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)

Addiction is increasingly described as a “chronic and relapsing brain disease”. The potential impact of the brain disease model on the treatment of addiction or addicted individuals’ treatment behaviour remains uncertain. We conducted a qualitative study to examine: (i) the extent to which leading Australian addiction neuroscientists and clinicians accept the brain disease view of addiction; and (ii) their views on the likely impacts of this view on addicted individuals’ beliefs and behaviour. Thirty-one Australian addiction neuroscientists and clinicians (10 females (...) and 21 males; 16 with clinical experience and 15 with no clinical experience) took part in 1 h semi-structured interviews. Most addiction neuroscientists and clinicians did not uncritically support the use of brain disease model of addiction. Most were cautious about the potential for adverse impacts on individuals’ recovery and motivation to enter treatment. While some recognised the possibility that the brain disease model of addiction may provide a rationale for addicted persons to seek treatment and motivate behaviour change, Australian addiction neuroscientist and clinicians do not assume that messages about “diseased brains” will always lead to increased treatment-seeking and reduced drug use. Research is needed on how neuroscience research could be used in ways that optimise positive outcomes for addicted persons. (shrink)

This book critically explores and analyses the scientific and ethical debates surrounding cognitive enhancers. Including contributions from neuroscientists, neuropsychopharmacologists, ethicists, philosophers, public health professionals, and policy researchers, the book offers a multidisciplinary, critical consideration of this topic.

Neuroscience research has improved our understanding of the long term consequences of sports-related concussion, but ethical issues related to the prevention and management of concussion are an underdeveloped area of inquiry. This article exposes several examples of conflicts of interest that have arisen and been tolerated in the management of concussion in sport (particularly professional football codes) regarding the use of computerized neuropsychological (NP) tests for diagnosing concussion. Part 1 outlines how the recommendations of a series of global protocols for (...) dealing with sports-related concussions (the 1st, 2nd and 3rd Consensus Statements on Concussion in Sport) have endorsed the use of NP testing. The development of these protocols has involved experts who have links with companies that sell computerised NP tests for concussion management. Part 2 describes how some professional football leagues—in particular the National Football League (NFL), the Australian Football League (AFL) and the National Rugby League (NRL)—have mandated specific NP testing products. They have done so on the basis of these international guidelines and by engaging experts who have conflicts of interest with NP testing companies. These decisions have also been taken despite evidence that casts doubt on the reliability and validity of NP tests when used in these ways. (shrink)

Debates about the ethical and social implications of research that aims to extend human longevity by intervening in the ageing process have paid little attention to the attitudes of members of the general public. In the absence of empirical evidence, conflicting assumptions have been made about likely public attitudes towards life-extension. In light of recent calls for greater public involvement in such discussions, this target article presents findings from focus groups and individual interviews which investigated whether members of the general (...) public identify ethical issues surrounding life-extension, and if so, what these ethical issues are? In this study, while some participants were concerned primarily with the likely personal consequences of life-extension, for others the question of whether or not to pursue interventions to extend longevity, and how they should be implemented, clearly raised important ethical issues, many of which have been prominent in debates among bioethicists. (shrink)

Brian Earp and colleagues argue that the major harms associated with the use of illicit drugs largely arise from, or are at least exacerbated by, the fact that their use attracts criminal pe...

Deep brain stimulation (DBS) has been proposed as a potential treatment of drug addiction on the basis of its effects on drug self-administration in animals and on addictive behaviours in some humans treated with DBS for other psychiatric or neurological conditions. DBS is seen as a more reversible intervention than ablative neurosurgery but it is nonetheless a treatment that carries significant risks. A review of preclinical and clinical evidence for the use of DBS to treat addiction suggests that more animal (...) research is required to establish the safety and efficacy of the technology and to identify optimal treatment parameters before investigating its use in addicted persons. Severely addicted persons who try and fail to achieve abstinence may, however, be desperate enough to undergo such an invasive treatment if they believe that it will cure their addiction. History shows that the desperation for a cure of addiction can lead to the use of risky medical procedures before they have been rigorously tested. In the event that DBS is used in the treatment of addiction, we provide minimum ethical requirements for clinical trials of its use in the treatment of addiction. These include: restrictions of trials to severely intractable cases of addiction; independent oversight to ensure that patients have the capacity to consent and give that consent on the basis of a realistic appreciation of the potential benefits and risks of DBS; and rigorous assessments of the effectiveness and safety of this treatment compared to the best available treatments for addiction. (shrink)

Lewis’ neurodevelopmental model provides a plausible alternative to the brain disease model of addiction that is a dominant perspective in the USA. We disagree with Lewis’ claim that the BDMA is unchallenged within the addiction field but we agree that it provides unduly pessimistic prospects of recovery. We question the strength of evidence for the BDMA provided by animal models and human neuroimaging studies. We endorse Lewis’ framing of addiction as a developmental process underpinned by reversible forms of neuroplasticity. His (...) view is consistent with epidemiological evidence of addicted individuals ‘maturing out’ and recovering from addiction. We do however hold some reservations about Lewis’ model. We do not think that his analysis of the neurobiological evidence is clearly different from that of the BDMA or that his neurodevelopmental model provides a more rigorous interpretation of the evidence than the BDMA. We believe that our understanding of the neurobiology of drug use is too immature to warrant the major role given to it in the BDMA. Our social research finds very mixed support for the BDMA among addicted people and health professionals in Australia. Lewis’ account of addiction requires similar empirical evaluation of its real-world implications. (shrink)

There is growing evidence that dopamine replacement therapy (DRT) used to treat Parkinson’s Disease can cause compulsive behaviours and impulse control disorders (ICDs), such as pathological gambling, compulsive buying and hypersexuality. Like more familiar drug-based forms of addiction, these iatrogenic disorders can cause significant harm and distress for sufferers and their families. In some cases, people treated with DRT have lost their homes and businesses, or have been prosecuted for criminal sexual behaviours. In this article we first examine the evidence (...) that these disorders are caused by DRT. If it is accepted that DRT cause compulsive or addictive behaviours in a significant minority of individuals, then the following ethical and clinical questions arise: Under what circumstances is it ethical to prescribe a medication that may induce harmful compulsive behaviours? Are individuals treated with DRT morally responsible and hence culpable for harmful or criminal behaviour related to their medication? We conclude with some observations of the relevance of DRT-induced ICDs for our understanding of addiction and identify some promising directions for future research and ethical analysis. (shrink)

The authors comments on several articles on addiction. Research suggests that addicted individuals have substantial impairments in cognitive control of behavior. The authors maintain that a proper study of addiction must include a neurobiological model of addiction to draw the attention of bioethicists and addiction neurobiologists. They also state that more addiction neuroscientists like S. E. Hyman are needed as they understand the limits of their research. Accession Number: 24077921; Authors: Carter, Adrian 1; Email Address: [email protected] Hall, Wayne 1; Affiliations: (...) 1: The University of Queensland, Brisbane, Australia; Subject: EDITORIALS; Subject: ADDICTIONS; Subject: BEHAVIOR; Subject: HYMAN, S. E.; Subject: NEUROBIOLOGISTS; Subject: NEUROSCIENTISTS; Number of Pages: 3p. (shrink)

Developments in the field of neuroscience, according to its proponents, offer the prospect of an enhanced understanding and treatment of addicted persons. Consequently, its advocates consider that improving public understanding of addiction neuroscience is a desirable aim. Those critical of neuroscientific approaches, however, charge that it is a totalising, reductive perspective–one that ignores other known causes in favour of neurobiological explanations. Sociologist Nikolas Rose has argued that neuroscience, and its associated technologies, are coming to dominate cultural models to the extent (...) that 'we' increasingly understand ourselves as 'neurochemical selves'. Drawing on 55 qualitative interviews conducted with members of the Australian public residing in the Greater Brisbane area, we challenge both the 'expectational discourses' of neuroscientists and the criticisms of its detractors. Members of the public accepted multiple perspectives on the causes of addiction, including some elements of neurobiological explanations. Their discussions of addiction drew upon a broad range of philosophical, sociological, anthropological, psychological and neurobiological vocabularies, suggesting that they synthesised newer technical understandings, such as that offered by neuroscience, with older ones. Holding conceptual models that acknowledge the complexity of addiction aetiology into which new information is incorporated suggests that the impact of neuroscientific discourse in directing the public's beliefs about addiction is likely to be more limited than proponents or opponents of neuroscience expect. (shrink)

The diagnosis of Fetal Alcohol Spectrum Disorders is embedded in a matrix of biological, social and ethical processes, making it an important topic for crossdisciplinary social and ethical research. This article reviews different branches of research relevant to understanding how FASD is identified and defined and outlines a framework for future social and ethical research in this area. We outline the character of scientific research into FASD, epidemiological discrepancies between reported patterns of maternal alcohol consumption during pregnancy and the incidence (...) of FASD, and the social and ethical considerations that may impact on who is, and is not, diagnosed. We highlight what further research investigating FASD diagnostic processes, as well as the multi-generational impacts of FASD, is needed. Important research priorities are to: 1) enumerate the variety of stakeholders involved in seeking FASD diagnoses; 2) understand the experiences and perspectives of mothers from different backgrounds who have consumed alcohol during pregnancy and their affected children; and 3) collect health histories of maternal alcohol consumption in families to determine the effect of FASD at sub-cultural and cultural levels. (shrink)

If one believes that the brain is, in some as yet unspecified way, the organ of mind and behaviour, then all human behaviour has a neurobiological basis. Neuroscience research over the past several decades has provided more specific reasons for believing that many addictive phenomena have a neurobiological basis. The major psychoactive drugs of dependence have been shown to act on neurotransmitter systems in the brain (Nutt 1997; Koob 2000); common neurochemical mechanisms underlie many of the rewarding effects of these (...) drugs and the phenomena of tolerance and withdrawal symptoms (Hyman & Malenka 2001; Koob 2000), and there is evidence for a genetic vulnerability to addiction (Nestler 2001; Uhl 1999) that is mediated by genes that regulate the metabolism of psychoactive drugs and the brain neurotransmitter systems on which they act (Uhl 1999). (shrink)

Impaired control over drug use is a defining characteristic of addiction in the major diagnostic systems. However there is significant debate about the extent of this impairment. This qualitative study examines the extent to which leading Australian addiction neuroscientists and clinicians believe that addicted individuals have control over their drug use and are responsible for their behaviour. One hour semi-structured interviews were conducted during 2009 and 2010 with 31 Australian addiction neuroscientists and clinicians (10 females and 21 males; 16 with (...) clinical experience and 15 with no clinical experience). Although many addiction neuroscientists and clinicians described uncontrolled or compulsive drug use as characteristic of addiction, most were ambivalent about whether or not addicted people could be said to have no control of their drug use. Most believed that addicted individuals have fluctuating levels of impaired control over their drug use but they nonetheless believed that addicted persons were responsible for their behaviour, including criminal behaviour engaged in to fund their drug use. Addiction was not seen as exculpating criminal behaviour but as a mitigating factor. (shrink)

Head injuries are an inherent risk of participating in the major collision sports played in Australia. Protocols introduced by the governing bodies of these sports are ostensibly designed to improve player safety but do not prevent players suffering from repeated concussions. There is evidence that repeated traumatic brain injuries increase the risk of developing a number of long term problems but scientific and popular debates have largely focused on whether there is a causal link between concussion and chronic traumatic encephalopathy. (...) We argue that the governing bodies of collision sports played in Australia have used uncertainty about CTE to justify a “wait and see” approach instead of attempting to prevent repeated head injuries. This stance is difficult to defend when these governing bodies claim to give a high priority to protecting player welfare. (shrink)

As the world's population ages, governments and non-governmental organizations in developed countries are promoting healthy cognitive ageing to reduce the rate of age-related cognitive decline and sustain economic productivity in an ageing workforce. Recommendations from the Productivity Commission, Dementia Australia, Government Office for Science, Presidential Commission for the Study of Bioethical Issues, Institute of Medicine, among others, are encouraging older adults to engage in mental, physical, and social activities. These lifestyle recommendations for healthy cognitive ageing are timely and well supported (...) by scientific evidence but they make implicit normative judgments about the responsibility of ageing individuals to prevent cognitive decline. Ethical tensions arise when this individual responsibility collides with social and personal realities of ageing populations. First, we contextualize the priority given to healthy cognitive ageing within the current brain-based medical and social discourses. Second, we explore the individual responsibility by examining the economic considerations, medical evidence and individual interests that relate to the priority given to healthy cognitive ageing. Third, we identify three key ethical challenges for policymakers seeking to implement lifestyle recommendations as an effective population-level approach to healthy cognitive ageing. The result is a prospectus for future in-depth analysis of ethical tensions that arise from current policy discussions of healthy cognitive ageing. (shrink)

Lack of guidance and regulation for authorizing medical cannabis for conditions involving the health and neurodevelopment of children is ethically problematic as it promulgates access inequities, risk-benefit inconsistencies, and inadequate consent mechanisms. In two virtual sessions using participatory action research and consensus-building methods, we obtained perspectives of stakeholders on ethics and medical cannabis for children and youth. The sessions focused on the scientific and regulatory landscape of medical cannabis, surrogate decision-making and assent, and the social and political culture of medical (...) cannabis. We found that evidence-gathering and data dissemination, pressures on clinical relationships, and the lack of integration of culturally diverse perspectives and Indigenous knowledges were key areas of concern. Participants emphasized the importance of utilizing adaptive study designs, highlighted the importance of trust-building between clinicians, patients and caregivers, and discussed barriers including historical and ongoing stigmatization of medical cannabis. We conclude that continued public consultation and strength-based research that integrate diverse perspectives are critical steps forward. (shrink)

The American Journal of Bioethics, Volume 11, Issue 12, Page 66-67, December 2011.

The misuse of alcohol inflicts a major toll on individual users, their families, and the wider society. This includes disruptions of family life, violence, absenteeism and problems in the workplace, child neglect and abuse, and excess morbidity and mortality. The World Health Organization estimates that alcohol ranks eighth among global risk factors for death and is the third leading global risk factor for disease and disability. In the United States, alcohol dependence affects four to five percent of the population at (...) any given time. Alcohol dependence also exacts a significant financial toll.... (shrink)

Debates about the ethical and social implications of research that aims to extend human longevity by intervening in the ageing process have paid little attention to the attitudes of members of the general public. In the absence of empirical evidence, conflicting assumptions have been made about likely public attitudes towards life-extension. In light of recent calls for greater public involvement in such discussions, this target article presents findings from focus groups and individual interviews which investigated whether members of the general (...) public identify ethical issues surrounding life-extension, and if so, what these ethical issues are? In this study, while some participants were concerned primarily with the likely personal consequences of life-extension, for others the question of whether or not to pursue interventions to extend longevity, and how they should be implemented, clearly raised important ethical issues, many of which have been prominent in debates among bioethicists. (shrink)

Name der Zeitschrift: Jahrbuch für Wissenschaft und Ethik Jahrgang: 19 Heft: 1 Seiten: 163-188.

Viet Nam has experienced rapid social change over the last decade, with a remarkable decline in fertility to just below replacement level. The combination of fertility decline, son preference, antenatal sex determination using ultrasound and sex selective abortion are key factors driving increased sex ratios at birth in favour of boys in some Asian countries. Whether or not this is taking place in Viet Nam as well is the subject of heightened debate. In this paper, we analyse the nature and (...) determinants of sex ratio at birth in Viet Nam, including a small family size norm, recent reinforcement by the Government of the "one-to-two child" family policy, traditional son preference, easy access to antenatal ultrasound screening and legal abortion, and an increase in the proportion of one-child families. In order to prevent an increased sex ratio at birth in Viet Nam, we argue for the relaxation of the one-to-two child family policy and a return to the policy of "small family size" as determined by families, in tandem with a comprehensive approach to promoting the value of women and girls in society, countering traditional gender roles, and raising public awareness of the negative social consequences of a high sex ratio at birth. (shrink)

The American Journal of Bioethics, Volume 12, Issue 2, Page 12-14, February 2012.

Australia does not allow adult smokers to buy or use electronic nicotine delivery systems that contain nicotine without a prescription. This paper critically evaluates the empirical and ethical justifications provided for the policy by Federal and State governments, public health advocates and health organisations. These are: that ENDS should only be approved as products for smoking cessation when there is evidence from randomised controlled trials that they are effective; that as a matter of precaution we should not allow the sale (...) of ENDS to smokers as consumer products because we do not know what their long-term effects will be; and that allowing ENDS to be sold as consumer goods will enable the tobacco industry to market ENDS to young people which will also lead to an increase in youth smoking. We show that the arguments and evidence offered in support of all these claims is very weak. We also argue that even if the evidence were stronger, it would not justify denying adult smokers the right to use ENDS either to quit smoking or as a long-term alternative to smoking cigarettes. We outline ENDS policies that would more ethically address the public health concerns that motivated the current policy by allowing adult smokers to access ENDS for smoking cessation or tobacco harm reduction under tight regulations that discourage commercial promotion and adolescent use. (shrink)