Abstract
Emerging data indicates the prevalence and increased use of pharmaceutical enhancements by young medical professionals. As pharmaceutical enhancements advance and become more readily available, it is imperative to consider their impact on medical professionals. If pharmaceutical enhancements augment a person’s neurological capacities to higher functioning levels, and in some situations having higher functioning levels of focus and concentration could improve patient care, then might medical professionals have a responsibility to enhance? In this paper, I suggest medical professionals may have a responsibility to use pharmaceutical enhancements. In some situations, having higher functioning levels of focus and concentration is conducive to providing the best possible care to a patient. In these circumstances medical professionals should use pharmaceutical cognitive enhancements. I conclude by examining the limitations and implications of this responsibility in the practice of medicine and areas for future research.
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Notes
For the present purposes of this article, I do not engage with issues and question concerning the treatment-enhancement distinction.
In respect to an anonymous reviewer’s comment, I would also make a further stipulation. Although cognitive enhancers augment some people’s capacities of focus and concentration, it does not follow that this augmentation will enhance their overall cognition. In other words, while these pharmaceutical enhancements may augment a person’s capacities of focus and concentration, it does not follow that these cognitive enhancers result in making him or her smarter or a better thinker. However, for the purposes of this project, I reasonably assume that augmenting a person’s capacities of focus and concentration is likely to be something that is conducive to at least creating the potential for a person to improve his or her overall cognition. But using a cognitive enhancer is not a necessary or sufficient condition for improvement of a person’s overall cognition.
It does not follow from my focus on the side effects of pharmaceutical stimulants that pharmaceutical non-stimulants are safer. Many of the side effects of non-stimulants mirror those of pharmaceutical stimulants. Traditionally, many held that since pharmaceutical non-stimulants were not amphetamine based, they were less dangerous in respect to addiction. However, there is a dispute on whether this is actually true. Since empirical studies and questions on the addictiveness of pharmaceutical non-stimulants have only recently begun, I remain neutral to the question of whether pharmaceutical non-stimulants are less addictive than pharmaceutical stimulants.
This study, however, does not include modafinil as it is not a stimulant.
This study included not just medical but also pharmacy and respiratory therapy students.
Although I have argued elsewhere that these are not the only or most interesting questions regarding cognitive enhancers (Enck 2013).
While the terms ‘obligation’ and ‘responsibility’ are often interchanged, for this paper, an obligation is understood at higher level of abstraction, and often more broad and generalized, whereas a responsibility is understood in a specific context and with more determinate content.
An anonymous reviewer succinctly made this point in an excellent comment “The best possible care is one that always balances the patient's interests against other's—other patients as well as vital doctor interests. If patients' health does not justify the imposition of unwanted treatment, why should doctors feel responsible to take medicines they do not wish to or that might harm them? If the best possible surgery is one that is carried out without gloves, does the doctor have a moral responsibility to operate without protective gloves?”.
I argue elsewhere that in some situations it is a person’s motivation for using a cognitive enhancer that can determine permissibility of using an enhancement (Enck 2013).
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Acknowledgments
This manuscript greatly benefited from the comments and input of Emily Statham, Christina E. Guajardo, Brittany Campbell, and Elizabeth Enck, as well as two anonymous reviewers for this journal. The Section of Integrated Ethics in cancer care at the University of Texas MD Anderson Cancer Center (MDACC) deserves praise since this manuscript would not have been possible without a clinical ethics fellowship and the department’s support of my neuroethics research. Also, I must thank all the members of the healthcare team that I have worked with over the past year in the Palliative Care Unit at MDACC. As a healthcare team and medical professionals, they exemplify—every day—what it means to provide patients and their caregivers with the best possible care, in the most difficult of times.
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Enck, G.G. Pharmaceutical enhancement and medical professionals. Med Health Care and Philos 17, 23–28 (2014). https://doi.org/10.1007/s11019-013-9507-z
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DOI: https://doi.org/10.1007/s11019-013-9507-z