, Volume 8, Issue 3, pp 231–242 | Cite as

Cognitive Enhancement and the Principle of Need

  • Barbro Fröding
  • Niklas Juth


In this article we argue that

(i) the principle of need, on some interpretations, could be used to justify the spending of publically funded health care resources on cognitive enhancement and

(ii) that this also holds true for individuals whose cognitive capacities are considered normal.

The increased, and to an extent, novel demands that the modern technology and information society places on the cognitive capacities of agents, e.g., regarding good and responsible decision-making, have blurred the line between treatment and enhancement. More specifically, it has shifted upwards. As a consequence, principles of need on their most reasonable interpretations can be used to support publically funded cognitive enhancement. At least this is so, if broader aims than curing and ameliorating diseases are included in the goals of health care. We suggest that it would be plausible to see health care as accepting such broader goals already today.


Cognitive capacities Egalitarianism Enhancement Goals of health care Principle of need Prioritizations 


  1. 1.
    Daniels, N. 2008. Just health: Meeting health needs fairly. New York: Cambridge University Press.Google Scholar
  2. 2.
    Walzer, M. 1983. Spheres of justice: A defence of pluralism and equality. New York: Basic Books.Google Scholar
  3. 3.
    Williams, B. 1962. The idea of equality. In Philosophy, politics, and society, ed. P. Laslett and W.G. Runciman, 110–131. Oxford: Basil Blackwell.Google Scholar
  4. 4.
    Crisp, R. 2002. Treatment according to need: Justice and the British National Health Service. In Medicine and social justice. Essays on the distribution of health care, ed. R. Rosamond, M.P. Battin, and M. Silvers, 134–143. New York: Oxford University Press.Google Scholar
  5. 5.
    Swedish Health Care Act. (1982:763), 2 §.Google Scholar
  6. 6.
    Elmersjö, C.-A., and G. Helgesson. 2008. Notions of just health care at three Swedish hospitals. Medicine, Health Care and Philosophy 11: 145–151.CrossRefGoogle Scholar
  7. 7.
    Buchanan, A., Brock, D., Daniels, N., and Wikler, D. 2000. From chance to choice—genetics and justice. Cambridge: Cambridge University Press.Google Scholar
  8. 8.
    Levy, N. 2014. Forced to be free? Increasing patient autonomy by constraining it. Journal of Medical Ethics 2014(40): 293–300.Google Scholar
  9. 9.
    Klingberg, T. 2007. Den översvämmade hjärnan. Stockholm: Natur och Kultur.Google Scholar
  10. 10.
    Hallowell, E. 2005. Overloaded circuits: Why smart people underperform. Harvard Business Review.Google Scholar
  11. 11.
    Stenfors, C., Magnusson Hanson, L., Theorell, T., Oxenstierna, G., and Nilsson, L.-G. 2013. Psychosocial working conditions and cognitive complaints among swedish employees. PLoS One, 8(4). doi: 10.1371/journal.pone.0060637.
  12. 12.
    Elovainio, M., Ferrie, J.E., Singh-Manoux, A., et al. 2009. Cumulative exposure to high-strain and active jobs as predictors of cognitive function: the Whitehall II study. Occupational and Environmental Medicine 66(1): 32–37.Google Scholar
  13. 13.
    Arnsten, A.F. 2009. Stress signalling pathways that impair prefrontal cortex structure and function. Nature Review Neuroscience 10(6): 410–422.CrossRefGoogle Scholar
  14. 14.
    Sandström, A., Rhodin I.N., Lundberg, M., et al. 2005. Impaired cognitive performance in patients with chronic burnout syndrome. Biological Psychology 69(3): 271–279. doi: 10.1016/j.biopsycho.2004.08.003.
  15. 15.
    Lupien, S.J., Maheu, F., Tu, M., et al. 2007. The effects of stress and stress hormones on human cognition: implications for the field of brain and cognition. Brain and Cognition 65(3): 209–237.Google Scholar
  16. 16.
    Brock, G. (ed.). 1998. Necessary goods: Our responsibility to meet others’ needs. Lanham: Rowman & Littlefield Publishers, Inc.Google Scholar
  17. 17.
    Culyer, A.J., and A. Wagstaff. 1993. Equity and equality in health and health care. Journal of Health Economics 12: 431–457.CrossRefGoogle Scholar
  18. 18.
    Mårtensson, J., Carlsson, P., Arvidsson, E., 2006. Experiences of, knowledge about and attitudes towards prioritizations—an interview study with personnel from primary care. In Swedish: Erfarenhet, kunskap och inställning till prioriteringar—en intervjustudie med personal från primärvården. CMT Rapport 2006:3. Linköping: University of Linköping. Accessed 24 October 2012.
  19. 19.
    Gustavsson, E. 2014. From needs to health care needs. Health Care Analysis 22: 22–35.CrossRefGoogle Scholar
  20. 20.
    Liss, L.-E. 1990. Health care need: Meaning and measurement. Linköping: Linköping University, Department of Health and Society.Google Scholar
  21. 21.
    Juth, N. 2013. Challenges for principles of needs in health care. Health Care Analysis. doi: 10.1007/s10728-013-0242-7.Google Scholar
  22. 22.
    Casal, P. 2007. Why sufficiency is not enough. Ethics 117: 296–326.CrossRefGoogle Scholar
  23. 23.
    Segall, S. 2010. Health, luck, and justice. Princeton: Princeton University Press.Google Scholar
  24. 24.
    De Grazia, D. 2005. Human identity and bioethics. New York: Cambridge University Press.Google Scholar
  25. 25.
    Juengst, E.T. 2003. “Enhancement uses of medical technology”. 3rd edition, Post, S G (ed.), Encyclopedia of Bioethics, Macmillan Reference USA, New York, 753 ff.Google Scholar
  26. 26.
    Fröding, B. 2013. Virtue ethics and human enhancement. Springer Briefs in Ethics, 2013, 2013, XVI, 85 p., ISBN 978-94-007-5671-7.Google Scholar
  27. 27.
    Zito, K., and Scheuss, V. 2007. NMDA receptor function and physiological modulation. The new Encyclopedia of Neuroscience (Squire L, ed), 276–283.Google Scholar
  28. 28.
    Tuszynski, M.H., Thal, L., Pay, M., et al. 2005. A phase 1 clinical trial of nerve growth factor gene therapy for Alzheimer disease. Nature Medicine 11: 551–555. doi: 10.1038/nm1239.
  29. 29.
    Alton, E., Ferrari, S., and Griesenbach, U. 2007. Progress and prospects series editors. Gene Therapy 14: 1555–1563. doi: 10.1038/
  30. 30.
    Juengst, E.T. 1998. “What does enhancement mean?”. In Enhancing human traits: Ethical and social implications, ed. E. Parens, 29–47. Washington DC: Georgetown University Press.Google Scholar
  31. 31.
    Crisp, R. 2003. Equality, priority, and compassion. Ethics 113: 745–763.CrossRefGoogle Scholar
  32. 32.
    Daniels, N. Normal functioning and the treatment-enhancement distinction. Cambridge Quarterly Healthcare Ethics, 9, 309–322.Google Scholar
  33. 33.
    Juth, N. 2003. Insurance companies access to genetic information: why regulation alone is not enough. Monash Bioethics Review 22: 25–41.CrossRefGoogle Scholar
  34. 34.
    Parfit, D. 1997. Equality and priority. Ratio 10: 202–221.CrossRefGoogle Scholar
  35. 35.
    Parfit, D. 2013. Another defence of the priority view. Utilitas 24: 399–440.CrossRefGoogle Scholar
  36. 36.
    Tännsjö, T. 2014. Priority Setting in Health Care. Normative Ethics Meets Medical Ethics. Unpublished manuscript.Google Scholar
  37. 37.
    Carlsson, P., Hoffmann, M., and Levin, L-Å. 2012. Prioritization and financing of drugs for treatment of patients with rare diseases. In Swedish: Prioritering och finansiering av läkemedel för behandling av patienter med sällsynta sjukdomar. Appendix 4 in the Official Governmental Inquiry (SOU) 2012:75. Price, Access, and Service—Continued Developments in the Drug- and Pharmaceutical Markets. (In Swedish: Pris, tillgång och service—fortsatt utveckling av läkemedels- och apoteksmarknaden.) (Accessed 2014-05-14).
  38. 38.
    Schramme, T. 2007. The significance of the concept of disease for justice in health care. Theoretical Medicine and Bioethics 28: 121–135.CrossRefGoogle Scholar
  39. 39.
    Nordenfelt, L. 1987. On the nature of health. Dordrecht: D. Reidel Publishing Company.CrossRefGoogle Scholar
  40. 40.
    Juth, N. 2012. Genetic information—values and rights: The morality of presymptomatic genetic testing. Saarbrücken: Lambert Academic Publishing.Google Scholar
  41. 41.
    The World Economic Forum issues a Global Risks Report listing the biggest threats to our future prosperity and security.
  42. 42.
  43. 43.
    Missimer, M. 2013. The social dimension of strategic sustainable development. Licentiate Dissertation, Blekinge Institute of Technology.Google Scholar
  44. 44.
    Lindley, R. 1986. Autonomy. London: Macmillan Education Ltd.CrossRefGoogle Scholar
  45. 45.
  46. 46.
    Singh, S., and E. Ernst. 2009. Trick or treatment? Alternative medicine on trial. London: Corgi Books.Google Scholar
  47. 47.
    Schwartz, B. 2004. The paradox of choice: Why less is more. New York: Harper Collins.Google Scholar
  48. 48.
    Scheibehenne, B., R. Greifeneder, and P.M. Todd. 2010. Can there ever be too many options? A meta‐analytic review of choice overload. Journal of Consumer Research 37(3): 409–425.CrossRefGoogle Scholar
  49. 49.
    Fröding, B., Osika, W. 2015. Mental training and meditation as neuroenhancers: a virtue ethics perspective. Forthcoming on Springer.Google Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2015

Authors and Affiliations

  1. 1.Department of PhilosophyRoyal Institute of Technology (KTH)StockholmSweden
  2. 2.Stockholm Centre for Healthcare EthicsKarolinska Institutet, LIMEStockholmSweden

Personalised recommendations