Abstract
The debate on “cognitive enhancement” has moved from discussions about enhancement in adults to enhancement in children and adolescents. Similar to positions expressed in the adult context, some have argued that pediatric cognitive enhancement is acceptable and even laudable. However, the implications differ between the adult and the pediatric contexts. For example, in the debate over cognitive enhancement in adults, i.e., those who have legal majority, respect for autonomy demands that personal preferences not be overridden in absence of strong arguments because competent adults are in the best position to recognize and protect their own interests. However, the concepts of best interest and autonomy provide a different picture in the case of pediatric enhancement. In the context of decision-making involving minors, it is assumed that the parents are in the best position to promote and protect the interests of their children and this is chiefly why they are granted the authority to make decisions on their behalf. However, we argue in favor of guarding the physical integrity of children from intrusive medical interventions without medical need and with clear and detrimental effects (e.g., suppressing growth). We also support leaving open other legitimate life trajectory and career choices, as this is in the best interest of the child, even if they are less in line with the expectations of parents or success in educational settings. In addition, parental decision-making in favor of cognitive enhancement suffers from a lack of information about cognitive enhancers (e.g., safety and efficacy) and potential biases. Thus, bearing in mind these issues and the development of volitional capacities of children, we argue that pediatric enhancement is not a morally acceptable practice and “inevitability” can be curbed with clear and fair rules that establish duties of state representatives, physicians, and public institutions. We conclude by canvassing evidence-based policy options that could protect the open future of minors and define the parameters of parental decision-making analogous to the cases of nicotine and alcohol.
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- 1.
This could be read as a broadly Millian argument for autonomy. An even stronger one could be made with a Kantian notion of autonomy which assumes that considerations of autonomy trump considerations of beneficence because autonomy itself would be considered intrinsically valuable as an end in itself. We believe that our argument holds whichever version of autonomy one prefers, and thank an anonymous reviewer for the constructive comments which prompted us to make this point more explicit.
- 2.
It should be noted here that a similar argument has been made for the use of tDCS on minors by Maslen and colleagues (2014). For this reason, our argument will briefly mention noninvasive brain stimulation techniques and focus mostly on psychopharmacological interventions.
- 3.
Sports doping could also be seen as a sufficiently like case. We thank an anonymous reviewer for this example.
- 4.
Perhaps the best example of such a “pro-enhancement” position is the view of Jessica Fanigan. She argues that “it […] is morally praiseworthy for parents and physicians to choose to make existing children’s lives as good as they can be. This is not to say that parents and pediatricians are morally required to provide neuro-enhancements when they suspect that the drugs would be beneficial, but that it is beneficent to give children greater opportunities and to correct for existing disadvantages. Parents and pediatricians have rights to refuse to act beneficiently just as parents have rights to choose sub-optimal educational plans…” (Flanigan 2013: 333. Emphasis added).
- 5.
The higher the rating the more harmful the substance. Caffeine was not rated nor ranked as a potentially harmful substance at that time.
- 6.
It might be objected here that this argument has implications beyond the issue of enhancement, say in cases of risky contact sports, such as American Football. However, there is a considerable difference in ethical status of direct neurointerventions and enjoying physical activities. Even though, for lack of space, we cannot pursue this further, suffice it to say that children are initiators of physical activities, whereas outside interference is necessary for providing psychoactive substances or brain stimulation.
- 7.
For a longer argument focusing specifically on tDCS in pediatric context, see Maslen et al. (2014).
- 8.
If the the conditions of distribution for cognitive enhancement are developed in such a way that it will benefit the least advantaged, this conclusion might be changed. However, it remains to be seen if any realistic type of policy proposal successfully tackles these and other ethical objections to cognitive enhancement. We thank an anonymous reviewer for suggesting this point.
References
Austin MW (2016) Rights and obligations of parents. The Internet Encyclopedia of Philosophy, ISSN 2161-0002. http://www.iep.utm.edu/parentri. Accessed 26 Aug 2016
Banjo OC, Nadler R, Reiner PB (2010) Physician attitudes towards pharmacological cognitive enhancement: safety concerns are paramount. PLoS One 5(12):e14322
Bell SK, Lucke JC, Hall WD (2012) Lessons for enhancement from the history of cocaine and amphetamine use. AJOB Neurosci 3(2):24–29
Berman SM, Kuczenski R, McCracken JT, London ED (2009) Potential adverse effects of amphetamine treatment on brain and behavior: a review. Mol Psychiatry 14(2):123–142
Bigelow BC (2006) UXL encyclopedia of drugs and addictive substances. UXL/Thompson Gale, Detroit
Bikson M, Bestman S, Edwards S (2013) Neuroscience: transcranial devices are not playthings. Nature 501:167
Bostrom N, Ord T (2006) The reversal test: eliminating status quo bias in applied ethics. Ethics 116(4):656–679
Buchannan A (2011) Cognitive enhancement and education. Theory Res Educ 9(2):145–162
Conrad P, Bergey MR (2014) The impending globalization of ADHD: notes on the expansion and growth of a medicalised disorder. Soc Sci Med 122:31–43
Deaton A, Arora R (2009) Life at the top: the benefits of height. Econ Hum Biol 7(2):133–136
Dressler M, Repantis D (2015) Cognitive enhancement in humans. In: Knafo S, Venero C (eds) Cognitive enhancement. Elsevier, Academic, Amsterdam, pp 273–306
Dubljević V (2012a) Principles of justice as the basis for public policy on pycho-pharmacological cognitive enhancement. Law Innov Technol 4(1):67–83
Dubljević V (2012b) Toward a legitimate public policy on cognition-enhancement drugs. AJOB Neurosci 3(3):29–33
Dubljević V (2013a) Cognitive enhancement, rational choice and justification. Neuroethics 6(1):179–187
Dubljević V (2013b) Prohibition or coffee-shops: regulation of amphetamine and methylphenidate for enhancement use by healthy adults. Am J Bioeth 13(7):23–33
Dubljević V (2013c) Autonomy in neuroethics: political and not metaphysical. AJOB Neurosci 4(4):44–51
Dubljević V (2015) Neurostimulation devices for cognitive enhancement: toward a comprehensive regulatory framework. Neuroethics 8(2):115–126
Dubljević V, Saigle V, Racine E (2014) The rising tide of tDCS in the media and academic literature. Neuron 82(4):731–736
Durrant JE (1996) The Swedish ban on corporal punishment: its history and effects. Family violence against children: a challenge for society. Prevention and intervention in childhood and adolescence. Walter De Gruyter, Berlin, New York, pp 19–25
Fitz NS, Reiner PB (2013) The challenge of crafting policy for do-it-yourself brain stimulation. J Med Ethics. Epub ahead of print June 3, 2013. https://doi.org/10.1136/medethics-2013-101458
Flanigan J (2013) Adderall for all: a defense of pediatric neuroenhancement. HEC Forum 25:325–344
Gaucher N, Payot A, Racine E (2013) Cognitive enhancement in children and adolescents: is it in their best interests? Acta Paediatr 102:1118–1124
Graf WD, Nagel SK, Epstein LG, Miller G, Nass R, Larriviere D (2013) Pediatric neuroenhancement: ethical, legal, social, and neurodevelopmental implications. Neurology 80(13):1251–1260
Habermas J (2001) Die Zukunft der menschlichen Natur [Future of Human Nature]. Suhrkamp, Frankfurt am Main
Iuculcano T, Cohen Kadosh R (2013) The mental cost of cognitive enhancement. J Neurosci 33(10):4482–4486
Krutzinna J (2016) Can a welfarist approach be used to justify a moral duty to cognitively enhance children? Bioethics 30(7):528–535
Leslie K (2008) Alcohol and drug use among teenagers. Can Med Assoc J 178(2):149
Lieb K (2010) Hirndoping: Warum wir nicht alles schlucken sollten. Artemis & Winkler, Mannheim
Maslen H, Earp BD, Cohen Kadosh R, Savulescu J (2014) Brain stimulation for treatment and enhancement in children: an ethical analysis. Front Hum Neurosci 8:953. https://doi.org/10.3389/fnhum.2014.00953
Morin K, Rakatansky H, Riddick FA, Morse LJ, O’Bannon JM, Goldrich MS et al (2002) Managing conflicts of interest in the conduct of clinical trials. J Am Med Assoc 287(1):78–84
Nutt D, King L, Saulsbury AW, Blakemore C (2007) Development of a rational scale to assess the harm of drugs of potential misuse. Lancet 369(9566):1047–1053
Peck P (2004) Cosmetic surgery in adolescents a booming, yet controversial medical niche. Medscape Medical News, Oct 13, 2004. http://www.medscape.com/viewarticle/491266
Racine E (2010) Pragmatic neuroethics: improving treatment and understanding of the mind-brain. MIT Press, Cambridge
Ruxton CHS (2014) The suitability of caffeinated drinks for children: a systematic review of randomised controlled trials, observational studies and expert panel guidelines. J Hum Nutr Diet 27:342–357
Sahakian B, Morein-Zamir S (2007) Professor’s little helper. Nature 450:1157–1159
Sandel MJ (2007) The case against perfection: ethics in the age of genetic engineering. Belknap Press of Harvard University Press, Cambridge
Savulescu J (2006) Justice, fairness and enhancement. Ann N Y Acad Sci 1093:321–338
Savulescu J, Foddy B, Clayton M (2004) Why we should allow performance enhancing drugs in sport. Br J Sports Med 38(6):666–670
Singh I, Kelleher KJ (2010) Neuroenhancement in young people: proposal for research, policy, and clinical management. AJOB Neurosci 1(1):3–16
Steenbergen L, Sellaro R, Hommel B, Lindenberger U, Khun S, Colzato LS (2016) Unfocus on foc.us: commercial tDCS headset impairs working memory. Exp Brain Res 234:637–643
Acknowledgments
Support for this work comes from the Banting Postdoctoral Fellowships Programme (Dubljević) and the Fonds de recherche du Québec—Santé for career awards (Racine). We extend our thanks to members of the Neuroethics Research Unit for feedback on previous versions of this manuscript. Special thanks to Matthew Sample for detailed constructive feedback on a previous version of this manuscript.
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Dubljević, V., Racine, E. (2019). Pediatric Neuro-enhancement, Best Interest, and Autonomy: A Case of Normative Reversal. In: Nagel, S. (eds) Shaping Children. Advances in Neuroethics. Springer, Cham. https://doi.org/10.1007/978-3-030-10677-5_13
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