Rethinking cognitive enhancement PDF
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Rethinking Cognitive Enhancement Rethinking Cognitive Enhancement Edited by Ruud ter Meulen Ahmed Dahir Mohamed Wayne Hall 1 1 Great Clarendon Street, Oxford, OX2 6DP, United Kingdom Oxford University Press is a department of the University of Oxford. It furthers the University’s objective of excellence in research, scholarship, and education by publishing worldwide. Oxford is a registered trade mark of Oxford University Press in the UK and in certain other countries © Oxford University Press 2017 The moral rights of the authors have been asserted Chapters 1– 12, 14– 16, 18– 22, and 19 © Oxford University Press, 2017 Chapter 13 © 2008, BMJ Publishing Group Ltd Chapter 17 © The Hastings Center, 2012 and Taylor and Francis Group, LLC, 2011 Chapter 18 © Taylor and Francis Group, LLC, 2012 Excerpts from “Lessons for Enhancement From the History of Cocaine and Amphetamine Use” from AJOB Neuroscience, 3 (2), pp. 24-9 by Stephanie K. Bell, Jayne C. Lucke, and Wayne D. Hall. Copyright 2012 by Taylor & Francis Ltd. Reprinted by permission of the publisher (Taylor & Francis Ltd, http://www. tandfonline.com). Impression: 1 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without the prior permission in writing of Oxford University Press, or as expressly permitted by law, by licence or under terms agreed with the appropriate reprographics rights organization. Enquiries concerning reproduction outside the scope of the above should be sent to the Rights Department, Oxford University Press, at the address above You must not circulate this work in any other form and you must impose this same condition on any acquirer Published in the United States of America by Oxford University Press 198 Madison Avenue, New York, NY 10016, United States of America British Library Cataloguing in Publication Data Data available Library of Congress Control Number: 2016960549 ISBN 978– 0– 19– 872739– 2 Printed and bound by CPI Group (UK) Ltd, Croydon, CR0 4YY Oxford University Press makes no representation, express or implied, that the drug dosages in this book are correct. Readers must therefore always check the product information and clinical procedures with the most up- to- date published product information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulations. The authors and the publishers do not accept responsibility or legal liability for any errors in the text or for the misuse or misapplication of material in this work. Except where otherwise stated, drug dosages and recommendations are for the non-p regnant adult who is not breast- feeding Links to third party websites are provided by Oxford in good faith and for information only. Oxford disclaims any responsibility for the materials contained in any third party website referenced in this work. Preface This multidisciplinary volume, including scientific, ethical, and legal perspectives, offers a much needed reality check to the debate on cognitive enhancement. While there may be potential benefits to human enhancement, and to cognitive enhancement in particu- lar, there is a danger of slipping into a way of speaking about it that plays down potential downsides. It may be implied or even asserted that enhancement is inevitable or that it is by definition an improvement. Even if it is inevitable, however, that a person or persons will seek to find means of cognitive enhancement, and even succeed in doing so, that by no means settles the ethical, legal, and policy issues. Also, we should beware of mak- ing enhancement an improvement by definition. Whether any particular enhancement intervention is an improvement from an ethical point of view is an open question. For whom will it be an improvement and in what way? We have to have regard to the respects in which something is enhanced. As papers in this volume make clear, enhancement in one characteristic may result in worse performance in some other characteristic or char- acteristics: the associated risks need proper assessment and consideration of the extent to which the trade- off is worthwhile. While these remarks are true of enhancement in general, where cognitive enhancement is concerned, there are specific issues to consider. On the plus side it might be thought that cognitive capacities are good for whatever life plan an individual might want to fol- low. Surely, it might be argued, greater cognitive capacities are associated with increased probability of a successful career and all the benefits that flow from that, although it is true that they do not guarantee happiness or well- being. Again, some people may argue that we cannot, and do not think we should, avoid affecting our cognitive capacities by education and other means such as meditation. Contemporary interest in practices such as mindfulness and their effects on neuroplasticity is increasing. On the other hand, there has been concern among paediatricians that some activities which people currently do without a thought may affect our brains in a deleterious way, such as too much passive consumption of screen time, especially in very young children. Given these facts, then why should there be anything wrong with choosing to enhance our cognitive capacities deliberately and in a targeted way, using pharmaceuticals and/o r other technologies? First, however, we need to have regard to what exactly is envisaged in cognitive enhance- ment, as this volume makes clear: how are we to understand the concept of cognitive enhancement, precisely which characteristics of the brain are to be enhanced and by what methods? Different technologies, including pharmaceutical products, brain stimulation, and genetic technologies, are all candidates, and each of these has associated safety, ethi- cal, and regulatory issues. The fact that manipulation of the brain is involved gives rise vi PREfAcE to multiple concerns discussed in this collection, including scientific evidence about the significance, in terms of effectiveness, of the baseline cognitive potential in an individual prior to an intervention; safety concerns about possible side effects such as addiction, especially but not exclusively in relation to drugs; philosophical questions about identity and disability; and ethical worries about the space for authentic autonomous choice. The inclusion of the legal dimension in this volume is particularly refreshing, as the potential implications of cognitive enhancement for professional responsibility and the laws of tort, and for other areas of law such as product liability, could be considerable. So the issues about when, how, and where cognitive enhancement should be introduced require considered thought, and input from different disciplines, in order to address the pertinent questions. In particular what needs to be asked includes the following: What are the purposes of any given enhancement intervention? Is there a moral difference between introducing a cognitive change as a remedial measure as opposed to enhancing some- one who already has high cognitive capacity, perhaps even beyond the current limits of human cognition? Among other dimensions to this issue which have been given perhaps less attention elsewhere, the question of potential biological constraints, relating to the way in which the human mind has evolved, is considered in this volume. Given the importance of the human brain to human identity, the current stage of research into its complexity, and the uncertainty about consequences of some of the enhancement interventions envisaged, it is very timely to have a note of caution injected into the debate, in order to facilitate the introduction of any potential future programmes of intervention in accordance with scientific, ethical, and policy considerations which are in turn informed by rigorous academic debate. This is to be welcomed in this collection. Ruth Chadwick University of Manchester Editorial This book came about because of unease of the editors, and of many of their colleagues, with the current debate on the possibilities of human enhancement by the use of pharma- cological drugs or other technologies impacting on the brain. They felt that the optimistic view of human cognitive enhancement as presented in the bioethics and transhumanist publications was not matched by evidence in the neurosciences about what these drugs could accomplish, and did not consider their harmful effects, including addiction and dangerous overconfidence. Moreover, they were not happy about the way critical views from the field of ethics, law, public health, and social science are ignored or pictured as conservative and Luddite responses that stand in the way of scientific and societal progress. When the three editors met in Bristol a few years ago at a presentation by Wayne Hall on deep brain stimulation and addiction, they agreed to work together on this edited volume. The ground work was already prepared by Ahmed Dahir Mohamed, who had drafted an initial proposal to Oxford University Press. The editors are grateful to Oxford University Press for their willingness to publish the book and for their support during the process of collecting and editing the chapters. They feel particularly indebted to Martin Baum for believing in this project and for Charlotte Green for her invaluable help during the editing of the book. The book Rethinking Cognitive Enhancement tries to present a critical reflection on the possible benefits and harms of the efforts to enhance the cognitive functioning of human individuals by the use of psychopharmacological drugs. This reflection is led by evidence from neurological and neuropsychological research, philosophical and ethical analysis, legal approaches, and perspectives from public health and drug policy. We hope that this multidisciplinary approach will help to “debunk” the high expectations of these drugs in academic circles but also the hype in the popular press about what these drugs could bring to people. What are needed are not exaggerated fantasies, but plain evidence and critical debate as the basis for sensible policy-m aking regarding the use of so-c alled cognitive- enhancing drugs. The editors would like to acknowledge some people who have been important in the editing of this book. Ahmed Dahir Mohamed is indebted to Anthony Holland and Simon Baron Cohen, who respectively supervised and advised his doctorate in psychology at the University of Cambridge, Marilyn Williams his mentor and undergraduate supervisor, his friend Jenny Lewis, and finally Evianne Van Gijn and Anthony Edward Phillips, who were working alongside him when he was finishing his doctorate at Clare Hall, Cambridge. They have followed his progress with enthusiasm and curiosity and have been supportive all along the way. viii EDitoRiAl Wayne Hall would like to thank his colleagues at the Centre for Youth Substance Abuse Research at the University of Queensland, particularly Stephanie Bell, Jayne Lucke, and Brad Partridge, for helping to refine his thinking about the topic of cognitive enhance- ment. He also thanks Sarah Yeates for her invaluable assistance in conducting literature reviews and preparing manuscripts for publication over many years. Ruud ter Meulen would like to thank his colleagues and post- graduate students at the Centre for Ethics in Medicine for their discussions about human enhancement, par- ticularly Sylvie Allouche, Alex McKeown, and Heather Bradshaw. He also thanks the many colleagues he worked with in European projects on human enhancement, like the ENHANCE project and the EPOCH project. Their contributions from the field of ethics, law, social science, and public policy-m aking have strengthened his belief in a multidis- ciplinary approach to the ethical issues of human enhancement as the basis for policy- making. Finally, he wants to thank Ruth Chadwick for writing the preface to this volume. Bristol, Otago, Brisbane January 2016 Contents Contributors xi Part i Introduction 1 Introduction 3 Ruud ter Meulen, Ahmed Dahir Mohamed, and Wayne Hall 2 The ethical debate on human enhancement and cognitive enhancement by way of biotechnologies 15 Ruud ter Meulen Part ii Risk and benefits of the use of neuropharmacological drugs for cognitive enhancement 3 Overclocking the brain? The potential and limitations of cognition- enhancing drugs 37 Reinoud de Jongh 4 Neuroenhancement: a call for better evidence on safety and efficacy 57 Charles F. Massie, Eric M. Yamga, and Brendon P. Boot 5 Exaggerating the benefits and downplaying the risks in the bioethical debate on cognitive neuroenhancement 69 Andreas Heinz and Sabine Müller 6 The effects of modafinil on creativity: results from a randomized controlled trial 87 Ahmed Dahir Mohamed 7 Does modafinil improve cognitive functioning in healthy individuals? 107 Ahmed Dahir Mohamed 8 Cognitive enhancement using noninvasive brain stimulation: weighing opportunity, feasibility, and risk 125 Priyanka P. Shah-B asak and Roy H. Hamilton 9 The use of brain stimulation technology for cognitive enhancement and the potential for addiction 150 Mark Attiah 10 Debunking the ethical neuroenhancement debate 164 Stephan Schleim and Boris B. Quednow
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