Imagine that you have been asked to prepare an article in a psychology newslette
ID: 3445187 • Letter: I
Question
Imagine that you have been asked to prepare an article in a psychology newsletter on the ethical implications of learning enhancement. Write a reflection paper that discusses your own ethical viewpoint toward the use of brain enhancement. Some of the issues you might consider in preparing your paper are:
• What types of pharmaceutical enhancements are currently being used? Of these, which ones are commonly considered acceptable, which ones are controversial?
• What types of brain/computer interfaces have already taken place? What might be the future of such interfaces?
• Will brain enhancements be equally available to all diverse groups? What happens if they are not?
• Who controls how brains are enhanced and who receives enhancement?
Explanation / Answer
ETHICAL IMPLICATIONS OF BRAIN ENHANCEMENT IN PSYCHOLOGY
Neuroethics is an emerging field that in general deals with the ethics of neuroscience and the neuroscience of ethics. In particular, it is concerned with the ethical issues in the translation of neuroscience to clinical practice and in the public domain. Numerous ethical issues arise when healthy individuals use pharmacological substances known as pharmacological cognitive enhancers (PCEs) for non-medical purposes in order to boost higher-order cognitive processes such as memory, attention, and executive functions. However, information regarding their actual use, benefits, and harms to healthy individuals is currently lacking. Neuroethical issues that arise from their use include the unknown side effects that are associated with these drugs, concerns about the modification of authenticity and personhood, and as a result of inequality of access to these drugs, the lack of distributive justice and competitive fairness that they may cause in society. Healthy individuals might be coerced by social institutions that force them to take these drugs to function better. These drugs might enable or hinder healthy individuals to gain better moral and self-understanding and autonomy. However, how these drugs might achieve this still remains speculative and unknown. Hence, before concrete policy decisions are made, the cognitive effects of these drugs should be determined. The initiation of accurate surveys to determine the actual usage of these drugs by healthy individuals from different sections of the society is proposed. In addition, robust empirical research need to be conducted to delineate not only whether or not these drugs modify complex higher-order cognitive processes but also how they might alter important human virtues such as empathy, moral reasoning, creativity, and motivation in healthy people
THE USE OF PCEs BY HEALTHY INDIVIDUALS
As society becomes more dependent on technology and the boundaries between humanity and artificial intelligence become blurred, heavy demands are increasingly placed on the individuals' cognitive and physical functions. Thus among healthy individuals the pursuit to enhance cognition might become commonplace. To simply keep up with these ever increasing demands to overproduce, healthy individuals are resorting to ever more creative ways of boosting their cognition, using any means of improving their attention. Recent scientific and philosophical debates about human enhancement indicate a growing interest in PCEs,where healthy non-sleep deprived individuals are using medications that are licensed for patients with clinical disorders to enhance their cognitive functions.
Overview of this Paper
The aim of this paper is to give an overview of the neuroethical issues in pharmacological cognitive enhancement. The first section of this paper will give an overview of the reported use of PCEs. It will attempt to define the term cognitive enhancement and will describe how these drugs might alter higher-order cognitive processes. It then highlights the current reported trends in the use of these drugs by healthy individuals. The second section of the paper focuses on the neuroethical issues in pharmacological cognitive enhancement. These include the culture wars in the cognitive enhancement debate, the advantages and disadvantages of using these drugs non-medically, and the bioethical issues that might arise from their use such as coercion, the lack of distributive justice and informed consent, and the importance of implementing the principles of benevolence and non-malfeasance. The overview concludes on recommendations on how a balanced neuroethical analysis could benefit society, particularly the healthy individual.
WHAT IS COGNITIVE ENHANCEMENT?
There is currently no agreed definition of the term cognitive enhancement and it is unclear whether a principled enhancement and/or treatment distinction can be offered. However, the distinction between enhancement and treatment may relate to the former being concerned with healthy individuals attempting to improve their cognition through neuroscientific technologies such as the use of these drugs for non-medical purposes while the latter is concerned with treating patients with recognizable clinical disorders.This distinction is very blurred and needs further in-depth discussion, which is not addressed here. However, three useful definitions of cognitive enhancement have been proposed.
Definitions
An information-processing definition of enhancement argues that cognitive enhancement is the amplification or extension of core capacities of the mind through improvement or augmentation of internal and external information processing systems. A welfarist definition of enhancement argues that enhancement is any change in the biology or psychology of a person which increases the chances of leading a good life in the relevant set of circumstances.However, bioethicists do not agree with above definitions. They argue that enhancement is an intervention which is beyond what is necessary to sustain good health. Because healthy individuals are using these drugs non-medically to amplify their cognition and are in essence going beyond what is necessary to sustain their good health, PCEs can be seen as one form of cognitive enhancement. Other forms of enhancement techniques include exercise and coffee but they are not considered here.
Pharmacological Cognitive Enhancers (PCEs)
Current Interests
The argument that these drugs improve cognitive performance in healthy individuals has been widely reported in the media and in research. This has generated an increased interest among the general public, particularly among healthy individuals who might want to use these drugs non-medically, especially for boosting higher-order cognitive processes.
HIGHER ORDER COGNITIVE PROCESSES
Executive Functions
Higher-order cognitive processes include executive functions, which are a set of cognitive processes that enable humans to plan ahead, solve complex problems, shift between mental mind-sets, inhibit unhelpful responses, and update relevant information.
Working Memory
Working memory is the ability to hold temporarily relevant information active over a short interval and to manipulate this information online.
Neuropsychiatric Disorders
There are primary deficits in executive functions and working memory in a number of neuropsychiatric disorders.These cognitive deficits are sometimes a result of a traumatic brain injury or from clinical neuropsychiatric disorders such as schizophrenia, attention deficit hyperactivity disorder (ADHD), Parkinson's, or Alzheimer's disease (AD). When these disorders occur, the affected patients are impaired in the capacity to plan, maintain goals, shift between different goals, update goals in the light of new information, and filter out irrelevant information. Consequently, these patients suffer from impaired day-to-day cognitive functioning. In these patients, drugs that pharmacologically alter neurotransmitter modulation of cognition lead to improvements in attention, acquisition of new information, better executive functioning, and working memory. However, these drugs are reported to be increasingly used non-medically by healthy individuals for enhancing their cognition.
Current PCEs
Among healthy individuals, most popular PCEs include methylphenidate (®Ritalin), a dopamine (DA) and noradrenaline (NA) reuptake inhibitor; dextroamphetamine (®Adderall), a mixed amphetamine salt that increases DA, and is licensed for the treatment of ADHD; and modafinil (®Provigil), a wake-promoting drug with multiple mechanisms of action that is licensed for narcolepsy. Other drugs that improve cognition include atomoxetine (®Strattera), a selective NA reuptake inhibitor (SNRI); and guanfacine (®Tanex), a 2 adrenergic agonist. Furthermore, ampakine has excitatory effects on glutamate receptors, and induces long-term potentiating processes to improve learning and memory in AD patients and in some healthy volunteers. Cholinesterase inhibitors boost acetylcholine in the brain, and are moderately effective in regulating attention and memory in AD. In contrast, -blockers, that are prescribed to reduce anxiety in clinical patients, have been used by musicians to dampen physiological tremors in order to improve their performances on stage.
CURRENT TRENDS IN THE USE OF PCEs
Data from US Surveys
In the past few years, it has been reported that there has been an unprecedented rise in the use of PCEs among healthy university students and academicswho are aiming to improve their cognitive functions. More specifically, it has been reported that students are specifically taking PCEs to improve academic performance, and are framing their actions as both physically harmless and morally acceptable. For example, in the United States, 16% of college studentsand 8% of undergraduates reported having illicitly obtained and used prescription psychostimulants.Furthermore, a 2005 survey by the US National Institute on Drug Abuse (NIDA) found that 2.5% of 13- to 14-year-olds, 3.4% of 15- to 16-year-olds, and 5.1% of 17- to 18-year-olds abused methylphenidate. In 2009, the figures for these groups were 1.8, 3.6, and 2.1%, respectively. The 2012 report by NIDA showed that non-medical use of prescription and over-the-counter medicines still remain a significant part of the teen drug problem.[ According to the Monitoring The Future Study, which is a long-term epidemiological study that surveys trends in legal and illicit drug use among American adolescents and adults, 14.8% of high-school seniors used a prescription drug non-medically in the past year. Data for specific drugs show that the most commonly abused prescription drugs by teens are the psychostimulant Adderall and the pain reliever Vicodin.
Underachievers Using PCEs
The most recent figures show a rise in the illicit use of PCEs among male, academically underachieving studentsand the most up-to-date evidence suggests that young healthy individuals are obtaining psychostimulant drugs from illicit sources (e.g., from others who have prescriptions to these drugs as medications or they are purchasing them via the internet or street dealers).