The Corpus Callosum

The topic of neural enhancement has created controversy.  This
came to wide attention in late 2007, upon the publication of various
articles in Nature, as noted by  href="http://scienceblogs.com/retrospectacle/2007/12/cognitive_enhancers_in_academi.php">Shelley
Batts, href="http://scienceblogs.com/ethicsandscience/2007/12/the_ethics_of_performance_enha.php">Janet
Stemwedel, href="http://scienceblogs.com/neuronculture/2008/04/steroids_for_the_brain_nature.php">David
href="http://scienceblogs.com/neuronculture/2008/12/survey_the_slippery_slope_of_c.php">Dobbs,
href="http://scienceblogs.com/geneticfuture/2008/12/cognitive_enhancement_academic.php">Daniel
MacArthur, href="http://scienceblogs.com/retrospectacle/2007/12/cognitive_enhancers_in_academi.php">Scicurious
and others.  But so far as I know, no esteemed medical
organization has taken a position on the subject.  Until now.

New
Guidance Document Takes on the Ethics of “Neuroenhancement”

Medscape Medical News
Susan Jeffrey

October 9, 2009 — The American Academy of Neurology’s Ethics, Law
and Humanities Committee has produced a new guidance document to help
neurologists respond to requests by healthy adults for drugs that
enhance memory or cognition.

In general, the committee concludes that prescribing medications
for
neuroenhancement is ethical for physicians, “provided that they adhere
to the well-known bioethical principles of respect for autonomy,
beneficence, and nonmaleficence,” the authors, led by Dan Larriviere,
MD, JD, from the Department of Neurology and School of Law at the
University of Virginia, Charlottesville, write.

Those physicians who prescribe these drugs, although they are
under no mandatory obligation to do so, are also acting lawfully, the
authors add. The report was published online September 23 and will
appear in the October 27 issue of Neurology

The abstract of the Guidance paper is here: href="http://www.neurology.org/cgi/content/abstract/WNL.0b013e3181beecfev1">Responding
to requests from adult patients for neuroenhancements: Guidance of the
Ethics, Law and Humanities Committee.  Because of the fact
that this is an “E-pub Ahead of Print,” the link might not be valid
after the formal publication date.  If that is the case, the
journal homepage is here.

Note that this pertains to the ethics of prescribing drugs for
neuroenhancement, which is not the same as the ethics of taking the
drug.  Even so, the two are closely related.  It obviously
would not be ethical to prescribe the drugs for this purpose, if it
were never the case that it is ethical to take them to enhance
cognition in the absence of a medical condition that affected cognition.

The University of Virginia Health System put out a href="http://www.healthsystem.virginia.edu/internet/news/archives09/neuroenhancements.cfm">news
release about this (the lead author is on the faculty there). 
This mentions the following:

The report’s guidance is that neurologists:

  • work within the context of the physician-patient relationship
    to make their prescribing decision;
  • respond to a patient’s request for brain-boosting drugs in the
    same
    way they would address a chief medical complaint that requires further
    investigation;
  • follow the same medical principles they would use in developing
    and initiating treatment plans for medical conditions;
  • consider the potential influence of neuroenhancement
    medications on a patient’s decision-making capacity;
  • follow principles of informed consent.

The authors of the Neurology paper concluded that:

[T]here are no legal or ethical barriers to prescribing,
refusing to
prescribe, or ending a prescription for neuroenhancement drugs.

This is not the last word on the subject.  Indeed, it is unlikely
that the controversy will go away anytime soon.

Comments

  1. #1 llnn
    October 12, 2009

    To be gratuitously difficult:

    In some tasks, being cognitively better helps other people (e.g. when being a doctor). In such a case, could there be an ethical obligation to use cognitive enhancers?

  2. #2 Joseph j7uy5
    October 12, 2009

    To my way of thinking, a person has a nearly-absolute right to determine what enters his or her own body; this would take precedence over a theoretical obligation to maximize one’s performance at all times.

  3. #3 llnn
    October 12, 2009

    But I don’t see what a nearly absolute right would have to do with it. That would only mean that they can refuse to take the drugs, not that it’s not wrong for them to do it.

    And think about the patients knowing that their doctor is intentionally underperforming. Or not knowing, but wondering.

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