An April 20th post in the Hastings Center’s “Bioethics Forum” brings attention the recent report by the Presidential Commission for the Study of Bioethical Issues (PCSBI) entitled, “Gray Matters: Topics at the Intersection of Neuroscience, Ethics, and Society.”
Chapter 2, “Cognitive Enhancement and Beyond” is a useful summary of issues surrounding “cognitive enhancement,” and provides a brief overview of three scientific goals: maintaining or improving neural health and cognitive function, treating disease and other impairments, and expanding or augmenting function above the normal human ranges. The PCSBI uses the term “neural modifiers” to refer to the broad array of agents that act on the brain across this spectrum of interventions.
Ultimately, the PCSBI provides sensible recommendations regarding the study and use of “neural modifiers”. It rightly attends to “societal background conditions” such as diet, sleep, exercise, and an environment unburdened by toxic agents as a top priority. Other recommendations include the need to prioritize treatments, and to “study novel neural modifiers to augment or enhance neural function.” This is not a commitment to the idea that they are a good idea, only that more information is needed to guide their ethical use. While the PCSBI leaves an open door to the possibility that there may be ethical uses for cognitive enhancement and augmentation, it is protective of children, drawing an ethical line: “Clinicians should not prescribe medications that have uncertain or unproven benefits and risks to augment neural function in children and adolescents who do not have neural disorders.”
The PCSBI raises important cautions about long-term effects, over-medicalization, and exploitation by those who would stand to gain the most (in this they cite the pharmaceutical industry, but we would do well to consider that other persons or groups could also find reasons to exploit). The most important contributions of this publication, however, come in the form of questions that the PCSBI does not, and cannot, answer in its brief report. Three such comments stand out:
- “What might happen, scholars ask, to traditional understandings of free will, moral responsibility, and virtue if science makes significant advances in the ability to technologically control the mind?”
- “Further, when we consider altering our memories, we trigger concerns at the core of defining one’s self.”
- “This desire for control might erode our appreciation for natural human powers and achievements.”
The PCSBI urges that more research be performed in order to provide us with more evidence for ethical decision-making, and that “professional organizations and other expert groups…create guidance about the use of neural modifiers.” They do us a service to highlight these concerns. But we must recognize that while the scientific method may produce clinical evidence to facilitate ethical decision-making, the foundational sense of what it means to be human will never come from a randomized controlled trial.