How does enhancing cognition affect human values? How does this translate into social responsibility?

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.

Neuroethics scope at a glance

The term neuroethics defines the bioethics field that deals with the dilemmas arising from the development of the neurosciences. Why are we so sensitive to ponder on neuroethics? Because it involves the brain, the organ responsible for our perceptions, our thoughts, and our conscience; and its knowledge and/or manipulation entail the most genuine and nontransferable aspects of the human being. Since 2002, neuroethics has been recognized as a new discipline that offers an area of consideration for neuroscientific knowledge and the actions regarding human beings as individuals, and the society as an organization. Within its framework, we can distinguish two branches: fundamental neuroethics and applied neuroethics. Neuroethics demands that we are on alert, and we offer the possibility of interdisciplinary exchange programs, encouraging society to participate, promoting the ethical opinions, and even working with anticipation on the dilemmas that are already emerging. Science does not stop, and its development has acquired such an accelerated pace that there has not been enough time to discuss its processes. We are convinced that neuroethics will be for the 21(st) century, what genetics was for the 20(th) century.

Closing thoughts for cognitive enhancement

The wide-ranging field of cognition enhancing research along with its ethics as it stands today is summarized. In the forefront are potentially novel drugs and non-pharmacological treatments for cognitive impairment across many different psychiatric and neurologic indications. Today's research will bring new drugs to patients tomorrow, and tomorrow's research will bring new molecular targets to clinical development that should be cognitive domain-specific. There is the likelihood that special populations may be better treated and that personalized medicine for cognitive impairment could become a reality. It is conceivable that with the current research effort, cognition enhancing drugs will become available to wide-ranging populations of people with neuropsychiatric illness and to those that are healthy. In some cultures, there is a push in society to be more intelligent or have more cognitive prowess. Thus, the ethical use of cognitive enhancing drugs should be an area of debate and communication. Neuroethics is a growing field and it intends to bring together key contributors such as physicians, disease experts, regulatory officials, and policy makers to discuss how such medicines can or should be made available. Together with this, one has to consider the possibility that no single medicine or technology will have a great impact on cognition and, therefore, combination therapy of drugs plus other approaches like exercise or transcranial direct-current stimulation may be the path forward. This is another area of scientific inquiry and debate, and the results should be fruitful and helpful to patients. The science of cognition is advancing at a rapid rate, and communication of its progress along with the development of rational and ethical policies for use of cognitive enhancers will be beneficial.