Abstract
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.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Notes
- 1.
See the work of the contended psychologist Timothy Leary, e.g. The Politics of Ecstasy (1968).
- 2.
For a history of antidepressants see also the pharmaceutical industry-critic Healy 2004, 4 ff.
- 3.
- 4.
Ritalin® (generic name: methylphenidate) is normally used in the drug therapy of children and adolescents with attention-deficit-hyperactivity-disorder (ADHD).
- 5.
According to this German report, which is based on interviews with 3,000 randomly chosen employees aged 20–50, 5% of the subjects take medication without a medical reason to enhance their abilities, 2.2% of inquired people do so on a regular basis, 1–1.9% take prescription drugs.
- 6.
The topic is so popular that there have been numerous upshots in that field: important publications, e.g. Levy 2007, Marcus 2002; a neuroethics website (http://neuroethics.upenn.edu/), the foundation of a neuroethics society in 2006 and, just recently, a journal on the topic.
- 7.
- 8.
Interestingly, in Germany Ritalin® is not approved for therapeutic use in adults.
- 9.
- 10.
Though their beneficiary effect on cognitively impaired individuals is a matter of ongoing discussion, see http://www.cochrane.org/reviews/en/ab006104.html NICE as well as IQWIG judged donepezil as effective (even if only with small efficacy) whereas piracetam has no evidence-based efficacy so far.
- 11.
In the context of treating depression the SSRI citalopram is the most frequent substance (DAK-Gesundheitsreport 2009, p. 50), the enhancement utilization of which is not yet known.
- 12.
In this context the happy-pill ‘Soma’ in Aldous Huxley’s novel Brave New World is often cited (Huxley 1932).
- 13.
In how far other anxiolytics, such as benzodiazepines like midazolam are used for enhancement purposes is unclear, but apart from its calming effect this substance has the potential to disrupt memory: it causes a retrograde amnesia. In clinical contexts this is useful for patients awaiting operations: to protect them against the stressful events before they are being taken to the operating theatre, but situations where the attenuation of painful memories e.g. chagrin d’amour, is desired as life-style improvement even by healthy people are imaginable. See also the movie ‘Eternal sunshine of the spotless mind’.
- 14.
See also Chapter 19.
- 15.
- 16.
Paul Wolpe summarizes this aspect when he says that from the fact that a memory is a good thing it does not necessarily follow that more memory is better (2002, p. 393).
- 17.
- 18.
Peter Kramer gives the example of his client Philip (1997, 291f).
- 19.
Norman Daniels illustrates this with an example from the field of PID: in a society where having a baby boy is an economic advantage compared to having a girl, and parents ‘produce’ a gender imbalance in favour of boys by means of PID, the former advantage of having male offspring might no longer apply (see Daniels 2000, p. 321).
- 20.
Considering cognitive enhancement we explicitly do not want to join a debate on query cases of ADS, but rather concentrate on unambiguous cases of neuro-enhancement.
- 21.
Analogous is Michael Sandel’s example of the ambitious father of the tennis players Venus and Serena Williams (2007, p. 52).
- 22.
Habermas explicitly refers to genetic enhancement, nevertheless his arguments seem extendable to the case of other forms of enhancement.
Abbreviations
- ADS:
-
Attention-Deficit-Syndrome
- AMPA:
-
α-Amino-3-Hydroxyl-5-Methyl-4-Isoxazole-Propionate
- CREB:
-
cycloAMP Response Element Binding Protein
- DAK:
-
Deutsche Angestellten-Krankenkasse
- DBS:
-
Deep Brain Stimulation
- IQWIG:
-
Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen
- NICE:
-
National Institute for Health and Clinical Excellence
- SAS:
-
Sleep-Apnoe-Syndrome
- SSRI:
-
Selective Serotonin Reuptake Inhibitor
- TMS:
-
Transcranial Magnetic Stimulation
References
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, Paderborn
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 15
Babcock Q et al (2000) Student perceptions of methylphenidate abuse at a public liberal arts college. J ACH 49:143–145
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):15020–15025
Beracochea D et al (2003) Enhancement of learning processes following an acute modafinil injection in mice. Pharmacol Biochem Behav 76(3–4):473–479
Blech J (2003) Die Krankheitserfinder: Wie wir zu Patienten gemacht werden. Fischer, Frankfurt
Bolt LLE (2007) True to oneself? Broad and narrow ideas on authenticity in the enhancement debate. Theor Med Bioeth 28:285–300
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. http://www.egms.de/en/meetings/dgnc2004/04dgnc0207.shtml
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, NY
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, DC
Brock DW et al (2001) From chance to choice – genetics and justice. Cambridge University Press, Cambridge
Buchanan A (2008) Enhancement and the ethics of development. Kennedy Inst Ethics J 18(4):1–34
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):272–282
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 2002
Chatterjee A (2004) Cosmetic neurology. Neurology 63(6):968–974
Clark A, Chalmers D (1998) The extended mind. Analysis 58:7–19
DAK-Gesundheitsreport (2009) http://www.presse.dak.de/ps.nsf/Show/A9C1DFD99A0104BAC1257551005472DE/$File/DAK_Gesundheitsreport_2009.pdf. Accessed 20 Apr 2009
Daniels N (2000) Normal functioning and the treatment-enhancement distinction. Camb Q Healthc Ethics 9(3):309–322
Daskalakis ZJ et al (2002) Transcranial magnetic stimulation: a new investigational and treatment tool in psychiatry. J Neuropsychiatry Clin Neurosci 14(4):406–415
DeGrazia D (2005) Enhancement technologies and self-creation. In: Human identity and bioethics. Cambridge University Press, Washington, DC, pp 203–243
Dimond SJ, Brouwers EM (1976) Increase in the power of human memory in normal man through the use of drugs. Psychopharmacology (Berl) 49(3):307–309
Elliott C (2000) Pursued by happiness and beaten senseless: prozac and the American dream. Hastings Cent Rep 30(2):7–12
Elliott C (2003) Better than well. American medicine meets the American dream. Norton & Company, New York, NY
Elliott C (2005) Medicine goes to the mall: enhancement technologies and quality of life. VM: Ethics J Am Med Assoc 7:2
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):196–206
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, NJ
Feinberg J (1986) Autonomy. In: Feinberg J (ed) Harm to self: the moral limits of criminal law. Oxford University Press, Oxford
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, DC
George MS (2003) Stimulating the brain. Sci Am Sept 289:66–73
Glover J (1984) What sort of people should there be? Penguin, London
Glover J (2006) Choosing children: the ethical dilemmas of genetic intervention. Oxford University Press, Oxford
Gordijn B (2004) Medizinische Utopien – Eine ethische Betrachtung. Vandenhoeck & Ruprecht, Göttingen
Greely H et al (2008) Towards responsible use of cognitive-enhancing drugs by the healthy. Nature 456:702–705
Habermas J (2002) The future of human nature. Polity, Oxford
Hall SS (2003) The quest for a smart pill. Sci Am Sept 289:54–65
Hanson MJ, Callahan D (eds) (1999) The goals of medicine: The forgotten issues in health care reform. Georgetown University Press, Washington, DC
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):1256–1263
Harris J (2007) Enhancing evolution: the ethical case for making people better. Princeton University Press, Princeton, NJ
Heyd D (2003) Human nature: an oxymoron? J Med Philos 28:151–169
Healy D (2004) Let them eat prozac. New York University Press, New York, NY
Huxley A (1932) Brave new world. Petersen, Hamburg
Jackson D et al (2004) The safety and tolerability of donepezil in patients with Alzheimer’s disease. Br J Clin Pharmacol 58(Suppl 1):1–8
Juengst ET (1998) What does enhancement mean? In: Parens E (ed) Enhancing human traits: ethical and social implications. Georgetown University Press, Washington, DC
Kamm F (2005) Is there a problem with enhancement? Am J Bio 5(3):5–14, May–June
Kass L (2003) Ageless bodies, happy souls: biotechnology and the pursuit of perfection. New Atlantis Spring 2003:9–28
Klerman GL (1972) Psychotropic hedonism vs. pharmacological Calvinism. Hastings Cent Rep 2(4):1–3
Kramer PD (1997) Listening to prozac: a psychiatrist explores antidepressant drugs and the remaking of the self. Penguin, New York, NY
Kosfeld M et al (2005) Oxytocin increases trust in humans. Nature 435:673–676
Lenk C (2002) Therapie und Enhancement: Ziele und Grenzen der modernen Medizin. LIT, Münster
Levy N (2007) Neuroethics. Oxford University Press, Oxford
Maguire GQ, McGee EM (1999) Implantable brain chips? Time for debate. Hastings Cent Rep 29(1):7–13
Marcus SJ (ed) (2002) Neuroethics: mapping the field. Dana Press, New York, NY
McCabe SE et al (2005) Non-medical use of prescription stimulants among US college students: prevalence and correlates from a national survey. Addiction 99:96–106
Merkel R et al (2007) Intervening in the brain. Springer, Berlin
Miller MC (2005) What is modafinil? Harv Ment Health Lett 21(7):8
Miller FG, Brody H (2001) The internal morality of medicine: an evolutionary perspective. J Med Phil 26(6): 581–599
Moynihan R, Cassels A (2005) Selling sickness: how the world’s biggest pharmaceutical companies are turning us all into patients. Nation Books, New York, NY
Müller U et al (2004) Effects of modafinil on working memory processes in humans. Psychopharmacology (Berl) 177(1–2):161–169
Normann C, Berger M (2008) Neuroenhancement: status quo and perspectives. Eur Arch Psychiatry Clin Neurosci 258(Suppl 5):110–114
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):359–371
Parens E (ed) (1998) Enhancing human traits: ethical and social implications. Georgetown University Press, Washington, DC
Payer L (1992) Disease-mongers: how doctors, drug companies and insurers are making you feel sick. Wiley, New York, NY
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):e299
President’s Council on Bioethics (ed) (2004) Beyond therapy: biotechnology and the pursuit of happiness. Dana Press, New York, NY
Quante M (2002) Personales Leben und menschlicher Tod: personale Identität als Prinzip der biomedizinischen Ethik. Suhrkamp, Frankfurt am Main
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):1107–1131
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. http://www.springerlink.com/content/175414g2916w1322. Accessed 30 May 2009
Sandel M (2007) The case against perfection: ethics in the age of genetic engineering. Harvard University Press, Cambridge, MA
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 511–520
Savulescu J, Bostrom N (2009) Human enhancement. Oxford University Press, Oxford
Schöne-Seifert B, Talbot D (2009) Enhancement: Die ethische Debatte. Mentis, Paderborn
Schöne-Seifert B et al (2009) Neuro-enhancement: Ethik vor neuen Herausforderungen. Mentis, Paderborn
Slomka J (1992) Playing with propranolol. Hastings Cent Rep 22(4):13–17
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 321–346
Tully T, Bourtchouladze R, Scott R, Tallman J (2003) Targeting the CREB pathway for memory enhancers. Nat Rev Drug Discov 2(4):267–277
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):455–464
Volkow ND, Insel TR (2003) What are the long-term effects of methylphenidate treatment? Biol Psychiatry 54:1307–1309
Walsh JK et al (2004) Modafinil improves alertness, vigilance, and executive function during simulated night shifts. Sleep 27(3):434–439
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):937–943
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):1272–1283
Whitehouse PJ, Juengst E, Mehlman M, Murray TH (1997) Enhancing cognition in the intellectually intact. Hastings Cent Rep 27(3):14–22
Wolpe PR (2002) Treatment, enhancement and the ethics of neurotherapeutics. Brain Cogn 50(3):387–395
Wurtzel E (1994) Prozac nation. Quartet Books, London
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 9
Acknowledgments
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.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2010 Springer Science+Business Media B.V.
About this chapter
Cite this chapter
Schöne-Seifert, B., Talbot, D. (2010). (Neuro-)Enhancement. In: Helmchen, H., Sartorius, N. (eds) Ethics in Psychiatry. International Library of Ethics, Law, and the New Medicine, vol 45. Springer, Dordrecht. https://doi.org/10.1007/978-90-481-8721-8_30
Download citation
DOI: https://doi.org/10.1007/978-90-481-8721-8_30
Published:
Publisher Name: Springer, Dordrecht
Print ISBN: 978-90-481-8720-1
Online ISBN: 978-90-481-8721-8
eBook Packages: MedicineMedicine (R0)