A recent discussion on cognitive enhancers has caused some controversy in the ethics and neuroscience fields by coming out in favour of making neuropharmaceuticals with enhancing properties available for general consumption. We highlight in this brief commentary why concerns regarding efficacy and safety, demands on resources, and public health are substantive enough to warrant serious reconsideration before pharmaceutical performance enhancement can be widely supported.

Neuroethics, as a domain of inquiry, was made necessary by this interdisciplinary march of technology that has been much documented and the resulting synergism, which resulted in the development of neuroimaging, deep brain stimulation, and advanced neuropharmaceutics. Closing the loop from discovery of basic mechanisms of illness to knowledge of structure and function en route to restorative therapeutics is a long way from earlier efforts to use electrical stimulation to address human maladies. The most challenging aspect about neuroethics is that (...) the technology used by neuroscientists needs to be understood in order to offer responsible neuroethical critique. The technocentricity of neuroscience makes it especially vulnerable to broader market forces and the sway of political economy, all of which might be exacerbated by the recent fiscal melt down and recent trends in healthcare reform. These challenges are illustrated by investigational work exploring the use of deep brain stimulation in the minimally conscious state. (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)