The Dana review examines the ethical issues relating to 'smart' drugs that may enhance brain function.

Ethicist Thomas Murray of the Hastings Institute offered the following question, an example from his work with sports-enhancing drugs, to neuroscientists beginning to think about the coming wave of “smart” drugs to enhance the brain: Should an Olympic-class sailor, receiving testosterone following the loss of his testicles to cancer, be allowed to compete? Murray had thought that an exception should be made to the rule forbidding testosterone supplementation, but the sports administrators he was working with had no trouble imagining an ambitious future athlete, desperate for Olympic stardom, submitting himself to testicular amputation just to get extra testosterone. What, then, will humans do to win at the game of life? In his lecture, Murray offered the tools of ethics— analysis, insights, and experience—as society begins to grapple with regulating cognitive enhancement drugs. A Timely Question Such drugs are not a thing of the future. In 2002, Jerome Yesavage and colleagues at Stanford University reported in Neurology that healthy air-line pilots in their 50s performed better on flight simulators after taking one of the current crop of drugs for Alzheimer’s disease. The drug methylphenidate (Ritalin), used for attention deficit hyperactivity disorder, and modafinil (Provigil), a drug for narcolepsy, also have been shown to enhance cognition in healthy people, and many more such drugs are in development. Neuroenhancers are already in use among the general population, writes Michael Gazzaniga of Dartmouth University in the September 21, 2005, issue of Scientific American. Beyond the triple latte, Gazzaniga writes that students are surreptitiously using drugs, developed for brain disorders, to raise test scores. “The government should stay out of it, letting our own ethical and moral sense guide us through the new enhancement landscape,” writes Gazzaniga, noting past and current difficulties in regulating other mind-altering substances. Toward a Neuroethics of Neuronal Enhancement Murray noted in his lecture that arguments such as Gazzaniga’s have been made against regulating performance-enhancing drugs in sports: * The “incoherency” argument says that anabolic steroids are no different than better sports gear. But if you buy that, Murray said, any way around the rules would be okay—including showing up on roller blades for a foot race. * The “arbitrariness” argument is that any line we draw will be arbitrary. Why not ban a stimulant such as coffee? We can still choose a line that is defensible based on what is legal and common in society, Murray said. * The “argument from liberty” argues against protecting people from themselves. This is a powerful argument, noted Murray: “Think about telling a downhill skier, who straps thin boards on her feet and goes down icy slopes at 75 mph, not to take steroids because they’re dangerous.” * The “resistance-is-futile” argument, borrowed from the popular Star Trek television series, notes that people will find ways to break the rules anyway. The way forward will not be easy, Murray said: If a loved one is under-going potentially life-saving brain surgery, wouldn’t you want them operated on by a surgeon using some future drug that enhances his cognitive performance? “The point of surgery is not to demonstrate the technical skill of the surgeon. The point is to heal the patient,” said Murray. But this example highlights the complexities of the situation. Some surgeons may choose not to take these drugs for health reasons. Should patients have the right to know that? Murray offered a list of questions from ethics that could help focus neuroethical discussions: Does the drug support or undermine the meaning or purpose of the activity? Does it exacerbate or ameliorate injustices? Will its use become involuntary because of institutional pressures? Will it reinforce suspect social norms or values— will “cosmetic neuropharmacology” emerge? “We need an ethics of neuronal enhancement that will be complex enough to encompass the irreducible complexities of the world that we share,” Murray concluded.

ethics, bioethics, neuroethics, enhancement, drug, medication, dana, foundation