• Bettina Schöne-Seifert
  • Davinia Talbot
Part of the International Library of Ethics, Law, and the New Medicine book series (LIME, volume 45)


According to available data, the use of medical – especially psychopharmacological – means for enhancing healthy individuals’ mood or cognitive function already seems popular among certain groups – and might well increase in the near future. This article sheds some light on ethical considerations for such a ‘neuro-enhancement’ practice. After a brief look at its history and at some of its conceptual difficulties, potential neuro-enhancement means are introduced to prepare the ground for debating ethical questions. Focus topics relating to self-chosen enhancements are risk-taking, autonomy or authenticity of the individual, a potential erosion of human nature or human virtue, issues of social fairness and latent social pressures. Focus topics relating to third-person-induced neuro-enhancement, in particular ‘improving’ children are concerns about a child’s best interests, its right to an open future and the proper limits of parental influence. Other ethical issues addressed in the paper are the role of doctors in neuro-enhancement, and matters of research policy in this field.


Deep Brain Stimulation Sleep Deprivation Cosmetic Surgery Professional Ethic Cognitive Enhancement 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.







cycloAMP Response Element Binding Protein


Deutsche Angestellten-Krankenkasse


Deep Brain Stimulation


Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen


National Institute for Health and Clinical Excellence




Selective Serotonin Reuptake Inhibitor


Transcranial Magnetic Stimulation



We would like to thank our research partners Thorsten Galert, Reinhard Merkel, Christoph Bublitz, Isabella Heuser and Dimitris Repantis with whom we cooperate in the project ‘Potentiale und Risiken des pharmazeutischen Enhancements psychischer Eigenschaften’ (Potentials and risks of pharmacologically enhancing psychological capacities) which is funded by the Federal Ministry of Education and Research (2007–2009). We are particularly grateful for Isabella Heuser’s brilliant suggestions on an earlier version of the manuscript. Further, we would like to thank our two unknown reviewers for their critical comments, and Silke Tandetzki for her help with the manuscript.


  1. Anderson J (2009) Neuro-Prothetik, der erweiterte Geist und die Achtung vor Personen mit Behinderung. In: Schöne-Seifert B et al (eds) Neuro-enhancement – Ethik vor neunen Herausforderungen. Mentis, PaderbornGoogle Scholar
  2. Appleby BS et al (2007) Psychiatric and neuropsychiatric adverse events associated with deep brain stimulation: a meta-analysis of ten years’ experience. Mov Disord 22(12):1722–1728, Sep 15CrossRefGoogle Scholar
  3. Babcock Q et al (2000) Student perceptions of methylphenidate abuse at a public liberal arts college. J ACH 49:143–145Google Scholar
  4. Barad M, Bourtchouladze R, Winder DG et al (1998) Rolipram, a type IV-specific phosphodiesterase inhibitor, facilitates the establishment of long-lasting long-term potentiation and improves memory. Proc Natl Acad Sci USA 95(25):15020–15025CrossRefGoogle Scholar
  5. Beracochea D et al (2003) Enhancement of learning processes following an acute modafinil injection in mice. Pharmacol Biochem Behav 76(3–4):473–479CrossRefGoogle Scholar
  6. Blech J (2003) Die Krankheitserfinder: Wie wir zu Patienten gemacht werden. Fischer, FrankfurtGoogle Scholar
  7. Bolt LLE (2007) True to oneself? Broad and narrow ideas on authenticity in the enhancement debate. Theor Med Bioeth 28:285–300CrossRefGoogle Scholar
  8. Brentrup A et al (2004) Alterations of sociomoral judgement and glucose utilization in the frontomedial cortex induced by electrical stimulation of the subthalamic nucleus (STN) in Parkinsonian patients. In: 55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), German Medical Science. Düsseldorf, Köln, Doc DI.06.06.
  9. Breggin PR (1995) Talking back to prozac: what doctors aren’t telling you about today’s most controversial drug. Saint Martin’s Press, New York, NYGoogle Scholar
  10. Brock DW (1998) Enhancements of human function: some distinctions for policymakers. In: Parens E (ed) Enhancing human traits: ethical and social implications. Georgetown University Press, Washington, DCGoogle Scholar
  11. Brock DW et al (2001) From chance to choice – genetics and justice. Cambridge University Press, CambridgeGoogle Scholar
  12. Buchanan A (2008) Enhancement and the ethics of development. Kennedy Inst Ethics J 18(4):1–34CrossRefGoogle Scholar
  13. Caldwell JA, Caldwell JL, Smythe NK, Hall KK (2000) A double-blind, placebo-controlled investigation of the efficacy of modafinil for sustaining the alertness and performance of aviators: a helicopter simulator study. Psychopharmacologia 150(3):272–282CrossRefGoogle Scholar
  14. Caplan AL (2002) No-brainer: can we cope with the ethical ramifications of new knowledge of the human brain? In: Marcus SJ (ed) Neuroethics: mapping the field. Conference proceedings. Dana Press, San Francisco, CA, pp 95–131, 13–14 May 2002Google Scholar
  15. Chatterjee A (2004) Cosmetic neurology. Neurology 63(6):968–974CrossRefGoogle Scholar
  16. Clark A, Chalmers D (1998) The extended mind. Analysis 58:7–19CrossRefGoogle Scholar
  17. Daniels N (2000) Normal functioning and the treatment-enhancement distinction. Camb Q Healthc Ethics 9(3):309–322CrossRefGoogle Scholar
  18. Daskalakis ZJ et al (2002) Transcranial magnetic stimulation: a new investigational and treatment tool in psychiatry. J Neuropsychiatry Clin Neurosci 14(4):406–415CrossRefGoogle Scholar
  19. DeGrazia D (2005) Enhancement technologies and self-creation. In: Human identity and bioethics. Cambridge University Press, Washington, DC, pp 203–243CrossRefGoogle Scholar
  20. Dimond SJ, Brouwers EM (1976) Increase in the power of human memory in normal man through the use of drugs. Psychopharmacology (Berl) 49(3):307–309CrossRefGoogle Scholar
  21. Elliott C (2000) Pursued by happiness and beaten senseless: prozac and the American dream. Hastings Cent Rep 30(2):7–12CrossRefGoogle Scholar
  22. Elliott C (2003) Better than well. American medicine meets the American dream. Norton & Company, New York, NYGoogle Scholar
  23. Elliott C (2005) Medicine goes to the mall: enhancement technologies and quality of life. VM: Ethics J Am Med Assoc 7:2Google Scholar
  24. Elliott R, Sahakian BJ, Matthews K, Bannerjea A, Rimmer J, Robbins TW (1997) Effects of methylphenidate on spatial working memory and planning in healthy young adults. Psychopharmacology (Berl) 131(2):196–206CrossRefGoogle Scholar
  25. Feinberg J (1980) The child’s right to an open future. In: Aiken W, LaFollette H (eds) Whose child? Children’s rights, parental authority, and state power. Rowman & Littlefield, Totowa, NJGoogle Scholar
  26. Feinberg J (1986) Autonomy. In: Feinberg J (ed) Harm to self: the moral limits of criminal law. Oxford University Press, OxfordGoogle Scholar
  27. Freedman C (1998) Aspirin for the mind? Some ethical worries about psychopharmacology. In: Parens E (ed) Enhancing human traits. Ethical and social implications. Georgetown University Press, Washington, DCGoogle Scholar
  28. George MS (2003) Stimulating the brain. Sci Am Sept 289:66–73CrossRefGoogle Scholar
  29. Glover J (1984) What sort of people should there be? Penguin, LondonGoogle Scholar
  30. Glover J (2006) Choosing children: the ethical dilemmas of genetic intervention. Oxford University Press, OxfordCrossRefGoogle Scholar
  31. Gordijn B (2004) Medizinische Utopien – Eine ethische Betrachtung. Vandenhoeck & Ruprecht, GöttingenGoogle Scholar
  32. Greely H et al (2008) Towards responsible use of cognitive-enhancing drugs by the healthy. Nature 456:702–705CrossRefGoogle Scholar
  33. Habermas J (2002) The future of human nature. Polity, OxfordGoogle Scholar
  34. Hall SS (2003) The quest for a smart pill. Sci Am Sept 289:54–65CrossRefGoogle Scholar
  35. Hanson MJ, Callahan D (eds) (1999) The goals of medicine: The forgotten issues in health care reform. Georgetown University Press, Washington, DCGoogle Scholar
  36. Harmer CJ et al (2004) Increased positive versus negative affective perception and memory in healthy volunteers following selective serotonin and norepinephrine reuptake inhibition. Am J Psychiatry 161(7):1256–1263CrossRefGoogle Scholar
  37. Harris J (2007) Enhancing evolution: the ethical case for making people better. Princeton University Press, Princeton, NJGoogle Scholar
  38. Heyd D (2003) Human nature: an oxymoron? J Med Philos 28:151–169CrossRefGoogle Scholar
  39. Healy D (2004) Let them eat prozac. New York University Press, New York, NYGoogle Scholar
  40. Huxley A (1932) Brave new world. Petersen, HamburgGoogle Scholar
  41. Jackson D et al (2004) The safety and tolerability of donepezil in patients with Alzheimer’s disease. Br J Clin Pharmacol 58(Suppl 1):1–8CrossRefGoogle Scholar
  42. Juengst ET (1998) What does enhancement mean? In: Parens E (ed) Enhancing human traits: ethical and social implications. Georgetown University Press, Washington, DCGoogle Scholar
  43. Kamm F (2005) Is there a problem with enhancement? Am J Bio 5(3):5–14, May–JuneCrossRefGoogle Scholar
  44. Kass L (2003) Ageless bodies, happy souls: biotechnology and the pursuit of perfection. New Atlantis Spring 2003:9–28Google Scholar
  45. Klerman GL (1972) Psychotropic hedonism vs. pharmacological Calvinism. Hastings Cent Rep 2(4):1–3Google Scholar
  46. Kramer PD (1997) Listening to prozac: a psychiatrist explores antidepressant drugs and the remaking of the self. Penguin, New York, NYGoogle Scholar
  47. Kosfeld M et al (2005) Oxytocin increases trust in humans. Nature 435:673–676CrossRefGoogle Scholar
  48. Lenk C (2002) Therapie und Enhancement: Ziele und Grenzen der modernen Medizin. LIT, MünsterGoogle Scholar
  49. Levy N (2007) Neuroethics. Oxford University Press, OxfordCrossRefGoogle Scholar
  50. Maguire GQ, McGee EM (1999) Implantable brain chips? Time for debate. Hastings Cent Rep 29(1):7–13CrossRefGoogle Scholar
  51. Marcus SJ (ed) (2002) Neuroethics: mapping the field. Dana Press, New York, NYGoogle Scholar
  52. McCabe SE et al (2005) Non-medical use of prescription stimulants among US college students: prevalence and correlates from a national survey. Addiction 99:96–106CrossRefGoogle Scholar
  53. Merkel R et al (2007) Intervening in the brain. Springer, BerlinGoogle Scholar
  54. Miller MC (2005) What is modafinil? Harv Ment Health Lett 21(7):8Google Scholar
  55. Miller FG, Brody H (2001) The internal morality of medicine: an evolutionary perspective. J Med Phil 26(6): 581–599Google Scholar
  56. Moynihan R, Cassels A (2005) Selling sickness: how the world’s biggest pharmaceutical companies are turning us all into patients. Nation Books, New York, NYGoogle Scholar
  57. Müller U et al (2004) Effects of modafinil on working memory processes in humans. Psychopharmacology (Berl) 177(1–2):161–169CrossRefGoogle Scholar
  58. Normann C, Berger M (2008) Neuroenhancement: status quo and perspectives. Eur Arch Psychiatry Clin Neurosci 258(Suppl 5):110–114CrossRefGoogle Scholar
  59. Oken BS, Kishiyama SS, Salinsky MC (1995) Pharmacologically induced changes in arousal: effects on behavioral and electrophysiologic measures of alertness and attention. Electroencephalogr Clin Neurophysiol 95(5):359–371CrossRefGoogle Scholar
  60. Parens E (ed) (1998) Enhancing human traits: ethical and social implications. Georgetown University Press, Washington, DCGoogle Scholar
  61. Payer L (1992) Disease-mongers: how doctors, drug companies and insurers are making you feel sick. Wiley, New York, NYGoogle Scholar
  62. Porrino LJ, Daunais JB, Rogers GA et al (2005) Facilitation of task performance and removal of the effects of sleep deprivation by an ampakine (CX717) in nonhuman primates. PLoS Biol 3(9):e299CrossRefGoogle Scholar
  63. President’s Council on Bioethics (ed) (2004) Beyond therapy: biotechnology and the pursuit of happiness. Dana Press, New York, NYGoogle Scholar
  64. Quante M (2002) Personales Leben und menschlicher Tod: personale Identität als Prinzip der biomedizinischen Ethik. Suhrkamp, Frankfurt am MainGoogle Scholar
  65. Rapport MD, Moffitt C (2002) Attention deficit/hyperactivity disorder and methylphenidate. A review of height/weight, cardiovascular, and somatic complaint side effects. Clin Psychol Rev 22(8):1107–1131CrossRefGoogle Scholar
  66. Repantis D et al (2008) Antidepressants for neuroenhancement in healthy individuals: a systematic review. Poiesis Prax: Int J Tech Assess Ethics Sci (27 Nov):1–36. Accessed 30 May 2009
  67. Sandel M (2007) The case against perfection: ethics in the age of genetic engineering. Harvard University Press, Cambridge, MAGoogle Scholar
  68. Savulescu J, Foddy B (2007) Ethics of performance enhancement in sport: drugs and gene doping. Principles of health care ethics. In: Ashcroft RE et al (eds) Principles of healthcare ethics. Wiley, London, pp 511–520Google Scholar
  69. Savulescu J, Bostrom N (2009) Human enhancement. Oxford University Press, OxfordGoogle Scholar
  70. Schöne-Seifert B, Talbot D (2009) Enhancement: Die ethische Debatte. Mentis, PaderbornGoogle Scholar
  71. Schöne-Seifert B et al (2009) Neuro-enhancement: Ethik vor neuen Herausforderungen. Mentis, PaderbornGoogle Scholar
  72. Slomka J (1992) Playing with propranolol. Hastings Cent Rep 22(4):13–17CrossRefGoogle Scholar
  73. Talbot D (2009) Ist Neuro-Enhancement keine ärztliche Angelegenheit? In: Schöne-Seifert B et al (eds) Neuro-enhancement: Ethik vor neuen Herausforderungen. Mentis, Paderborn, pp 321–346Google Scholar
  74. Tully T, Bourtchouladze R, Scott R, Tallman J (2003) Targeting the CREB pathway for memory enhancers. Nat Rev Drug Discov 2(4):267–277CrossRefGoogle Scholar
  75. Turner DC, Robbins TW, Clark L, Aron AR, Dowson J, Sahakian BJ (2003) Relative lack of cognitive effects of methylphenidate in elderly male volunteers. Psychopharmacology (Berl) 168(4):455–464CrossRefGoogle Scholar
  76. Volkow ND, Insel TR (2003) What are the long-term effects of methylphenidate treatment? Biol Psychiatry 54:1307–1309CrossRefGoogle Scholar
  77. Walsh JK et al (2004) Modafinil improves alertness, vigilance, and executive function during simulated night shifts. Sleep 27(3):434–439Google Scholar
  78. Wesensten NJ, Reichardt RM, Balkin TJ (2007) Ampakine (CX717) effects on performance and alertness during simulated night shift work. Aviat Space Environ Med 78(10):937–943CrossRefGoogle Scholar
  79. Wezenberg E, Verkes RJ, Ruigt GS et al (2007) Acute effects of the ampakine farampator on memory and information processing in healthy elderly volunteers. Neuropsychopharmacology 32(6):1272–1283CrossRefGoogle Scholar
  80. Whitehouse PJ, Juengst E, Mehlman M, Murray TH (1997) Enhancing cognition in the intellectually intact. Hastings Cent Rep 27(3):14–22CrossRefGoogle Scholar
  81. Wolpe PR (2002) Treatment, enhancement and the ethics of neurotherapeutics. Brain Cogn 50(3):387–395CrossRefGoogle Scholar
  82. Wurtzel E (1994) Prozac nation. Quartet Books, LondonGoogle Scholar
  83. Yesavage JA, Mumenthaler MS, Taylor JL et al (2002) Donepezil and flight simulator performance: effects on retention of complex skills. Neurology 59(1):123–125, July 9CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2010

Authors and Affiliations

  1. 1.Institut für Ethik, Geschichte und Theorie der MedizinMünsterGermany
  2. 2.Institut für Ethik, Geschichte und Theorie der MedizinMünsterGermany

Personalised recommendations