Montreal, QC, Canada

    Cynthia Forlini

  2. Programmes de bioéthique, Université de Montréal, Montreal, QC, Canada

    Cynthia Forlini

  3. Director, Neuroethics Research Unit, Institut de recherches cliniques de Montréal, Montreal, QC, Canada

    Eric Racine

  4. Department of Medicine and Department of Social and Preventive Medicine, Université de Montréal, Montreal, QC, Canada

    Eric Racine

  5. Department of Neurology and Neurosurgery & Biomedical Ethics Unit, McGill University, Montreal, QC, Canada

    Eric Racine

  6. 110, Avenue des Pins O., Montréal, QC, H2W 1R7, Canada

    Eric Racine

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  1. Cynthia Forlini
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Correspondence to Eric Racine.

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Forlini, C., Racine, E. Autonomy and Coercion in Academic “Cognitive Enhancement” Using Methylphenidate: Perspectives of Key Stakeholders. Neuroethics 2, 163–177 (2009). https://doi.org/10.1007/s12152-009-9043-y

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  • DOI: https://doi.org/10.1007/s12152-009-9043-y

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