Neuroethical issues in pharmacological cognitive enhancement

Autonomy, procedural and substantive: a discussion of the ethics of cognitive enhancement

As cognitive enhancement research advances, important ethical questions regarding individual autonomy and freedom are raised. Advocates of cognitive enhancement frequently adopt a procedural approach to autonomy, arguing that enhancers improve an individual's reasoning capabilities, which are quintessential to being an autonomous agent. On the other hand, critics adopt a more nuanced approach by considering matters of authenticity and self-identity, which go beyond the mere assessment of one's reasoning capacities. Both positions, nevertheless, require further philosophical scrutiny. In this paper, we investigate the ethics of cognitive enhancement through the lenses of political and philosophical arguments about autonomy and freedom. In so doing, we contend that a substantive, relational account of individual autonomy offers a more holistic understanding of the ethical concerns of cognitive enhancement.

The Role of Different Behavioral and Psychosocial Factors in the Context of Pharmaceutical Cognitive Enhancers’ Misuse

In an effort for better memory, greater motivation, and concentration, otherwise healthy individuals use pharmaceutical cognitive enhancers (PCEs), medicines for the treatment of cognitive deficits of patients with various disorders and health problems, to achieve greater productivity, efficiency, and performance. We examined the use of PCEs among 289 students at the Slovenian Faculty of Electrical Engineering and Computer Science in the behavioral and psychosocial context (students’ attitudes towards study, parents, health, leisure time, and work). Furthermore, we also addressed the immediate reasons, or the hypothesized connections of behavioral and psychosocial aspects, related to PCE misuse. The study consisted of a structured questionnaire, and chi-squared tests were used. An analysis of student statements revealed differences in students’ and parents’ attitudes toward good academic grades. In addition, students chose among 17 values related to relationships with parents, friends, partners, careers, study obligations, leisure, hobbies, material goods, appearance, and the future, and assessed their importance. Regardless of the group they belonged to, young people cited the same values among the most important. Good grades and parental opinions have proven to be key factors in the context of PCE abuse. This research was the first study to examine the relation between PCE misuse and the role of different behavioral and psychosocial factors.

Super-Men and Wonder-Women: the Relationship Between the Acceptance of Self-enhancement, Personality, and Values

Due to ongoing technological innovations, self-enhancement methods are publicly discussed, researched from different perspectives, and part of ethical debates. However, only few studies investigated the acceptance of these methods and its relationship with personality traits and values. The present study investigated to what extent people accept different enhancement methods and whether acceptance can be predicted by Big Five and Dark Triad traits, vulnerable narcissism, and values. In an online survey (N = 450), we measured personality traits and values. Additionally, participants read scenarios about enhancement methods and answered questions about their acceptance of these scenarios. Factor analysis indicated a general factor of acceptance across scenarios. Correlation analyses showed that high agreeableness, agreeableness-compassion, conscientiousness, conscientiousness-industriousness, and conservation- and self-transcendence values are related to less acceptance of self-enhancement. Moreover, individuals high on Dark Triad traits, vulnerable narcissism, and self-enhancement values exhibit more acceptance. Hierarchical regression analysis revealed that said values and Big Five traits explained unique variance in the acceptance of self-enhancement. These findings highlight the importance of considering personality and values when investigating self-enhancement—a topic that is receiving increasing attention by the public, politicians, and scientists.

Public Opinion on Cognitive Enhancement Varies across Different Situations

People vary widely in their acceptance of the use of pharmacological cognitive enhancement (CE). We tested the hypothesis that the acceptability of CE is malleable, by varying the context in which CE use takes place, by framing the use of CE with positive and negative metaphors, and by distinguishing between self and other CE use. 2,519 US-based participants completed 2 surveys using Amazon's Mechanical Turk. First, participants responded to vignettes describing a fictional character, which varied by framing metaphor (Pandora's box that releases brain performance vs. key that unlocks brain potential), role/setting (student/educational vs. employee/professional), and activity type (blue vs. white collar). Second, participants viewed personalized vignettes describing their own situations. Across both surveys, participants generally found CE use more acceptable for employees than students, while the effects of framing metaphors were unreliable and smaller than previously reported. People were more accepting of CE use by others than by themselves. Participants also found CE use more acceptable if more peers used CE, the environment was less competitive, and authority figures encouraged CE use. Our findings suggest that opinions about CE are indeed malleable, and concerns that peer pressure, the influence of authority figures, and competition might affect CE use are not unfounded.

The Downsides of Cognitive Enhancement

Cognitive enhancement is becoming progressively popular as a subject of scientific investigation and by the public, although possible adverse effects are not sufficiently understood. We call for cognitive enhancement to build on more specific, mechanistic theories given that a-theoretical approaches to cognitive enhancement are both a cause and a consequence of a strong, if not exclusive focus on the benefits of procedures suited to enhance human cognition. We focus on downsides of cognitive enhancement and suggest that every attempt to enhance human cognition needs to deal with two basic principles: the neuro-competition principle and the nonlinearity principle. We discuss the possibility of both principles in light of recent attempts to improve human cognition by means of transcranial direct current stimulation, a well-established brain stimulation method, and clinically relevant nootropic drugs. We propose that much stronger emphasis on mechanistic theorizing is necessary in guiding future research on both the upsides and the downsides of cognitive enhancement.

Comparison of philosophical concerns between professionals and the public regarding two psychiatric treatments

BACKGROUND

Psychiatric interventions are a contested area in medicine, not only because of their history of abuses, but also because their therapeutic goal is to affect emotions, thoughts, beliefs, and behaviors that are regarded as pathological. Because psychiatric interventions affect characteristics that seem central to who we are, they raise issues regarding identity, autonomy, and personal responsibility for one's own well-being. Our study addresses two questions: (1) Do the public and academic researchers understand the philosophical stakes of these technologies in the same way? Following from this, (2) to what extent does the specific type of psychiatric technology affect the issues these two groups raise? This study compares how ethical issues regarding neurosurgical and pharmaceutical psychiatric interventions are discussed among the public and in the professional community of academic medicine and bioethics.

METHODS

We analyzed (1) online public comments and (2) the medical and bioethics literature, comparing the discussions of pharmacological and neurosurgical interventions in psychiatry in each source.

RESULTS

Overall, the public discussed philosophical issues less frequently than academics. For the two types of psychiatric interventions, we found differences between the academic literature and public comments among all themes, except for personal responsibility.

CONCLUSIONS

These findings reveal some of the similarities and discrepancies in how philosophical issues associated with psychiatric treatments are discussed in professional circles and among the public. Further research into what causes these discrepancies is crucial.

From 'Hard' Neuro-Tools to 'Soft' Neuro-Toys? Refocussing the Neuro-Enhancement Debate

Since the 1990’s, the debate concerning the ethical, legal and societal aspects of ‘neuro-enhancement’ has evolved into a massive discourse, both in the public realm and in the academic arena. This ethical debate, however, tends to repeat the same sets of arguments over and over again. Normative disagreements between transhumanists and bioconservatives on invasive or radical brain stimulators, and uncertainties regarding the use and effectivity of nootropic pharmaceuticals dominate the field. Building on the results of an extensive European project on responsible research and innovation in neuro-enhancement (NERRI), we observe and encourage that the debate is now entering a new and, as we will argue, more realistic and societally relevant stage. This new stage concerns those technologies that enter the market as ostensibly harmless contrivances that consumers may use for self-care or entertainment. We use the examples and arguments of participants in NERRI debates to describe three case studies of such purportedly innocent ‘toys’. Based upon this empirical material, we argue that these ‘soft’ enhancement gadgets are situated somewhere in the boundary zone between the internal and the external, between the intimate and the intrusive, between the familiar and the unfamiliar, between the friendly and the scary and, in Foucauldian terms, between technologies of the self and technologies of control. Therefore, we describe their physiognomy with the help of a term borrowed from Jacques Lacan, namely as “extimate” technologies.

Prescription Psychostimulant Use Among Young Adults: A Narrative Review of Qualitative Studies

BACKGROUND

Within the last decade, the nonmedical use of prescription drugs has raised concern, particularly among young adults. Psychostimulants, that is to say amphetamine and its derivatives, are pharmaceuticals, which contribute to what has come to be known in Canada and the United States as the "prescription drug crisis." Research in the fields of public health, addiction studies, and neuroethics has attempted to further understand this mounting issue; however, there is a paucity of data concerning the underlying social logics related to the use of these substances.

OBJECTIVES

The objective of this article is to provide an overview of the current literature related to the social context of prescription psychostimulant use among young adults, and to discuss theoretical considerations as well as implications for future research.

METHODS

A narrative review of the literature was performed.

RESULTS

We found that research efforts have chiefly targeted college students, yet there is a lack of knowledge concerning other social groups likely to use these pharmaceuticals nonmedically, such as persons with high strain employment. Three main emerging patterns related to prescription psychostimulant use were identified: (1) control of external stressors, (2) strategic use toward the making of the self, and (3) increasing one's performance.

CONCLUSIONS

Prescription psychostimulant use among young adults is anchored in contemporary normativity and cannot be separated from the developing performance ethic within North-American and other Western societies. We suggest that pharmaceuticalization and Actor-Network Theory are useful conceptual tools to frame future research efforts.

Modafinil increases the latency of response in the Hayling Sentence Completion Test in healthy volunteers: a randomised controlled trial

Background

Modafinil is a medication licensed for the treatment of narcolepsy. However, it has been reported that healthy individuals without wakefulness disorders are using modafinil off-label to enhance cognitive functioning. Although some studies have reported that modafinil improves cognitive task performance in healthy volunteers, numerous other studies have failed to detect cognitive enhancing effects of modafinil on several well-established neuropsychological tasks. Interestingly, several clinical and preclinical studies have found that improved cognitive task performance by modafinil is accompanied by slower response times. This observation raises the question as to whether this slowing of response time in healthy volunteers is a necessary and sufficient condition for cognitive enhancement with modafinil. The aim of the current experiment was to explore this question by investigating the effects of modafinil on the Hayling Sentence Completion Test (HSCT).

Methodology

Sixty-four healthy volunteers received either a single dose (200 mg) of modafinil (n = 32) or placebo (n = 32) in a randomized, double-blind, placebo-controlled, parallel group study in which the principal outcome measures were response latencies on the response initiation and response inhibition sections of the HSCT.

Principal Findings

Participants dosed with modafinil had significantly longer mean response latencies on the HSCT for both the response initiation and response inhibition compared to participants dosed with placebo. However, participants in both groups made a similar number of errors on each of these measures, indicating that modafinil did not enhance the accuracy of performance of the task relative to placebo.

Conclusions

This study demonstrated that administration of single 200 mg doses of modafinil to healthy individuals increased the latency of responses in the performance of the HSCT, a task that is highly sensitive to prefrontal executive function, without enhancing accuracy of performance. This finding may provide important clues to defining the limitations of modafinil as a putative cognitive enhancer.

Trial Registration

ClinicalTrials.gov NCT02051153