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.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Walzer M., (1983), pp. 86–90 
We are interested in cognitive capacities, such as better focus, capacity to disregard irrelevant stimuli, fewer bias, risk assessment, compassion, and sense of fairness, rather than an improvement of general IQ.
Daniels N., (2008), p 34–36 
For more on the conceptual distinction between enhancement and treatment, see Juengst 1998 .
Crisp R., (2003), p. 758 
Since there will always be persons below the threshold (unless it is set unreasonably low, Juth N., (2013) 
What previously has been called the minimise insufficiency version of the principle of need (Juth 2013).
Juth N., (2003), p. 35 ,
Tännsjö T., (2014), p 184 
Carlsson P., et al. (2012), p 896 
Carlsson P., et al. (2012), p 894 and 900–902 
Segall S., (2010), p. 121 
Segall S., (2010), p. 121 
Unless one would like to say that whatever health care decides to do makes it a medical goal—but then it would of course become a truism.
It should be noted that while we do not speak of specific methods for cognitive enhancements in this article we would, given today’s technology and that of the near future, suggest that the most plausible method would be a combination of drugs and life-style (in this we include diet, exercise and education—both classical and more specific e.g., memory training, meditation.
Levy N. (2014), p. 293 ; Kahneman, D. and Tversky, A. (1984). “Choices, Values, and Frames”. American Psychologist 39 (4): 341–350. doi:10.1037/0003-066x.39.4.341 DOI:10.1037 %2 F0003-066x.39.4.341 . Kahneman D. (2011). Thinking, Fast and Slow. Macmillan. Bostrom, N., & Ord, T. (2006). The Reversal Test: Eliminating Status Quo Bias in Applied Ethics*. Ethics, 116(4), 656–679.
One could even claim that the point of (or value in) respecting autonomy is derived from the value of living an autonomous life. This seems to be an underlying assumption in Levy’s text that he does not argue in favour of (he does not even seem to be very aware of the distinction between autonomy conceived of as a right and as a value). For such an argument see Lindley R., (1986). 
Levy N., (2014), p. 293 
Levy N., (2014), p. 299 
Levy N., (2014), p. 295–97 
Daniels, N. 2008. Just health: Meeting health needs fairly. New York: Cambridge University Press.
Walzer, M. 1983. Spheres of justice: A defence of pluralism and equality. New York: Basic Books.
Williams, B. 1962. The idea of equality. In Philosophy, politics, and society, ed. P. Laslett and W.G. Runciman, 110–131. Oxford: Basil Blackwell.
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.
Swedish Health Care Act. (1982:763), 2 §.
Elmersjö, C.-A., and G. Helgesson. 2008. Notions of just health care at three Swedish hospitals. Medicine, Health Care and Philosophy 11: 145–151.
Buchanan, A., Brock, D., Daniels, N., and Wikler, D. 2000. From chance to choice—genetics and justice. Cambridge: Cambridge University Press.
Levy, N. 2014. Forced to be free? Increasing patient autonomy by constraining it. Journal of Medical Ethics 2014(40): 293–300.
Klingberg, T. 2007. Den översvämmade hjärnan. Stockholm: Natur och Kultur.
Hallowell, E. 2005. Overloaded circuits: Why smart people underperform. Harvard Business Review.
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.
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.
Arnsten, A.F. 2009. Stress signalling pathways that impair prefrontal cortex structure and function. Nature Review Neuroscience 10(6): 410–422.
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.
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.
Brock, G. (ed.). 1998. Necessary goods: Our responsibility to meet others’ needs. Lanham: Rowman & Littlefield Publishers, Inc.
Culyer, A.J., and A. Wagstaff. 1993. Equity and equality in health and health care. Journal of Health Economics 12: 431–457.
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. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-34033. Accessed 24 October 2012.
Gustavsson, E. 2014. From needs to health care needs. Health Care Analysis 22: 22–35.
Liss, L.-E. 1990. Health care need: Meaning and measurement. Linköping: Linköping University, Department of Health and Society.
Juth, N. 2013. Challenges for principles of needs in health care. Health Care Analysis. doi:10.1007/s10728-013-0242-7.
Casal, P. 2007. Why sufficiency is not enough. Ethics 117: 296–326.
Segall, S. 2010. Health, luck, and justice. Princeton: Princeton University Press.
De Grazia, D. 2005. Human identity and bioethics. New York: Cambridge University Press.
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.
Fröding, B. 2013. Virtue ethics and human enhancement. Springer Briefs in Ethics, 2013, 2013, XVI, 85 p., ISBN 978-94-007-5671-7.
Zito, K., and Scheuss, V. 2007. NMDA receptor function and physiological modulation. The new Encyclopedia of Neuroscience (Squire L, ed), 276–283.
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.
Alton, E., Ferrari, S., and Griesenbach, U. 2007. Progress and prospects series editors. Gene Therapy 14: 1555–1563. doi:10.1038/sj.gt.3303033.
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.
Crisp, R. 2003. Equality, priority, and compassion. Ethics 113: 745–763.
Daniels, N. Normal functioning and the treatment-enhancement distinction. Cambridge Quarterly Healthcare Ethics, 9, 309–322.
Juth, N. 2003. Insurance companies access to genetic information: why regulation alone is not enough. Monash Bioethics Review 22: 25–41.
Parfit, D. 1997. Equality and priority. Ratio 10: 202–221.
Parfit, D. 2013. Another defence of the priority view. Utilitas 24: 399–440.
Tännsjö, T. 2014. Priority Setting in Health Care. Normative Ethics Meets Medical Ethics. Unpublished manuscript.
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.) http://www.regeringen.se/content/1/c6/20/25/65/36dbeb36.pdf (Accessed 2014-05-14).
Schramme, T. 2007. The significance of the concept of disease for justice in health care. Theoretical Medicine and Bioethics 28: 121–135.
Nordenfelt, L. 1987. On the nature of health. Dordrecht: D. Reidel Publishing Company.
Juth, N. 2012. Genetic information—values and rights: The morality of presymptomatic genetic testing. Saarbrücken: Lambert Academic Publishing.
The World Economic Forum issues a Global Risks Report listing the biggest threats to our future prosperity and security. http://www3.weforum.org/docs/WEF_GlobalRisks_Report_2013.pdf.
Missimer, M. 2013. The social dimension of strategic sustainable development. Licentiate Dissertation, Blekinge Institute of Technology.
Lindley, R. 1986. Autonomy. London: Macmillan Education Ltd.
Singh, S., and E. Ernst. 2009. Trick or treatment? Alternative medicine on trial. London: Corgi Books.
Schwartz, B. 2004. The paradox of choice: Why less is more. New York: Harper Collins.
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.
Fröding, B., Osika, W. 2015. Mental training and meditation as neuroenhancers: a virtue ethics perspective. Forthcoming on Springer.
About this article
Cite this article
Fröding, B., Juth, N. Cognitive Enhancement and the Principle of Need. Neuroethics 8, 231–242 (2015). https://doi.org/10.1007/s12152-015-9234-7
- Cognitive capacities
- Goals of health care
- Principle of need