Our scientific advancements have made it possible to alter brain function and to monitor and manipulate the human mind. Neurocognitive interventions can assist those who seek to regain normal brain function. But they can also be used to enhance the mental processes of those who already have normal brain function.
Neurocognitive enhancement can seem like science fiction. It entails interventions to improve cognitive abilities beyond what is considered average or normal. These increasingly popular interventions have prompted concerns about safety, fairness and ethics.
Many aspects of cognitive function are potential targets for pharmacological enhancement. Between 2005 and 2012, the use of medication for attention deficit hyperactivity disorder (ADHD) in youth increased by 10.7% in the US, and by 56.6% in the UK. While most people who use ADHD medication have a valid prescription, an estimated 5–35% of young adults and adolescents in North America use stimulants such as Ritalin (generic methylphenidate) without a prescription. And because these stimulants can improve reasoning, problem solving and memory function even in healthy individuals, an estimated 3–11% of college students use prescription stimulants to improve their academic performance: some fake symptoms in order to obtain a prescription.
Scientific interest in cognitive enhancement is not limited to mitigating the symptoms of ADHD. Memory enhancement is also of interest—particularly for older adults. Various drugs are being developed to address age related memory decline. However, interest in enhancing normal memory function is also growing. One study found that donepezil, which is used to treat Alzheimer’s dementia, also enhanced the performance of healthy middle-aged pilots on a memory test administered to them after flight simulator training. These results suggest that donepezil might help trainee pilots remember the steps involved in complex aviation tasks. Since the risk of commercial plane accidents is already miniscule, this type of cognitive boost might be even more helpful to military pilots.
Just as we can enhance memory, we might also be able to dampen it. One symptom of post-traumatic stress disorder (PTSD) is intrusive memories, which interfere with daily functioning. A 2002 study provided preliminary evidence for the use of propranolol in PTSD patients, demonstrating that, if taken within six hours of a traumatic event, it could prevent the consolidation of traumatic memories. Propranolol is a Nobel-prize-winning medication originally developed to treat hypertension and coronary artery disease. This means of reducing traumatic memories could be used by people who wish to minimize unpleasant experiences, potentially raising ethical concerns.
In addition to pharmaceutical methods of altering brain function, the last decade has seen the development of complementary approaches. For example, transcranial magnetic stimulation (TMS) has moved out of the lab and into clinics and hospitals, where it is being used to treat depression. Preliminary findings show that it is an effective treatment for major depressive disorder, and has minimal side effects. However, since the early 2000s, TMS has also been explored as a means of altering mood and cognitive style in healthy people.
Thus, there is a disconnect between the original purpose of some medical interventions and the ways in which they are used today.
Neuroscientist Martha Farah notes that there are three categories of ethical considerations to keep in mind. The first relates to the individual effects of cognitive enhancement. For example, is it safe? What are the side effects? And what are the unintended consequences? Although every medical intervention comes with risks, are the risks posed by cognitive enhancement comparable to those of other elective treatments, such as cosmetic surgery? Given how complex the brain is, and how little we know about it, the chance of unanticipated outcomes is probably higher. And what should we do if someone breaks the law under the influence of cognitive enhancement? Is such a person responsible? If not, who is to blame?
The second category of ethical considerations relates to the effect of these developments on the general public. For example, an individual’s choice to abstain from cognitive enhancement could be unsustainable if her competitors are using cognitive enhancement agents. And, in recent decades, parents have brought court cases claiming that they are being coerced by schools to medicate their kids for ADHD. Is it right to pressure parents into medicating their children on the basis of a highly controversial diagnosis? The military has long used amphetamines to enhance pilots’ attention on longer missions. Is it morally acceptable to order troops to undergo such interventions? If there are barriers preventing some people from accessing cognitive enhancement agents, could this further exacerbate social inequality?
A third category that Farah notes relates to the idea of personhood. If we engage in brain enhancement, what does that say about the value of personal effort, accomplishment or autonomy? Is it cheating if people take medication to enhance their performance at school? Are we treating ourselves as objects if we chemically upgrade our cognition? Do cognitive enhancements blur the distinction between personhood and material things?
I do not have an answer to these questions, and nor does the scientific community. But we have some preliminary results on public attitudes towards cognitive enhancement. One study of approximately 4,000 Americans and Canadians found that participants recognized the ethical concerns raised by cognitive enhancement; they didn’t outright reject its use, but were moderate in their endorsement. The authors conclude that there was no evidence of widespread support for radical enhancement, but there was cautious acceptance of the idea, in spite of the recognized risks.
Another study of roughly 2,500 Americans revealed that public attitudes towards cognitive enhancement are context dependent. Participants were more accepting of its use by employees than by students, and more accepting of its use by others than by themselves. Cognitive enhancement was also deemed more acceptable if more people were using it, if the environment was less competitive, or if authority figures encouraged its use. Overall, participants were sensitive to concerns about peer pressure, the influence of authority figures and social competition.
The scientific community have made massive strides, bringing us remarkable new ways to improve our quality of life and extend our lifespans. But developments that can be used for good can also be misused. We face new questions, not just about what practices are ethical, but also about what even qualifies as an ethical consideration. The best we can do is balance the harms of brain enhancement against its benefits so we can reach decisions that support and protect both the individual and society.