Cognitive and affective enhancement aims to extend the abilities of the human mind and to modulate affective and hedonic states through genetic, neuropharmaceutical, computer or direct neural interventions. Since the introduction of Prozac (fluoxetine), selective serotonin reuptake inhibitors (SSRIs) have been widely and controversially used to treat psychiatric disorders but also simply to feel ‘better than well’ (Kramer 1993; Elliot 1998). Non-pharmaceutical methods for altering mood are also in development (Farah & Wolpe, 2004). Existing cognition-enhancing drugs include stimulants (Lee & Ma 1995), nutrients and hormones (Martinez & Kesner 1991), and consolidation enhancers (Lynch 2002). Recent research promises techniques for unlearning over-consolidated fears (Pittman 2002), potentially allowing memory modification. Drugs that improve executive functions such as working memory and attention (Mehta 2000; Turner et al. 2003) might be the first step towards true intelligence enhancing drugs. Traditional stimulants have a host of risks but new alertness and sleep-regulating drugs such as Modafinil appear to enable high-performance function with little risk of side effects and addiction (Myrick et al. 2004).
Given the rapid advances in drug design, targeted gene therapy and neural interfaces, it appears likely that radical forms of cognitive and affective enhancement will become commonplace within the next two decades. But although enhancement holds great promise, it also raises ethical challenges. Much of the debate so far has been conducted from the armchair or pulpit. We shall develop a much needed scientifically-informed ethical framework for assessing different means of enhancement by focusing on three central issues:
1. What constitutes enhancement? Progress in the debate is hindered by obscurity and disagreement about the nature of enhancement (Savulescu & Bostrom, eds. 2009).
a. How is enhancement related to the concepts of disease, therapy and normal functioning?
b. Should we understand enhancement neutrally, in terms of increased function, or in value-laden terms, in terms of promotion of well-being?
2. Is enhancement morally permissible, even required, or is its pursuit morally hazardous?
Critics of enhancement have alleged that it violates human nature or dignity, amounts to cheating or inauthenticity, infringes autonomy of future generations, and expresses a hubristic striving for perfection (Kass 2002; Sandel 2007; Habermas 2003). These are not just philosophical questions. On some campuses, it is not uncommon for students to take Ritalin or Modafinil. A recent Nature debate highlighted their extensive use by UK academics ( Sahakian & Morein-Zamir 2007 ). We shall conduct a systematic survey of objections to enhancement, assessing their strengths and implications for practice.
a. Are these moral objections to enhancement valid and can they be answered (Bostrom 2008)?
b. How, if at all, do controversial forms of enhancement differ from current means of improving capacities, such as better nutrition?
3. To the extent that enhancement is permissible, what would be the social and global effects of widespread use ?
One important set of concerns is that social or global inequality might be exacerbated by cognitive enhancement, further marginalizing the poor. In this context, it is necessary both to consider whether future cognitive enhancements would be expensive or relatively cheap (like caffeine) and to establish criteria whereby society might have an obligation to ensure universal access to enhancers. Access to enhancement, especially in education, may be a key element in enabling participation of developing countries in the global economy. Furthermore, enhancement might lead to dramatic social benefits by reducing natural inequality and promoting social justice (Savulescu 2009) . Widespread population level increases in cognitive ability could have profound social and economic benefits. Some studies estimate that a 3% population wide increase in IQ would reduce poverty rates by 25% ( Weiss 1998), leading to an annual economic gain of US $165-195 billion and 1.2-1.5% GDP ( Schwartz 1994; Salkever 1995).
ReferencesBostrom N. 2008. Enhancement and Dignity, In Human Dignity and Bioethics: Essays Commissioned by the President’s Council on Bioethics (Washington, D.C): pp. 173-207. Elliott, C. (1998), The tyranny of happiness: ethics and cosmetic psychopharmacology. In Parens, E. (ed.), Enhancing human traits. Ethical and social implications,Washington, D.C.: Georgetown University Press, pp. 177-188. Farah, M.J. & Wolpe, P.R. (2004), 'New neuroscience technologies and their ethical implications,' Hastings Center Report 34: 35-45. Habermas, J. (2003), The Future of Human Nature, Cambridge: Polity Press. Kass,L. (2002), Life, Liberty, and Defense of Dignity: The Challenge for Bioethics, San Francisco, Encounter Books Kramer, P.D. (1993), Listening to Prozac, New York: Penguin. Lee, E.H.Y. & Ma., Y.L. (1995), 'Amphetamine Enhances Memory Retention and Facilitates Norepinephrine Release From the Hippocampus in Rats,' Brain Research Bulletin 4: 411-441.
Lynch, G. (2002), 'Memory enhancement: the search for mechanism-based drugs,' Nature Neuroscience, 5: 1035-1038.
Martinez, J.L., Kesner, R.P. (1991), Learning and Memory: A Biological View, San Diego:Academic.
Mehta, M.A., Owen, A.M., Sahakian, B.J., Pickard, J.D., Mavvadat, N., & Robbins, T.W. (2000), 'Methylphenidate enhances working memory by modulating discrete frontal and parietal lobe regions in the human brain,' Journal of Neuroscience, 20: RC651-656.Myrick, H., Malcolm, R., Taylor , B. & LaRowe, S. (2004), 'Modafinil: preclinical, clinical, and postmarketing surveillance—a review of abuse liability issues,' Ann. Clin. Psychiatry 16: 101–109. Pitman, R.K., Sanders, K.M., Zusman, R.M., Healy, A.R., Cheema, F., Lasko, N.B., Cahill, L., and Orr, S.P. (2002), 'Pilot study of secondary prevention of posttraumatic stress disorder with propanolol,' Biological Psychiatry 51: 189-192. Sahakian, B. & Morein-Zamir, S. (2007), 'Professor's little helper,' Nature 450: 1157-1159. Salkever, D.S. (1995), 'Updated estimates of earnings benefits from reduced exposure of children to environmental lead,' Environ Res, 70: 1-6. Sandel, M. (2007), The Case against Perfection: Ethics in the Age of Genetic Engineering, Belknap. Savulescu, J. & Bostrom, N. (eds.) (2009), Enhancement of Human Beings, Oxford: Oxford University Press. Savulescu, J. (2009), Enhancement and Fairness. In Healey, P. (ed.), Tomorrow’s People: The Challenges of Technologies for Life- Extension and Enhancement, London: Earthscan. Schwartz, J. (1994), 'Low-level lead exposure and children's IQ: a meta-analysis and search for a threshold,' Environ Res 65: 42-55. Weiss, B. (1998), A' Risk Assessment perspective on the neurobehavioral toxicity of endocrine disruptors,' Toxicol Ind Health 14: 397–418.