Abstract
Within the broad field of human enhancement, pediatric cognitive neuro-enhancement appears to arouse particular interest. The increasing importance of cognitive capacities in our contemporary and cultural context appears to be the main reason for the focus on cognition as the preferred trait of enhancement, while the choice of pharmacological means is based on factors of feasibility, accessibility, and cost. While the ethical issues arising in the adult context have already been extensively covered in the literature, pediatric neuro-enhancement brings with it additional ethical challenges requiring further attention. Although there are numerous important ethical considerations, the focus of this chapter is on the pursuit of normalcy as the goal in pediatric neuro-enhancement. Parental attempts to shape children are not new, and the resources available for them to do so include widespread and mostly uncontroversial tools, such as education. The increasing use of psychotropic drugs, however, reveals the significant impact of the concept of normalcy, which has resulted in a trend to medicalize what used to be considered “normal” (childhood) behavior. In this context, special challenges are posed by psychiatric disorders, where the familiar treatment-enhancement distinction continues to be relied upon to justify interventions in children. Drawing on the examples of attention deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD), it will be argued that children are already being enhanced within psychiatric practice and that this is incompatible with an understanding of disability under a mixed model.
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Notes
- 1.
The use of potential performance enhancing drugs is not a new phenomenon: substances such as amphetamines and cocaine have a long history of being used for this purpose: see Bell et al. (2012).
- 2.
However, as will be discussed below, a lack of diagnostic clarity means that medication might be administered even in the absence of a valid diagnosis, which would effectively amount to neuro-enhancement, or that a diagnosis is only given to permit prescription, while in other cases diagnosis might be medically justified. For this reason, too heavy reliance on “healthy person” within the definition of neuro-enhancement is somewhat difficult.
- 3.
There is an abundance of literature on this topic; however, a detailed review of the treatment/enhancement debate is beyond the scope of this chapter. For further information on the debate see Harris (2007).
- 4.
Full consideration of these issues is beyond the scope of this Chapter, which has as its focus the pediatric context. For an interdisciplinary overview, see Hildt and Franke (2013). In addition, questions of distributive justice and fairness are relevant on a collective level.
- 5.
It might be objected that it seems bizarre that if there is nothing morally wrong with an enhancement method, it should not be permissible. The reasons for this will be addressed in the next section.
- 6.
This is not to argue that something only becomes a medical condition once it is labeled as such, but it illustrates how culture and context affect what is perceived as a condition warranting intervention.
- 7.
It is important to note that sadness is but one of the diagnostic criteria for major depressive disorder. Others include diminished interest or pleasure in activities and feelings of worthlessness or guilt.
- 8.
This means a preference to be referred to as an “autistic” rather than as “a person with autism.” A similar preference exists in part of the Deaf community.
- 9.
Whether or not it will be deemed morally permissible will depend on the facts of the case and would have to be determined through a careful weighing of risks and benefits, as well as consideration of the preferences of the child in as far as this is feasible. In addition, relational aspects matter: for example, where the parents and other family members are harmed as a result of the child’s behavior, intervention might become justifiable.
- 10.
Arguably, if education were (mis)used in such a way, it would no longer be education in the proper meaning of the term.
- 11.
That is, for instance, to confer a competitive advantage to the child in comparison to his or her peers.
- 12.
Dawson herself was diagnosed with ASD as an adult and has continuously challenged the scientific foundation of ABA-based autism interventions. She has also challenged the medical necessity of such an intervention in the Supreme Court of Canada in the case of Auton v. British Columbia.
- 13.
Other ethical concerns are those based on justice and/or fairness, which typically arise whenever resources are limited or access is restricted. Since this applies to most if not all health-related interventions, they are excluded in the present context for brevity’s sake and the focus is instead on those types of concerns that arise in the specific context of pediatric neuro-enhancement. This is not to imply, however, that justice and fairness are less important in the overall ethical debate.
- 14.
I am grateful to an anonymous reviewer for this suggestion.
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Krutzinna, J. (2019). Shaping Children: The Pursuit of Normalcy in Pediatric Cognitive Neuro-enhancement. In: Nagel, S. (eds) Shaping Children. Advances in Neuroethics. Springer, Cham. https://doi.org/10.1007/978-3-030-10677-5_2
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