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(Neuro-)Enhancement

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Ethics in Psychiatry

Part of the book series: International Library of Ethics, Law, and the New Medicine ((LIME,volume 45))

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.

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Notes

  1. 1.

    See the work of the contended psychologist Timothy Leary, e.g. The Politics of Ecstasy (1968).

  2. 2.

    For a history of antidepressants see also the pharmaceutical industry-critic Healy 2004, 4 ff.

  3. 3.

    In the aftermath of the described American Prozac® (generic name: fluoxetine) optimism a critical debate on the implications and consequences of such psychopharmacological modification commenced, see Breggin 1995, Wurtzel 1994.

  4. 4.

    Ritalin® (generic name: methylphenidate) is normally used in the drug therapy of children and adolescents with attention-deficit-hyperactivity-disorder (ADHD).

  5. 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. 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. 7.

    Pathologizing normal phenomena and labelling them with medical terminology is called ‘disease mongering’ (Blech 2003, Payer 1992).

  8. 8.

    Interestingly, in Germany Ritalin® is not approved for therapeutic use in adults.

  9. 9.

    Though it is difficult to pin down the utilization rate, see Babcock (2000) and McCabe (2005).

  10. 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. 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. 12.

    In this context the happy-pill ‘Soma’ in Aldous Huxley’s novel Brave New World is often cited (Huxley 1932).

  13. 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. 14.

    See also Chapter 19.

  15. 15.

    It has been suggested, for instance, that enhancing cognitive functions is to be paid for by loosing emotional depth or creativity. See Whitehouse et al. 1997, p. 20. Generally sceptical: Kass 2003, p. 15.

  16. 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. 17.

    However, the moral relevance of the body boundaries has been contested (see Clark and Chalmers 1998 and Anderson 2009).

  18. 18.

    Peter Kramer gives the example of his client Philip (1997, 291f).

  19. 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. 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. 21.

    Analogous is Michael Sandel’s example of the ambitious father of the tennis players Venus and Serena Williams (2007, p. 52).

  22. 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

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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.

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Authors and Affiliations

  1. Institut für Ethik, Geschichte und Theorie der Medizin, Von-Esmarch-Str. 62, 48149, Münster, Germany

    Bettina Schöne-Seifert

  2. Institut für Ethik, Geschichte und Theorie der Medizin, 48149, Münster, Germany

    Davinia Talbot

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  1. Bettina Schöne-Seifert
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Correspondence to Bettina Schöne-Seifert .

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  1. Charité Campus Benjamin Franklin, Klinik für Psychiatrie/ Psychotherapie, Universitätsklinikum Berlin, Eschenallee 3, Berlin, 14050, Germany

    Hanfried Helmchen

  2. chemin Colladon 14, Geneve, 1209, Switzerland

    Norman Sartorius

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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

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