Cognitive Enhancement Conference Program

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Program below, which contains presenting authors only, is subject to revision.

Parallel session papers fall into one of  three content themes.  In the schedule below, they are color-coded as follows:

Autonomy/Authenticity theme

Normative and legal aspects of enhancement theme

Empirical theme


 

Wednesday – August 13th

9:15-9:30 – Coffee and Registration – TBM Building ground floor

9:30-9:45 – Conference Welcome – Nicole Vincent (Room A)

9:45 – 10:45 – Keynote #1Masud Husain – Altered States: Drugs for Attention and Motivation?

10:45-10:55 – Break

10:55-11:40 – Parallel Sessions

Monika Michałowska – Cognitive enhancement & challenges to personal identity – abstract

Ben Davies – Cognitive enhancement and the ends of education – abstract

Nadira Faulmüller – You pop pills, I suffer side effects? Empirical evidence for indirect psychological costs of cognitive enhancement – abstract

11:40-12:25 – Parallel Sessions

Nada Gligorov – Continuity and the Changing Self – abstract

Pieter Bonte – Taking pride in taking pills – A plea to subvert the ‘talentocratic’ moral culture in learning environments – abstract

Felix Heise – The Hidden Costs of Cognitive Enhancement – Attribution of Responsibility and Morality in Pharmacologically Improved Performance – abstract

12:30-1:30 – Lunch

1:30-2:30 – Keynote #2Jan Schildmann – Knowledge, experiences and views of German university students toward neuroenhancement: An empirical-ethical analysis

2:30-2:40 – Break

2:40-3:25 – Parallel Sessions

Tom Buller – Authenticity, Enhancement, and the Extended Mind – abstract

Filippo Santoni de Sio – The Nature-of-Activities Approach to the Ethics of Cognitive Enhancement – abstract

Dimitris Repantis – Evidence on psychopharmacological interventions for neuroenhancement – abstract

3:25-4:05 – Parallel Sessions

Jon Leefmann – Making Sense of Authenticity in the Debate on Cognitive Enhancement – abstract

Owen Schaefer – Reasoning improvement as moral enhancement – abstract

Kirsten Brukamp – Cognitive Enhancement: Lack of Evidence and Challenges to Health Care Systems – abstract

4:05-4:15 – Break

4:15-5:15 Panel Discussion – The Use of Cognitive Enhancement in Educational Contexts

6:00-7:00 Reception at Delft Stadhuis


Thursday – August 14th

9:15-9:30 – Coffee and Registration – TBM Building ground floor
9:30-10:30 – Keynote #3Roshan Cools – Helped or Hurt by Smartdrugs?: Insights from the cognitive neuroscience of dopamine

10:30-10:40 – Break

10:40-11:25 – Parallel Sessions

Ori Lev – Biomedical Cognitive Enhancements: Coercion, Competition and Inducements – abstract

James DiGiovanna – Memory enhancement, Identity and Responsibility – abstract

Charmaine Jensen – Study Habits, Health and Cognitive Enhancement – abstract

11:25-12:10 – Parallel Sessions

Nicole A Vincent and Emma A. Jane – Should we fear the “new normal”? – abstract

Yasha Rohwer – A Duty to Cognitively Enhance Animals – abstract

Larissa Maier  – The relationship b/w stress in the workplace/education and neuroenhancement: A crosssectional study – abstract

12:10-1:15 – Lunch

1:15-2:15 – Keynote #4 – Reinhard Merkel – Neuroenhancement and the Right to Mental Self-Determination

2:15-2:25 – Break

2:25-3:10 – Parallel Sessions

Jeremy Garrett – Two Dubious Objections to Pediatric Neuroenhancement – abstract

Imogen Goold – Obliging Surgeons to Enhance: negligence liability for uncorrected fatigue and the problem of causation – abstract

Sebastian Sattler – Work-related stress and the use of as well as the willingness to use cognitive enhancement drugs among German university teachers – abstract

3:10-3:55 – Parallel Sessions

Orsolya Friedrich – Cognitive Enhancement: is there a need to inform about the possibility of medicalization to save authenticity? – abstract

Phil Robichaud – Enhancement and the Right to Mental Self-Determination – abstract

Kimberly Schelle – Treatments for GPA’s: The Effect of Levels of Performance on Cognitive Enhancing Drug Use – abstract

3:55-4:05 – Break

4:05-5:05 – Keynote #5Tom Douglas – Three Objections to Moral Neuroenhancement
7:00-9:00 – Optional dinner at Café Belvédère


Friday – August 15th

9:15-9:30 – Coffee and Registration – TBM Building ground floor
9:30-10:30 – Keynote #6Illina Singh – What’s All the Fuss About? : Smart drugs and self-care in the UK

10:30-10:40 – Break

10:40-11:25 – Parallel Sessions

Jonathan Pugh – Cognitive Enhancement: Two Dimensions of Autonomy – abstract

Pax Abad – How to rest content with who you are and what you’ve got – abstract

Lucius Caviola – Concerns about cognitive enhancement are partly driven by cognitive biases – abstract

11:25-12:10 – Parallel Sessions

Cesar Palacios Gonzalez-Do cognitive enhancers cause epistemic harm? A response to Lubomira Radoilska – abstract

Jan Willem Wieland – The Argument for cognitive enhancement from excuses – abstract

Aleksi Hupli – Student perspectives on cognitive enhancement drugs: A mix-method case study – abstract

12:10-1:15 – Lunch

1:15-2:00 – Parallel Sessions

Adam Kadlac – Against Phoniness: Enhancement, Authenticity, and Self-Creation – abstract

Carissa Véliz – Breaching Global Solidarity. The Case of Cognitive Enhancement – abstract

Hannah Maslen – Are all enhancements equal? The merit of distinguishing enhancement effects in the cheating debate – abstract

2:00-2:45 – Parallel Sessions

Pei-hua Huang – Enhancement, Authenticity, and Autonomy – abstract

Marcelo de Araujo – Moral enhancement and political realism – abstract

Nick Fitz – Social perceptions of enhancement in the workplace – abstract

2:45-2:55 – Break

2:55-3:55 – Keynote #7Neil Levy – Towards a More Banal Neuroethics
 



 

COGNITIVE ENHANCEMENT AND CHALLENGES TO PERSONAL IDENTITY

Anna Alichniewicz & Monika Michałowska (presenting)

 

In our paper we would like to focus on the challenges stemming from intensely progressing possibilities of cognitive enhancement enabled by development of neuroscience and genetics and their technological application in modern medicine. First, we are going to present a brief review of two main theories of individual identity and point to major conceptual differences in the understanding of human-self. The first conceptualization we are going to take a closer look at is a tradition going back to theories of John Locke and David Hume and flourishing now in the philosophy of Derek Parfit. In Lockean philosophy we meet the notion of the punctual self, founded on the self- consciousness of personal identity. It is a tradition of thinking of human-self from which Parfit’s notion of ‘personal identity is not what matters’ has arisen. In opposition to the above approach remains the narrative concept of personal identity argued by Charles Taylor. According to him, our identity develops in lifetime and we achieve the understanding of selfhood only and “inescapably in narrative”.

Secondly, we are going to analyze two main meanings of cognitive enhancement encountered in the works of both its advocates and critics. The first meaning of cognitive enhancement we are going to deal with has been introduced by John Harris in his well-known and influential book entitled “Enhancing evolution”. In Harris’ opinion, cognitive enhancement is implied by a moral obligation of self-improvement and self-realization, and is an inevitable part of “progress of evolution” that will serve “humankind to achieve its potential”. A similar approach to human enhancement has been taken by Julian Savulescu who, as one of very few, attempts to provide a definition of human enhancement. In his analyses, he has adopted the so-called Welfarist definition, according to which human enhancement is: “Any change in the biology or psychology of a person which increases the chances of living a good life in the relevant set of circumstances”. Applying this definition to the problem of cognitive enhancement, he states that, despite the potential risks it poses, it can become a crucial factor in the promotion of human well-being. In the straightforward opposition to his account stands the sense of cognitive enhancement claimed by Francis Fukuyama, Michael Sandel and George Annas. These authors view it as a threat to human genetic specificity that is our common heritage and therefore should be protected. They believe that human enhancement will inevitably lead to creation of ‘posthumans’ who will never be perceived as our equals. Also, the idea of human enhancement given in the works of Jürgen Habermas seems to oppose the one adopted by Harris and Savulescu. In Habermas’ opinion, any genetic enhancement violates person’s autonomy, since genetically enhanced people cannot consider themselves as “the sole authors of their own history”.

Finally, we will discuss the diversity of classification of the forms of cognitive enhancement that nonetheless usually follow an oversimplified distinction between natural and non-natural, mechanical and chemical, or dysfunction therapy and function augmentation. Our conclusions are that in the discussion of cognitive enhancement two essential issues have to be taken into account: the problem of the personal identity and the problem of possible forms of cognitive enhancement. In our opinion, moral evaluation of cognitive enhancement largely depends on the version of the notion of personal identity and meaning of cognitive enhancement that are adopted, as well as on the criteria according to which cognitive enhancement forms are classified.

 



 

COGNITIVE ENHANCEMENT AND THE ENDS OF EDUCATION

Ben Davies

 

One concern about cognitive enhancements is that they will be misused in ways that undermine the ends of education; some writers conclude that enhancement should be banned in education. I consider three plausible ends of education, and assess the way that each might be impacted by student use of cognitive enhancements.

The first is the award of positional goods. A worry is that pressure to achieve could push students to unwillingly take cognitive enhancers lest they be left behind. I argue that this concern overestimates the effectiveness of cognitive enhancers, and ignores the current role of cognitive enhancers in many students’ academic work. Unless cognitive enhancements are otherwise objectionable, e.g. on grounds of safety, it is unproblematic if some students are unwilling to take them.

I criticise an analogy with doping in professional sport. One might reject enhancements in sport because the purpose of sport is achievement within artificial limits, such as the rules of the game. The aims of academia are very different from such artificially constrained targets. Our goal as students, teachers and researchers is not to construct a system of limits within which we must operate to the best of our ingenuity, but to produce the best work possible to advanced shared academic goals. I consider an argument from Schermer that allowing enhancements means that academic institutions will end up testing the ‘wrong’ factors, and particularly that we will lose sight of the importance of effort. I argue that cognitive enhancers do not obviate the need for effort, and that a focus on effort for its own sake is misguided.

The second end is the transfer and generation of knowledge and understanding. Cognitive enhancements aim towards this end; various cognitive functions are required for learning, analysis and interpretation, so enhancements that improved these functions seem likely to further these aims. One concern is that some cognitive functions might conflict with one another; excessive concentration might compromise creativity, for instance. Still, this does not mean that cognitive enhancement will necessarily undermine knowledge. Different capacities may be important in different elements of the educational process; the potential for clashes of purpose suggest that we should focus on temporary enhancements in areas that clash, not that we should abandon enhancement altogether.

Some critics of enhancement point to current use of cognitive drugs to fuel practices opposed to the proper ends of education, such as ‘cramming’ for exams. I suggest that such usage says more about individuals who use cognitive enhancements, and the institutional context in which they operate, than it does about enhancements themselves. Most tools can be used towards a variety of ends, good and bad. Just as some current students use the internet to take academic shortcuts, and may be encouraged to do so by perverse incentives within the educational system, so might this happen with cognitive enhancers. But this should compel us to provide students with different incentives in their working practices, not to eliminate valuable tools.
The final end I consider is perseverance. The experience of struggling and failing can develop skills and character traits that are important in an individual’s future working life. If cognitive enhancement eliminates such experiences from the educational environment, students may be ill-prepared for the future.

I reiterate that we are far from the stage where cognitive enhancers eliminate the need for personal effort, or the possibility of failure. We should also consider other responses than total prohibition. One option is a ‘sliding scale’ of regulation; just as we offer more personal responsibility for learning as students grow older, so might we assume that they are more likely to have learned lessons such as self-reliance and perseverance.

Finally, lessons about perseverance and self-reliance are necessary only if those qualities are needed in the future. If cognitive enhancements are more widely available in the working world, it might be that those lessons no longer need to be learned. An obvious response to this thought is that such qualities are useful in non-professional contexts where enhanced cognitive capacities may not help. We need to be resilient in all aspects of our lives. I suggest that this response in fact reveals a problem in the criticism itself; just as the relevant lessons are needed in other areas, so they are available in non-educational contexts. We experience failure and frustration in all facets of our lives. If the end of learning perseverance can be promoted in other areas, there is no need to ban a useful tool from education just because it obstructs this end.

 


 

UNEXPECTED PSYCHOLOGICAL SIDE-EFFECTS OF COGNITIVE ENHANCEMENT: WHEN YOUR SMART DRUG USE MAKES MY PERFORMANCE WORSE

Nadira Faulmüller (presenting), Jan Crusius, Felix Heise, Lucius Caviola & Miles Hewstone

 

Even though the pharmacological effects – and side-effects – of the new ‘smart drugs’ often are not categorically different – or worse – than those of coffee (i.e., caffeine), cognitive enhancement is seen critically by the general public. Hence, going beyond the pharmacological effects, we argue that taking such substances entails certain psychological costs.
Employing an empirical-psychological perspective, in several behavioural experiments we investigated a) how people perceive others who use cognitive enhancers and b) how this affects the perceivers themselves. We found clear evidence for psychological costs of cognitive enhancement for both the user and the perceiver. For example, when confronted with the success of another person, participants judged this success as less deserved when the other person used a cognitive enhancer than when the other person used coffee. Moreover, comparing themselves to a successful person using a cognitive enhancer (rather than coffee) led to more malicious envy involving increased hostile motivational tendencies, and less benign envy associated with decreased performance motivation. This decreased motivation even let to reduced performance of the perceiver when interacting with an enhancement user.

 


 

CONTINUITY AND THE CHANGING SELF

Nada Gligorov

 

The Presidential Council on Bioethics (2003) has brought up alterations to personal identity as a potential moral obstacle to neurocognitive enhancement. The charge is that the use of enhancers could change not just our intellectual abilities but might alter core personality characteristics. Arguments that use of enhancers could disrupt personal identity are often based on the confusion between numerical and narrative identity. I distinguish between those concepts.
Numerical identity refers to the identity of an individual across time and is often discussed in philosophy because it gives rise to the problem of personal identity over time. Some criteria of numerical identity over time select psychological characteristics while others select biological or physical features to establish identity over time.

Numerical criteria, whether psychological or physical, do not rely on features of the self that are important to individual people. Rather, those devising such criteria select particular features of human psychology or biology that are the most likely to remain the same over time and could be used to establish the continuity of identity over time. To the extent that they are useful in resolving troubling questions about how we change while remaining the same individual, they apply to all people in the same way and in virtue of the same properties, either psychological ones or biological ones. In this way, personal identity and conceptions of self diverge.

DeGrazia (2005) describes our individual conceptions of self as constructions of narrative identities that can answer the question of “Who am I?” Each of us has an autobiography, which provides an answer to that question. Conceptions of self may depend on core values, beliefs, personal interests, and characteristics. But there are individual differences in the constitution of our self-conception. When generating a conception of self, we need only to formulate a personal autobiography. Individual conceptions of self do not establish standards for what should be true of conceptions of self in general.

Use of cognitive enhancers that might precipitate a change in personality would not entail the demise and literal replacement of the one person with another; it would merely precipitate a change in self-conception. Because narrative identity is subjective, each person has his or her own conception of self. And since such conceptions are intra- and inter-personally variable, there can be no normative requirements for people to construct a particular kind of self nor are there such requirements to maintain that sense of self throughout life. Accordingly, I conclude that cognitive enhancement is permissible even if it does affect conceptions of self.

In addition, changes in self over time occur spontaneously. Research by Jordi Quoidbach et al. (2013) supports the claim that people change a great deal over time. Those changes occur both in personality traits, as in expressed commitment to particular values, and as they occur in personal preferences. The participants in the study were able to assess accurately the amount of change they underwent in the past, but kept their conviction that their current cluster of personality traits, values, and preferences would persist in the future. It seems then that a concept of self can be maintained despite change.

Given that continuity can be maintained despite change to even purportedly important features of the self, it seems wrong to argue that cognitive enhancers ought not to be used because they might change core personality traits. If individual traits can vary as a result of education, change of religion, or shifts in social and other circumstances, then alterations in narrative identity that result from cognitive enhancement ought to be conceived of as just one kind of potential change to self over time.

 



 

THE HIDDEN COSTS OF COGNITIVE ENHANCEMENT – ATTRIBUTION OF RESPONSIBILITY AND MORALITY IN PHARMACOLOGICALLY IMPROVED PERFORMANCE

Felix Heise (presenting), Nadira Faulmüller & Nicole Vincent

 

Over the past few years the debate over the regulation of Cognitive Enhancement (CE) has vastly risen in popularity amongst academics. CE is usually referred to as the off-label use of medical substances like methylphenidate (Ritalin) or modafinil (Provagil) for the purpose of improving mental performance (e.g. memory or concentration).

As the pharmacological effects – and side effects – of these new so-called ‘smart drugs’ seem to be similar to those of ‘old’ enhancers like caffeine (i.e. coffee), advocates of CE call for the regulated distribution of CE substances to the general public. While critics have raised concerns about the moral permissibility (e.g. with regards to fairness) of CE substances, there has been no empirical investigation of the indirect social costs their use might entail. Previous research has suggested that in contrast to coffee, the general public’s unfamiliarity with CE substances leads to an overestimation of their effectiveness and therefore their categorically different perception. Hence, we argue that making use of CE entails indirect social costs similar to the use of a street-drug like cocaine.

Drawing on attribution theory and previous work on CE, we investigated in a series of experiments (conducted online and in the laboratory) how people attribute responsibility for success to users of the CE substance Ritalin, as contrasted to coffee and cocaine. In addition, we looked at the overall attribution of morality to the use of the respective substance. We found clear differences between coffee and Ritalin: when confronted with a successful other person, participants attributed this success less to the other person and more to the used substance when the other person was described as having consumed Ritalin or cocaine than when described as having consumed coffee. No difference between Ritalin and cocaine was found. Furthermore, the use of Ritalin or cocaine and the user him-/herself was perceived as less moral than for coffee. Again, no difference between Ritalin and cocaine was found. Reasons for these differences are discussed.

 



 

AUTHENTICITY, ENHANCEMENT, AND THE EXTENDED MIND

Tom Buller

 

At first glance it would seem that the distinction between direct interventions into the brain and indirect interventions into the environment tracks the distinction between authentic and inauthentic mental states: a state is authentic if and only if it is the result of an indirect intervention. Unfortunately, however, this claim is too strong: First, being the result of a indirect intervention is not sufficient for authenticity, for mental states can be inauthentic despite being the result of indirect interventions, for example, beliefs that are held after brainwashing. Second, authentic states can be the result of direct interventions, for example, the restoration of a calm and coherent personality as the result of successful treatment for anxiety disorder. Accordingly, the conclusion drawn by many is that if authenticity is a problem, it is not just a problem for direct interventions.
In this paper I wish to consider an interesting and more radical response to the relationship between authenticity and direct interventions that has been presented by Neil Levy. According to Levy, adoption of the Extended Mind thesis (EM) – briefly the thesis that the mind can extend beyond the skill-and-skull boundary and into the world – undermines the authenticity objection. For if the mind extends into the world then interventions that were previously categorized as indirect, environmental interventions can now be regarded as interventions into our mental states.

In this paper I wish to argue that the appeal to EM is unsuccessful because the thesis is consistent with the distinction between authentic and inauthentic mental states. Specifically, I argue (a) that the set of conditions proposed by Chalmers and Clark in their original article provide a framework for differentiating authentic and inauthentic mental states, and (b) that if these conditions fail to provide such a framework then the EM thesis is too liberal – the conditions for “playing the right sort of cognitive role” will be too broad.

I will conclude by proposing that the best candidates for making sense of the notion of authenticity are psychological integration and self-hood at the personal rather than the sub-personal level. Accordingly, cognitive enhancement, whether direct or indirect, can be authentic to the extent to which it is informed by the person’s view of her self, and the content of new or enhanced mental states can be integrated into the overall psychology. This account is consistent with a liberal account of cognitive enhancement and does not track the direct/indirect distinction.

 



 

EVIDENCE ON PSYCHOPHARMACOLOGICAL INTERVENTIONS FOR NEUROENHANCEMENT

Dimitris Repantis

 

The consumption of psychopharmaceutical prescription drugs by healthy people has given rise to heated debate. Although much has been said on the ethics of consuming medications for cognitive enhancement, still not enough is known about the actual effects of nowadays available substances. Since these drugs are presumed to be already in widespread use as neuroenhancers, questions regarding their efficacy and safety of their use for non-medical reasons arise. Therefore, an insight into the available empirical research is warranted. Based on a review of the literature available evidence for the most cited enhancement drugs would be presented. The focus would be on prescription stimulants, especially methylphenidate and modafinil, but also antidementia drugs such as donepezil. It can be shown that expectations regarding the effectiveness of these drugs exceed their actual effects, as has been demonstrated in single- or double-blind randomized controlled trials. In most cases there is not enough evidence to support the reputation of these substances as neuroenhancers. A number of studies exist showing no effect and in some cases even negative effects have been shown. The case of donepezil would make the latter point clearer. Beside these points regarding efficacy, subtle side effects normally not in focus of clinical trials make the picture even more unclear.

According to the current data, it seems that the strongest reason not to use prescription drugs for enhancement purposes at the moment is the lack of evidence both for their effectiveness and their long-term safety in healthy people. The – mostly implicit – interpretations of the inconclusive data at hand has often polarized the academic debate. Still, no evidence of an effect is not equivalent to evidence of no effect. Therefore, the question regarding the implications for research is naturally relevant. By presenting the current state of research, a framework for discussing the ethics of research on such medications is provided.

 



 

MAKING SENSE OF AUTHENTICITY IN THE DEBATE ON COGNITIVE ENHANCEMENT

Jon Leefmann

 

Surprisingly to many moral philosophers, the concept of ‘authenticity’ has been a point of reference for arguments within the ethical debates on human cognitive enhancement. Whenever the application of some technology could challenge human self-understanding and whenever concepts of ‘self’ and ‘identity’ are under attack by new possibilities of technological self-design, concepts of ‘authenticity’ leap into the debates. Proponents and opponents of cognitive enhancement intuitively take the moral relevance of ‘authenticity’ for granted. However, the meaning of ‘authenticity’ in the context of human enhancement is far from clear. Furthermore, it is highly debatable, whether the use of this term expresses any morally relevant concerns.

In my paper, I will argue that the function of the concept of ‘authenticity’ in the debate on human cognitive enhancement is primarily diagnostic. I will put forward this hypothesis by answering two questions. First: What is the relevant meaning of the terms ‘authentic’ and ‘authenticity’ for the ethical debate on human cognitive enhancement? And second: Is there any moral significance of ‘authenticity’ in questions of human cognitive enhancement?
In response to the first question I will argue that the meaning of ‘authenticity’ in the debate on human enhancement generally depends on the underlying picture of ‘the self’. I claim that ‘authenticity’ is a fundamentally relational, attributive, affirmative and evaluative term that cannot be properly understood unless there is a reference to a ‘self’ or an ‘identity’. In the debate on cognitive enhancement differing conceptions of freedom and ‘the self’ are often implicitly presupposed. These varying presuppositions do not only explain the different notions of ‘authenticity’ within the debate but they also set different limits to the possibility of an ‘authentic’ enhancement of human mental capacities.

In the last part of the paper, I present three accounts of ‘authenticity’ and show how they represent different intuitions about what it means to be ‘a self’. In either of these accounts the ‘authenticity’ of the ‘enhanced self’ basically depends on what is most important to the person, who uses enhancement technologies. Therefore, I conclude that the threat of ‘inauthenticity’ in the debate on cognitive enhancement is about not living up to what is most important in one’s idea of a life worth living. The concern expressed by talk of ‘authenticity’ is therefore more about not being fully rational relative to one’s evaluative self-understanding than about acting morally wrong.

 



 

REASONING IMPROVEMENT AS MORAL ENHANCEMENT

Owen Schaefer

 

While much of the debate over moral enhancement has focused on identifying traits or dispositions that are primarily moral in nature and improving on them, much of that sort of identification will be controversial and engender intense disagreement. A more moderate approach is instead to focus on how improvements in reasoning can constitute moral enhancement. Beyond their prudential benefits, then, improvements in cognition may also count as moral enhancements. This approach has the advantage of avoiding some of the pitfalls of more direct forms of enhancement as well as helping clarify what sorts of cognitive enhancements we should focus on developing at present.

The idea that improved reasoning can be a form of moral enhancement relies on having some confidence in people’s basic moral ideas. Without a reliable basis, any improvements in reasoning processes would simply be ‘garbage in, garbage out’. As it turns out, though, we are almost all implicitly committed to the basic reliability of our moral ideas. This presupposition grounds our confidence in a wide range of moral views, without which we would not be able to say with confidence that any given moral idea we entertain. Even nihilists (insofar as they make certain negative moral judgments) will have to agree with this perspective, at least internally.

Given this reliable basis, we can see improved reasoning can lead to improved moral ideas. ‘Reasoning’ is admittedly a loaded concept, and I will not offer a complete conceptual analysis. Instead, I will focus on a few aspects of reasoning that can engender moral improvement. These are: empirical competence, logical competence, conceptual moral understanding, critical analysis and bias avoidance. Empirical competence is relevant to empirical premises in moral arguments. Consider the following argument: “If John killed Ed, he should be punished”; “John killed Ed”; “Therefore, John should be punished.” The first premise and conclusion are moral, but the second premise is empirical. Being more competent in evaluating and assessing that empirical claim will (given that the moral premises are generally reliable) lead to more reliable and morally correct conclusions. Logical competence, for similar reasons, is important; it both allows one to recognize when some moral conclusion (such as, John should be punished) follows from one’s premises as well as recognize when one has contradictory moral views that should be corrected. Again, on account of general optimism about our moral discernment, we can generally expect that correction will be in the right direction. Conceptual understanding and critical analysis concern one’s ability to grasp as well as effectively critique moral ideas relevant to deliberation. Better understanding helps clarify the force and implications of any given idea, while better analysis helps identify potential flaws in one’s thoughts and arguments – as well as those of others. In addition, it may be important to be open to correction in a wide set of cases. None of us are infallible, after all. And finally, bias interferes with one’s ability to reason properly. The general problem with biases is that irrelevant factors (e.g., race, geography, how hungry you are) affect moral judgments in particular circumstances. By tipping the balance in favour of only relevant factors, we would increase the moral reliability of judgments.

Some of these areas (such as empirical competence, vis-a-vis memory) are more susceptible to manipulation via presently-available biological means than others. But given the prospect of moral improvement (undoubtedly a worthy goal), we should seek out novel interventions that might improve on other areas like logical competence or bias avoidance. To be sure, the most widespread form of enhancement currently in use – education – already addresses many of these areas of reasoning, it would be greatly beneficial if novel biological interventions could lead to such improvements as well.

 



 

COGNITIVE ENHANCEMENT: Lack of evidence and challenges to health care systems

Kirsten Brukamp

 

The topic of cognitive enhancement evokes new controversies in the field of biomedical ethics. Pro and con arguments are related to concepts in diverse disciplines like medicine, sociology, and ethics, for example with respect to human nature, liberty, justice, and virtue ethics. Two select aspects are discussed here: the lack of evidence according to the standards of evidence-based medicine and the challenges to health care systems. Only current pharmacological cognitive enhancement options will be addressed because medication use is the most feasible route to enhancement at present.

The field of cognitive enhancement shows a relative lack of evidence in support of its benefits according to the practice of evidence-based medicine. Normally, medication for medical therapies is tested carefully in controlled studies. The safety requirements for pharmacological enhancers should be higher than normal because of the increased objective cost-benefit ratio in comparison to medication for therapeutic or preventive treatments. A typical medical drug should possess beneficial short-term and long-term effects. In contrast, the short-term benefits of enhancers are not entirely convincing, and their long-term consequences are unclear. Even if they improved immediate cognitive performance, would this result in a better quality of life overall? The satisfaction with one’s life is likely influenced by a multitude of determinants. According to the established standards of evidence-based practice, the benefits of enhancers would need to be proven in comparison to widely accepted, non-pharmacological strategies with lower risks.

Enhancement constitutes a challenge to health care systems because it may deplete assets that are meant for therapy, prevention, rehabilitation, and palliative care as the conventional purposes of medicine. Health care systems in most countries are responsible for patient care, not for consumer
The topic of cognitive enhancement evokes new controversies in the field of biomedical ethics. Pro and con arguments are related to concepts in diverse disciplines like medicine, sociology, and ethics, for example with respect to human nature, liberty, justice, and virtue ethics. Two select aspects are discussed here: the lack of evidence according to the standards of evidence-based medicine and the challenges to health care systems. Only current pharmacological cognitive enhancement options will be addressed because medication use is the most feasible route to enhancement at present.

The field of cognitive enhancement shows a relative lack of evidence in support of its benefits according to the practice of evidence-based medicine. Normally, medication for medical therapies is tested carefully in controlled studies. The safety requirements for pharmacological enhancers should be higher than normal because of the increased objective cost-benefit ratio in comparison to medication for therapeutic or preventive treatments. A typical medical drug should possess beneficial short-term and long-term effects. In contrast, the short-term benefits of enhancers are not entirely convincing, and their long-term consequences are unclear. Even if they improved immediate cognitive performance, would this result in a better quality of life overall? The satisfaction with one’s life is likely influenced by a multitude of determinants. According to the established standards of evidence-based practice, the benefits of enhancers would need to be proven in comparison to widely accepted, non-pharmacological strategies with lower risks.

Enhancement constitutes a challenge to health care systems because it may deplete assets that are meant for therapy, prevention, rehabilitation, and palliative care as the conventional purposes of medicine. Health care systems in most countries are responsible for patient care, not for consumer satisfaction. Consequently, enhancement might be criticized for this reason. The depletion of assets may occur on several levels: provider services, physicians’ personal resources, research and development in pharmaceutical companies, and shifts from health insurance to direct-to-consumer advertising.
Economic expenses stem from complications of enhancers, which are treated in the health care system due to insurance coverage. Physicians devote time and attention to their patients. Enhancement intentions may divert the physicians’ focus away from medical problems. Currently, it remains unclear to which extent physicians are liable for prescribing enhancers. Pharmaceutical companies could decide to invest in research on enhancers rather than on traditional medication. Such a change in the target group is not desirable from a societal perspective. Traditionally, physicians initiated prescriptions, but direct-to-consumer advertising might increase. This development could weaken health care systems overall because of a loss of interest in health insurances and a rise of self-paid enhancement tools. Empirical studies prove that direct-to- consumer advertising in general promotes patients to engage their physicians in conversations about the marketed medication, and this often results in a prescription.

In conclusion, the ethical and social assessment of cognitive enhancement results in an overall skeptical stance towards it at the present time. The lack of evidence according to the evidence-based practice of medicine does not allow a recommendation in favor of pharmacological cognitive enhancers. Considering potential strains for health care systems, political and social priorities will most likely have to concern medical treatments rather than enhancement purposes.

 



 

COGNITIVE ENHANCEMENT: TWO DIMENSIONS OF AUTONOMY

Jonathan Pugh

 

Advocates of human enhancement have begun to consider whether autonomy might be enhanced using emerging biotechnologies. I suggest that it is possible to identify two strands in this burgeoning literature which map on to a distinction between what I call the reflective and practical dimensions of autonomy. On this distinction, the reflective dimension pertains to the critical reflection that agents must carry out on their motivating desires in order to be autonomous with respect to them, whilst the practical dimension pertains to the agent’s freedom to act effectively in pursuit of their own ends. Whilst bioethicists have argued that enhancement technologies could be used to directly enhance autonomy on each of these dimensions, I claim that they have overlooked the fact that these two dimensions of autonomy are importantly interrelated. Having acknowledged this, I suggest a further indirect way that enhancement technologies might impact on personal autonomy.

 



 

TAKING PRIDE IN TAKING PILLS: A plea to subvert the ‘talentocratic’ moral culture in learning environments

Pieter Bonte

 

Constitutive luck in learning ability is one of the most profound and pivotal inequalities all school-goers are vividly confronted with. Talented ‘naturals’ can absorb, retain, recall and interrelate knowledge markedly better than others. This cognitive talent differentiation can frustrate, anger and dishearten the less constitutive lucky, who can often be found exclaiming how this natural inequality is ‘simply not fair’. In this talk, I examine how the advent of cognitive enhancement interventions (CEIs) might advance two emancipatory struggles. The first concerns redistributive justice, in which cognitive enhancement interventions might be extolled as one set of tools for incrementally increasing ‘equal constitutive opportunity’, for instance by offering CEIs at no or subsidy-lowered cost to those declared to be significantly less-endowed. Clearly, such a theoretical redistributive scheme faces daunting practical challenges, mainly concerning the R&D of safe, effective and mass-administrable CEIs and concerning the methodology for defining and detecting (lack of) ‘talent’. However, beyond these daunting practicalities, a daunting moral quandary must be faced as well. This concerns the second emancipatory struggle for a revision of the shame and moral depreciation of the less-endowed, and the correlate pride and moral celebration of the talented. I argue that our contemporary moral culture remains deeply plagued with a ‘talentocratic’ value system, which surfaces explicitely in the stigmatization of pill-takers, surgery- electors and otherwise self-enhancing persons. I conclude that even without all that much actual game- changing CEIs at the ready, compelling thought-experimentation on a hypothetical CEI-providing world already yields strong reasons to start subverting talentocratic morality today. Mindful of clear and present philosophical pitfalls and practical dangers such as co-opting by morally dubious commercial institutions, I nevertheless push on to argue for a subversive, emancipatory narrative of ‘pill pride’.

 



 

STUDY HABITS, HEALTH AND COGNITIVE ENHANCEMENT

Charmaine Jensen (presenting), Dr. Cynthia Forlini & Prof. Wayne Hall

 

Cognitive enhancement, the use of prescription stimulants (for example, Ritalin or Adderall) by the healthy to improve cognitive function, has been reported as a widespread and increasing phenomenon among university students. Media and bioethics discussions have, at times, inflated the prevalence and efficacy of putative cognition enhancing drugs in ways that may encourage their use by students to facilitate achievement and career opportunities. Furthermore, university campuses are described as competitive environments requiring students to maximize their potential and competitiveness. The extent of cognitive enhancement in Australian university students remains unclear, as do the factors that may predispose or protect students from using these drugs.

Aims: This study explored the context in which cognitive enhancement occurs in Australian universities by investigating student motivations and experiences of studying. We inquired about study habits and strategies or substances used to enhance their ability to juggle demands of student life. We also probed about the adverse impacts on health that arise from these strategies or substances. With students familiar with cognitive enhancement, we discussed their experience including, motivations for use, perceived safety and efficacy, and ethical perspectives.

Method: Participants were recruited through multiple avenues including advertisements posted around university campuses and sent via faculty email lists. Semi-structured qualitative interviews were carried out. Interview transcripts were coded using an inductive approach that identified major themes in the interviews. The sample of 35 university students came from a range of disciplines, were aged 18 to 24 years of age, and were predominantly Australian citizens and female (n=21).

Results: Many of the Australian university students from this sample were completely unaware of cognitive enhancement. Only 2 participants had used cognitive enhancing drugs. Those who were aware of the practice attributed their knowledge to the internet or word-of-mouth. Students in the sample were generally health conscious engaging in exercise, healthy eating and good sleeping habits. However, managing both study and other commitments caused them to compromise these health habits in times of pressure. Themes generated by students focused on educational impetus, study habits and strategies, achievement, demands, stress, support and health. Authenticity was a common thread supported by these themes, with many students identifying interest and meaningfulness as an important motive for the way they approach study and in opposition to using cognitive enhancement drugs. Several assumptions in the cognitive enhancement literature were supported, such as reasons for non-use being concerned with health, drug efficacy, legality, and enhancement as treatment. Other assumptions were not supported, namely, that heightened perception of stress was seen solely as negative and a major reason for using cognitive enhancing drugs, and that all students were highly competitive and achievement-focused.

Conclusion: The use of prescription stimulants for cognitive enhancement by Australian university students appears to be uncommon and limited, with students managing student life without the use of cognitive enhancing drugs. They may be less inclined to consider or use stimulants for cognitive enhancement because of protective factors like authenticity, their evaluation of stress, their perception of success and achievement, and health awareness. These findings contribute valuable insight to the bioethics debate by exploring the broader context of student life and challenging portrayals of widespread and increasing use of prescription stimulants for cognitive enhancement.

 



 

BIOMEDICAL COGNITIVE ENHANCEMENTS: COERCION, COMPETITION AND INDUCEMENTS

Ori Lev

 

The debate over the ethical permissibility of using cognitive enhancement interventions is ongoing. This debate has generated a variety of concerns; one worry that stands out in this regard concerns the question of coercion. Curiously, although pointed out by many, this concern has not received close scrutiny. The aim of this paper is to begin addressing this conceptual gap.

The concern about coercing people to use cognitive biomedical enhancements has been highlighted by several authors, Henry T. Greely, argues that coercion in the context of cognitive enhancements is one of the more serious concerns. Similarly, a group of leading bioethicists and neuroscientists has also argued that one of the most important issues that should be addressed about cognitive enhancements is coercion. Here is how they describe the concern: “Coercion. If neurocognitive enhancement becomes widespread, there will inevitably be situations in which people are pressured to enhance their cognitive abilities.”

In order to explore this concern, I will employ Alan Wertheimer’s understanding of coercion and will defend it against various objections. After clarifying this notion and its various implications, the claim that coercion is a concern with regard to cognitive enhancements will be examined. In a nutshell, according to Wertheimer’s account coercion involves a wrongful threat in which one has little choice but to succumb. Moreover, the wrongfulness of the threat stems from the fact that it violates the coercee’s rights. I will suggest that if one accepts this account, it follows that coercing people to enhance would be impermissible.

Using this framework the paper will assess the claim that competition over jobs, goods and positions coerces people to enhance. I shall argue, however, that competition cannot be coercive, at least according to the Wertheimer’s account; this is because, generally speaking, competition does not involve a wrongful threat. Indeed, competition between individuals over jobs, goods and positions, (assuming it is pursued within a proper legal framework) does not violate persons’ rights.

Nonetheless, I shall propose that although competition is not coercive, enhancing because of competitive pressure is morally problematic as it could restrict persons’ autonomy and harm their well-being. I shall argue that within the context of competition, people should have the choice whether to enhance or not, if they cannot exercise that freedom, their autonomy is diminished. Accordingly, I explore ways which the state could devise to protect people against such pressure. As for well-being, I will suggest that given a competitive environment being pressured to enhance in order to maintain one’s position is likely to be detrimental to people’s welfare. This is because persons would need to spend more time working just to maintain their social standing rather than pursue valuable goals.

The paper then turns to examine whether there are non-coercive permissible ways to induce people to cognitively enhance. Using various hypothetical cases I will delineate criteria that could be used to determine whether a particular enhancement should be considered mandatory or whether it should be encouraged, discouraged or perhaps even prohibited. For instance, I shall argue that cognitive enhancements that would have minor side effects and which significantly minimize harm to others ought to be made mandatory. However, enhancements that have only a modest positive impact on third parties but also have side effects that are more than minor, should not be required. The use of such enhancements ought to be encouraged through the provision of particular incentives. In other words, as a society regulating cognitive enhancements should be based on their particular features, their purpose and how they affect important values.

I conclude by suggesting that although the case against coercing people to cognitively enhance is decisive, there are still many open questions regarding the ways it would be ethically permissible to induce people to enhance.

 



 

A DUTY TO COGNITIVELY ENHANCE ANIMALS

Yasha Rohwer

 

Currently there is a growing literature on the ethics of cognitively enhancing humans (e.g. Buchanan 2011; Persson and Savulescu 2012; Sandel 2007; Savulescu and Bostrom 2009). With this growing literature on humans there are also questions about the permissibility of enhancing non-human animals. For example, one could argue that it is permissible to enhance the cognitive capacities of certain animals that help humans—e.g. search and rescue dogs; or helper monkeys. However, I will explore whether or not humans have a prima facie duty to cognitively enhance other animals, not for the benefit of humans, but for the benefit of the animals themselves. In this paper I will argue that human sometimes do have a prima facie duty to cognitively enhance other animals in order to right wrongs that occurred in the past. I will focus on a particular set of animals– Australian marsupials, particularly those whose populations have been devastated by anthropogenic novel predators.

After Europeans introduced the fox and the domestic cat to the continent, these novel predators naturalized and nearly drove extinct a host of small native marsupials such as the bilby, the numbat and the bridled nailtail wallaby. Ecologists conjecture that the native fauna do not have the behavioral flexibility to cope with predators to which they are naïve (Davis 2009). Humans have wronged these animals in the past and are still doing so, and many argue that we can have duties of restitution or restoration to nonhuman animals and other species (Taylor 1986, Cairns 2003). These duties of restitution or restoration however, are quite difficult to fulfill to these Australian marsupials. Conservation practices such as trapping and relocating foxes and cats is not a viable option on a continent-wide scale (Marris 2011, Winnard & Coulson 2008). The alternative—keeping these animals fenced into tiny reserves—limits their numbers and exposes them to the risk of wildfires, which could destroy entire populations. Therefore, traditional means of conservation simply cannot fulfill our duties to these animals. This doesn’t mean that we have no duty of restitution or restoration to these animals, just that the means to fulfilling these duties will not be the typical conservation strategies.

Conservationists have had some success with training endangered species to fear and avoid exotic predators and toxic exotic prey (cane toads) (Royds 2010, McLean et. al. 2000, Griffin & Evans 2003). This training is a form of cognitive enhancement. Pharmaceutical and genetic engineering may offer more permanent and wide-scale cognitive enhancement of animals, and these techniques are becoming a possibility (Anthes 2013). Cognitively enhancing these marsupials may allow them a chance at leading flourishing lives in ecosystems with foxes and cats. Therefore, humans have a prima facie duty to cognitively enhance some animals to fulfill our duty to right the wrongs of the past.

 



 

THE RELATIONSHIP BETWEEN STRESS IN THE WORKPLACE OR IN EDUCATION AND NEUROENHANCEMENT: A cross- sectional study among Swiss employees and people in education

Larissa Maier (presenting) & M.P. Schaub

 

Background:
Neuroenhancement refers to the use of psychoactive substances by healthy subjects to enhance cognitive or affective functioning. Possible side-effects and long-term effects of the use of substances for neuroenhancement are not yet investigated. Stress in the workplace and in education has increased in recent years. Response to stress can vary greatly between individuals; some people try to cope with their stress by using prescription drugs and drugs of abuse for neuroenhancement.

Methods:
Participants were drawn from the representative Internet panel of the LINK institute in Switzerland, which consists of several thousand members national who consented to be contacted for public opinion surveys administered through the Internet. The online survey was conducted in March 2013 and reached a stratified sample of 10’000 Swiss employees and people in education, which was weighted for sex, age and language region. The questionnaire was specifically designed for the present survey at the Swiss Research Institute for Public Health and Addiction. Some questions were taken from existing questionnaires on stress or neuroenhancement. Questions concerning consumption patterns and consumption frequency of different substances were based on the recommendations of the Swiss Addiction Monitoring. The questionnaire included questions on socio- demographic data, stress in the workplace or in education, self-efficacy, health, and use of neuroenhancing substances. Each medication was presented graphically with packing and pills to facilitate the recognition for the experienced users. For each substance, participants had to indicate the frequency of use within the last 30 days, motives for use, and whether their expectations regarding the medication’s effects were met. These questions were asked for nonmedical use of the following groups of substances: methylphenidate, modafinil, activating antidepressants including selective serotonin reuptake inhibitors (SSRIs), anti-dementia agents, sedatives/hypnotics, and beta- blockers. Furthermore, the survey asked questions about frequency of use and motives for use of drugs of abuse, such as alcohol, cannabis, cocaine, ecstasy (MDMA), amphetamines, ketamine, and GHB/GBL (liquid ecstasy). Participants were also asked about their use of soft enhancing substances such as herbal sedatives (e.g., St. John’s Wort, common valerian), vitamins and tonics (e.g., gingko biloba, zinc), tobacco, coffee, caffeine tablets, and energy drinks. Correlation and statistical models were used to describe the relationship between stress in the workplace and in education and neuroenhancement.

Results:
Of the study population, 411 subjects (4%) reported use of prescription drugs or drugs of abuse for neuroenhancement. The nonmedical use of prescription drugs with effects on mood and mental well-being for indirect neuroenhancement (3.1%) appears to be more popular than the nonmedical use of prescription drugs for direct cognitive enhancement (1.4%). The lifetime prevalence for neuroenhancement was significantly higher for people in education (6.8%) and people aged 15 to 24 (5.5%). More than half of the group with neuroenhancement experience (62%) felt frequently or very frequently stressed during the last 12 months and three quarter of them (74%) experienced long- term stress. This group reported significantly more often a high pace of work, tight deadlines, unclear instructions, unnecessary breaks in work processes, lacks of control, competitive pressure and feelings that did not coincide with their own feelings. Of this specific group, 17% claimed that they never have a possibility of coping with their stress. One quarter of all participants (25.4%) had already consumed alcohol with the motive of relaxation after stress in the workplace or in education, what could be also defined as indirect neuroenhancement. The use of soft enhancing substances (e.g., caffeine products, vitamins and tonics) for cognitive enhancement, mood enhancement, or relaxation was common in the study population (63.3%).

Conclusions:
Participants, who reported higher levels of stress and only few opportunities to cope with stress, were also more experienced with neuroenhancement. Especially people in education and young adults in general rated their perceived stress highest and reported more frequently use of prescription drugs or drugs of abuse for neuroenhancement. Substance use to cope with stress was prevalent in the study population.

 



 

TWO DUBIOUS OBJECTIONS TO PEDIATRIC NEUROENHANCEMENT

Jeremy Garrett

 

In a 2013 position paper on pediatric neuroenhancement endorsed by the American Academy of Neurology (AAN), Child Neurology Society, and American Neurological Association, the AAN’s Ethics, Law and Humanities Committee (ELHC) concludes that “neuroenhancement in legally and developmentally nonautonomous children and adolescents without a diagnosis of a neurologic disorder is not justifiable” [1]. The paper cites a host of ethical considerations in support of this conclusion, including predictable concerns regarding the safety of neurostimulants and the potential for parental/societal coercion, over-medicalization, and medical child abuse. These misgivings, and most of the others raised by ELHC against pediatric neuroenhancement, are not principled objections to pediatric neuroenhancement per se, but instead are contingent practical objections with substantial empirical content. As such, it is possible that they might be either false or inapplicable to at least some current forms of pediatric neuroenhancement or, alternatively, that they might be eliminated by future developments in the practice of pediatric neuroenhancement.

However, ELHC raises at least two objections to pediatric neuroenhancement that are more philosophical in nature and that seem to constitute principled objections to any form of the practice. The first concerns physicians’ obligations to “protect authenticity in childhood and adolescence” [1]. Here the worry seems to be that neurostimulants, powerful pharmacological agents that they are, might interfere with or altogether stifle the “true development of unique individuality and self-fulfillment throughout life” [1]. The second objection raises a similar philosophical concern about the formation of the self, appealing to the familiar pediatric ideal of a child’s right to an open future (i.e., the right to “reach maturity with as many open options, opportunities, and advantages as possible” [1]). Here the worry is that the use of neurostimulants might unduly determine the trajectory of childrens’ lives before they themselves are in a position to autonomously make such fundamental choices for themselves.

In this presentation, I critically examine these two philosophical objections to pediatric neuroenhancement. I argue that both objections rest on a common dubious assumption – namely, that the decision to use neurostimulants somehow belongs within a special category of possible choices for children and is thus subject to stricter standards and greater scrutiny than the myriad options and decisions which determine one’s future self and life path. After considering a variety of ways in which critics of pediatric neuroenhancement might defend such a special status for the practice, I conclude that none of them successfully distinguish it from any number of morally unobjectionable practices to which children are allowed access. While this conclusion does not itself amount to an all-things-considered defense of pediatric neuroenhancement, it does undercut the most prominent principled objections to the practice and thus emphasizes just how important it is for critics to establish empirical support for their contingent practical objections.

 


 

OBLIGING SURGEONS TO ENHANCE: NEGLIGENCE LIABILITY FOR UNCORRECTED FATIGUE AND THE PROBLEM OF CAUSATION

Imogen Goold (presenting) and Hannah Maslen

 

The widening use of cognitive enhancing pharmaceuticals, such as modafinil, has led to considerable ethical debate about issue around authenticity, fairness and even whether there is a moral obligation to enhance. This latter question has raised questions as to whether there might be a legal obligation to enhance. We have argued elsewhere that the law will not oblige a professional to self-enhance (the first obstacle to a claim), but others disagree. In this paper, we explore a second obstacle to claim of negligence for a failure to enhance: the problem of establishing causation. We argue that as the science on enhancers and what they are capable of currently stands, it will not be possible to establish a causal link between failure to enhance to redress fatigue, and alleged harm that has resulted in most cases. In those where a link could be established, it is unlikely that taking the enhancer would actually have been redundant. We focus on the most likely context in which such claims might arise – clinical negligence – and on the most efficacious enhancing drug currently available – modafinil.

 


 

WORK-RELATED STRESS AND THE USE OF AS WELL AS THE WILLINGNESS TO USE COGNITIVE ENHANCEMENT DRUGS AMONG GERMAN UNIVERSITY TEACHERS

Sebastian Sattler

 

Objectives: Working conditions in academia have become increasingly complex, and perceived work stress has increased. One study found that every other full-time professor and about one-third of non-professorial staff in German universities describe their job as “very stressful.” However, research examining work stress and coping strategies in academia is scarce. Therefore, we a) investigate the extent to which university teachers are willing to use cognitive enhancement (CE) medication and they have used CE-drugs and b) examine work- related stress along with other confounds as potential antecedent of CE-drug use.

Methods: University teachers at four German universities were asked to respond to three web-based surveys (N1=3,618, response rate=40.4%; N2=3,655, 38.4%; N3=3,916, 35.7%). CE-drug use was assessed using multiple measures. Willingness to use CE-drugs and past CE-drug use were assessed as predictors of future use. Furthermore, the following potentially confounding relevant covariates are measured and controlled for in a multivariate regression analysis: gender, age, status, academic discipline, norms against CE-drug usage, and social support.
Results: In study 1, 79.6% of the respondents deemed any personal future use of CE-drugs as very unlikely. The refusal rates CE-drugs were similar across studies 2 (88.1%) and 3 (86.4%). The results indicate that willingness was similar across times of measurement and different measures. Only approximately 1% of respondents reported actual prior use of CE-drugs. Together, the results of the three studies indicate that there are strong and robust associations of perceived work-related stress with all CE measures. Prior CE-drug use increased the willingness of university teachers to use CE-drugs again. Two different measures showed that the refusal to use CE-drugs on moral grounds decreased the probability that university teachers would use CE-drugs. Lower levels of social support a university teacher receives were associated with an increased willingness to use CE-drugs. Socio- structural variation among university teachers played a minor role.

Discussion: Our three interconnected large-scale studies of German university teachers show that the prevalence of CE-drug use is very low but willingness to use enhancers is comparatively higher and stable over time, and the latter result was robust across different measures. This difference between intake willingness and behavior may have multiple explanations. For example, university teachers may like to use such medications but do not have access, or they may not have previously had reasons to use CE-drugs but would be willing to do so if a reason arose. Some teachers might wait until more powerful and/or safer medication is available. The recent past has witnessed an increase of work-related stress in universities. We expected that some healthy individuals would consider meeting these heightened job demands by pharmaceutical CE. Using multiple measures of CE in three studies, we found that increased work-related stress was consistently and robustly associated with an increased willingness to use enhancers and the prior use of such drugs. The fact that prior CE-drug use promotes the willingness to future CE-drug use may indicate that time- invariant factors (such as preferences or lack of self-control) that influence prior decisions also influence subsequent decisions. The decreased the CE-drug use willingness for stronger moral perceptions against CE-drugs might be explained by the effects of internal control and the associated fact that feelings of shame might arise as a result of violating such moral perceptions, because CE-drug use may conflict with the social norms of fairness, authenticity, and autonomy of some individuals. University teachers perceiving a lack of support, which is an important resource to achieve life goals, to deal with problems and to create well-being, reported greater willingness to use CE-drugs. Therefore, CE-drug use could be interpreted as a strategy to compensate for this deficiency. Public health authorities, which consider acting to curtail CE-drug use, can use our results to reduce CE-drug use. For example, as several university teachers consider CE-drug use a strategy for coping with stress, they can be supported in using other means to improve cognitive performance, work-life balances, and relaxation such as psychological treatments and non-pharmacological means.

 



 

COGNITIVE ENHANCEMENT: is there a need to inform about the possibility of medicalization to save authenticity?

Orsolya Friedrich

 

Medical technology is expansively interlocked with our human self-concept and our social cohabitation. The medicalization of society is a term which illustrates this vast link. The term refers to the observation that technological means, which were initially implemented to detect medical disease patterns, are infiltrating areas of life that are not necessarily related to medicine and that, in addition, are expanding the sphere of medical treatment possibilities. It is often the case that the necessity and need for specific treatment is recognized and encouraged because of these technological means. In this presentation, the possibilities and methods of medical technology that are facilitated by neuroscientific developments and that raise questions concerning cognitive enhancement will be analyzed. First, it will be shown through examples where and how medicalization tendencies can be applied for methods of cognitive enhancement. Next, the main research question will be pursued: to what extent does the possibility of medicalization for cognitive enhancement have to be included in clarifying information to warrant authenticity, and also how information on this topic could even be initiated and established. To clarify the importance of informing about the potential medicalization tendencies concerning cognitive enhancement and how this could be achieved in various contexts, this paper will discuss the different levels of self- determination and its conditions (cognitive competency, rationality, authenticity, etc.), which are relevant for clarification processes and which will help answer the research question. In the process, this paper will focus mainly on reflective authenticity, in that pre-reflective authenticity cannot be used as a part of the self-determination concept because the coherence of moral sanctions and long- term ethical values merely occur to the pre-reflectively authentic person. Thus, reflective authenticity is relevant for clarification processes about cognitive enhancement and the question of authenticity. In recent literature, reflective authenticity is often presented as an emulation of the classic second-order-volitions approach by Harry Frankfurt. According to this approach, an action is authentic because of the volition to perform this action; the individual fosters the higher-level wish that the action will go into effect. During this higher-level wish, an individual reflects on the first level of the wish as well as its moral sanctions. This reflective form of authenticity is a condition that goes beyond (cognitive) competency conditions (such as understanding and processing information). Reflective authenticity can fail, whereas competency can succeed. Even on the level of cognitive competency, in which one is capable of formulating convictions on aims and means, it is relevant not to succumb to deceiving information. On the level of reflective authenticity, the reliability, influence, and the way the information that higher-level wishes depend on was attained is of even greater importance. In this context, social factors that are deposited within medicalization tendencies become even more important. The aim of this presentation is to highlight the correlation between the medicalization of society as a sociological observation, cognitive enhancement endeavors, and authenticity with regard to self-determination. As a result, it becomes clear that in the case of cognitive enhancement it is necessary to inform about medicalization tendencies in order to warrant self-determination in terms of authenticity. In order to do so it is necessary to establish general conditions. What these general conditions could entail for methods of cognitive enhancement will be presented at the end of this presentation.

 


 

ENAHNCEMENT AND THE RIGHT TO MENTAL SELF-DETERMINATION

Philip Robichaud

 
The aim is to explore the idea, suggested by Christoph Bublitz and Reinhard Merkel, that we have a right to mental self-determination, which would rule out certain ways of changing another person’s mind. In part 1, I characterize a version of Bublitz and Merkel’s argument for the existence of the right to mental self-determination (MSD), and I critically examine and the arguments they offer. In part 2, I explore a distinction between different kinds of manipulation that seems to capture many of Bublitz and Merkel’s concerns about mental integrity. I then show that this distinction would permit certain nonconsensual enhancing neurointerventions.

In making their case, Bublitz and Merkel defend two distinct claims. First, they argue that certain interventions have effects that are so “grave” as to constitute on their face a violation of the right to MSD. For example, if an intervention gravely impaired someone’s cognitive capacities, altered preferences, beliefs or behavioral dispositions, then there is some reason to suspect that this intervention violate her MSD right. This argument seems to rest on an intuitive distinction between the non-grave kinds of mental effects one might evoke simply by, say, talking to someone, and grave mental effects such as those that would be brought about by neurointerventions. I argue that this intuitive appeal either begs the question against one who thinks that nonconsensual neurointerventions may be permissible (or even obligatory) in certain circumstances or it simply establishes the descriptive claim that certain causes have stronger mental effects than others without advancing Bublitz and Merkel’s central normative agenda.

Their second argument is more substantive, but I still think wrong-headed. In it, they focus on the means of neurointervention and argue that MSD-right-violating and MSD-right-non-violating interventions map closely on to the distinction between direct vs. indirect interventions. They argue that direct interventions do while indirect interventions don’t bypass the patient’s psychological processes, and that this bypassing is normatively significant. I will argue that this mapping is problematic for several reasons, one of which is that certain indirect interventions realize their effects via entirely subconscious mechanisms, and are thus similar in terms of phenomenology, feeling of control, and foreseeability of relevant mental effect to direct interventions.

In part 2, I develop a distinction that might capture the difference between illegitimate and legitimate meddling in cognitive affairs that is less rights-y but still involves considerations about the mental that have been on the table thus far. Here I appeal to recent work on the nature and ethics of manipulation and suggest that certain interventions constitute problematic manipulations not because they bypass cognitive processes (indeed, manipulations can rely on cognitive processes) but because they have some other morally questionable property or other. I explore several candidates for this property and argue that certain cases of enhancing neurointervention either lack these properties or, if they don’t, that these properties constitute reasons not to neurointervene that are far from decisive and may be outweighed by reasons to intervene. Thus it is possible for neurointerventions to realize their effects by bypassing the agent’s psychological processes without thereby qualifying as problematic interventions.

 



 

TREATMENTS FOR GPA’S: The Effect of Level of Performance on Cognitive Enhancing Drug Use

Kimberly J. Schelle (presenting), Nadira Faulmüller & Jan Bransen

 

Pharmacological cognitive enhancement has become a widespread topic of concern, with studies showing prevalence rates from 1 to 20% in Europe and Australia and even higher rates at some USA colleges (e.g. Dietz et al., 2013; Mazanov, Dunn, Connor, & Fielding, in press; Smith & Farah, 2011). So far, studies have shown characteristics associated with the use of PCE, such as a higher intake of other substances (Arria et al., 2008; Barret, Darredeau, Bordy, & Pihl, 2005; Herman-Stahl et al., 2007; McCabe et al., 2005). Moreover, other characteristics, such as cognitive test anxiety, have even been shown to be related to the development of PCE use over time (Sattler & Wiegel, 2013). However, only an experimental design is able to demonstrate a causal relationship between a characteristic of interest and the use of PCE.

This abstract describes a first experimental study on the use of cognitive enhancement drugs. We examined the hypothesis that feedback on previous performances would influence the choice to take or not take a drug before a subsequent task. Based on a short pre- assessment task we randomly assigned participants to one of three experimental conditions by providing false feedback: (1) they score almost similar to a group with very low scores and aversive consequences, (2) they score similar to a group with average scores without any important consequences and (3) they score similar to a group with high scores and positive consequences. Participants were allegedly given the choice to enhance themselves for a consecutive task by practising the task, taking a drug or doing nothing. After this choice the experiment ended with a debriefing. The study was designed to reflect a real life decision situation that students face when they are confronted with an examination and their expectations for a certain level of result.

In contrast to our hypothesis, participants who were allegedly close to a border of performing particularly highly did not more often chose to take a cognitive enhancement drug than a control group of participants who allegedly performed average. Prospect theory is discussed as an explanation for this finding (Kahneman & Tversky, 1979), if taking the drug is seen as risky. As hypothesized, participants who allegedly were close to a border of performing particularly poorly chose more often to take a cognitive enhancement drug than the control group. Two explanations for this finding are discussed. Firstly, a performance motivation driven by loss aversion – students with low scores take the drug because they believe it will actually help them to achieve higher results – and a self-handicapping motivation – students with low scores take the drug to be able to attribute similar or even lower following scores to the drug instead of themselves. To sum up, the results of the study demonstrate that there is a causal path from achieving low results to taking a cognitive enhancing drug before a subsequent task.

 



 

DO COGNITIVE ENHANCERS CAUSE EPISTEMIC HARM? A RESPONSE TO LUBOMIRA RADOILSKA

Cesar Palacios Gonzalez

 

In this paper I respond to Radoilska’s claims that cognitive enhancers inflict epistemic harm on its users. (Radoilska 2010) In order to do so I will explain what I mean by cognitive enhancers, then I will develop Radoilska’s account of epistemic harm, and finally I will show that Radoilska’s arguments fail because she is misunderstanding the nature of cognitive enhancers and because she is making a false generalization about the phenomenology of their use.
I will understand cognitive enhancers as any substance or other biotechnological interventions that alters someone’s natural cognitive powers (executive function, concentration, learning, memory, speed of processing, and visuo-spatial ability) by intensifying them. (British Medical Association, 2007)
Now, Radoilska has argued that cognitive enhancers inflict epistemic harm on its users in two different ways:
• by diminishing or annihilating the users’ epistemic credit for an action that she would want to be credited for, and
• by wrongly altering the prospective knower’s attitude towards the value of epistemic achievement

I will turn to the first type of epistemic harm inflicted by cognitive enhancers. Cognition, as a human activity, is generally regarded as susceptible to judgments of value or worth, contrary to mere physiological processes (e.g. digestion). It is commonly assumed that we regard cognition as a distinctive accomplishment not only because of the goals it can achieve, but because there is value in the exercise of its powers (there is value in the process and ends of an epistemic endeavour).(Radoilska 2010) Having in mind this we need to ask exactly how do cognitive enhancers inflict epistemic harm? Radoilska thinks that she can explain this by contrasting their use with variations of a Frankfurt style case as presented by Zagzebski. (Radoilska 2010) The author asks us to imagine how the epistemic creditability of a prospective knower would be affected if a “manipulator ensures that a prospective knower believes only truths.” (Radoilska 2010, 366) In order to do so she presents three variations of this scenario. In the first one the prospective knower does not know that she is being manipulated, in the second the manipulator acts with the consent of the “manipulee”, and in the third one the manipulator and the “manipulee” are one and the same person (the manipulator as her broader intentional agency and the prospective knower qua prospective knower). In these cases, Radoilska concludes, the manipulator is epistemically creditable while the “manipulee” is not, and this conclusion could be extended to the use of cognitive enhancers.

I respond to this objection by noting and explaining that cognitive enhancers are not epistemic “manipulators” in the relevant sense. In the previous cases we could state that there is epistemic harm because the manipulator arrives at the result through its “processing” powers and then transmits the true belief to the prospective knower. This means that the manipulee is not epistemically creditable for her true beliefs because she did not perform the epistemic action that realizes certain value, nor expressed commitment to such action. Now, while the three cases explained by Radoilska are accurate the analogy between cognitive enhancers and manipulators is mistaken because of three things. First, the process of arriving at the result cannot be realised by the cognitive enhancer; second, the use of cognitive enhancers does not undermine the nature and value of our epistemic endeavours, because there is not a qualitative change in the nature of the process of knowing; and third, in an epistemic endeavour scenario we cannot posit that the manipulator and manipulee are the same person because this would mean that the prospective knower will know the answer and not know the answer at the same time and in the same respect, thus violating the principle of non-contradiction.

I will turn now very briefly to the second source of epistemic harm. For Radoilska the continuous use of cognitive enhancers would change our attitude towards epistemic achievements by considering them valuable only in relation to the good externalities they produce. This means that rather than valuing the process and goal of our epistemic endeavours by themselves we would only value our epistemic endeavours by the positive externalities that they would bring about. (Radoilska 2010)
In relation to this claim I will argue that it does not follow that by using cognitive enhancers someone is closer to slide down the slope of appreciating epistemic achievements only as means towards other goals (just as we do not think that this happens to people that drink coffee). In order for this argument to work Radoilska needs to show that there is a stronger link between using cognitive enhancers and this type of epistemic harm than there is one between drinking coffee and epistemic harm.

 



 

MEMORY ENHANCEMENT, IDENTITY AND RESPONSIBILITY

James DiGiovanna

 

Between 1957 and 1964, psychiatrist Donald Even Cameron gave subjects large doses of LSD and extended periods of sensory deprivation, creating, in some instances, complete memory loss . Reduced to the cognitive level of 2-year-olds, they had to be re-taught how to walk, talk, use a toilet, etc. The experiment showed that the human mind or brain could be erased. More recently, research has shown the possibility of erasing or “dampening ” specific, unwanted memories by means of drugs or neural stimulation. Further, it has been shown that false memories are easily implanted . By combining the erasure of unwanted memories and the implantation of “beneficial” memories, say, of successful interpersonal encounters or life goals, confidence can be boosted and behavior changed. The most common theories of personal identity include memory as either the essential component, or part of a bundle of essential components . Thus, alterations of memory can be taken as alterations of some degree of identity. A complete memory erasure, such as those instituted by Cameron, seems to create a new person (or at least to have erased an old one). If a full erasure creates a new person, partial erasure, and partial rewriting, can create a partially new person, and we accept this as part of the natural maturation process: no one at 43 is precisely the same person he or she was at 15. However, with controlled memory erasure and implantation, this natural process is speeded up and subject to the agent’s control. This may be the easiest route to neural enhancement, and raises a number of ethical questions: can someone be held responsible for actions they are incapable of remembering? Would it matter if the memory loss was externally imposed (as in the Cameron cases) or chosen by the subject? What if the subject has no memory of making the choice? How would we judge a formerly habitual criminal who had undergone memory implantation/erasure therapy that radically altered his/her character, such that he or she had (1) no memory of committing crimes and (2) no further inclination to do so? Can we enhance our way out of guilt? Does it make sense to punish someone who has undergone a radical change in personality, or even in personal identity? If the goal of the penal system is reform, what about “neural reform” by reshaping memory? I will argue that a form of responsibility applies even in cases where there is no strong identity between the wrong-doer and the person held responsible. This will be based on an analogy with national responsibility and on Hume’s idea of the self as like a “commonwealth” that undergoes a constant changing of its citizenry. In short, when a head of state apologizes for the actions of a predecessor, she takes on responsibility for an act she did not commit, because she is the rightful heir to the responsibility for that act. Similarly, when a nation pays reparations for an action committed at a time when most of its citizens where not alive, those citizens too act as rightful heirs to prior acts. Importantly, while reparations and apologies are called for, it would be morally impermissible to imprison the citizens or president for these prior acts. If we accept that the self is composed of parts, such as memories, and that the loss or change of some large or centrally important set of these parts results in something like a change in personhood, we can still attach responsibility by thinking of “responsibility heirs,” on the model of nations and heads of state taking responsibility for the actions of their predecessors. This calls for a discussion of degrees of applicability and acceptability of both punishment and responsibility, related to how much of a person remains, and to what extent future persons are identical with, or are the “responsibility heirs,” of prior persons.

 



 

COGNITIVE BIASES AFFECTING MORAL INTUITIONS ABOUT COGNITIVE ENHANCEMENT

Lucius Caviola (presenting), Adriano Mannino, Julian Savulescu and Nadira Faulmüller

 

The enhancement of cognitive brain functions, such as memory or concentration is already a reality. Off-label use of pharmacological substances like methylphenidate (Ritalin) or modafinil (Provigil) seems to be widespread, in particular among students. Recent research shows that the general public has strong negative opinions regarding the use of pharmacological cognitive enhancement (PCE), raising, for example, concerns regarding its medical safety, coercion and fairness. We argue that these concerns prevalent in the general public—even though they are justified to some extent—are partly driven by cognitive biases. Empirical research into biases from the last four decades has shown that human reasoning is very prone to such systematic irrational patterns, especially when the subject matter is as complex, practically novel, abstract and ideologically loaded as is the use and regulation of PCE. We argue that a number of biases well-known in psychology and behavioral economics—such as status quo bias, omission bias and risk aversion—might partly explain the negative attitude towards PCE. While we believe the biases against PCE to be generally dominant, we also indicate biases that may lead us to irrationally favor PCE. Hence, we propose that to fully understand people’s opinions on PCE, it is necessary to gain an understanding of the role such systematic biases play in this context. Moreover, we argue that the debate on PCE would benefit from the development of techniques that help people to make more unbiased judgments on this topic.

 



 

SHOULD WE FEAR THE “NEW NORMAL”?

Nicole A Vincent and Emma A. Jane

 

We have recently argued (Vincent 2014; Vincent & Jane 2014) that once cognitive enhancement technologies become sufficiently effective and have sufficiently few adverse medical side effects, without adequate regulation people may eventually lose the freedom to choose whether to enhance themselves or not. The thought is that, without the right kind of regulation, society will arrive at a “new normal”. This is a situation in which everyone has higher expectations of one another – expectations that originally increased due to the availability and use of cognitive enhancement technologies – and a concomitant duty to meet those elevated expectations which can only be met by using those technologies.

Various features of the new normal seem deeply unattractive to us. For instance, that it may foster a culture of workaholism that is antagonistic to other things we value, that we would arrive at such a social arrangement with our eyes wide shut rather than because we consciously chose it, and, quite simply, the attendant loss of liberty about whether to enhance ourselves or not rubs us up the wrong way too. We take such features of the new normal to furnish us with at least prima facie reasons for pause, so that we may consider whether the new normal should indeed be avoided, and, if so, how.

Not everyone agrees though. Enhancement enthusiasts maintain that not only are there overwhelming and decisive reasons to embrace effective and side-effect-free cognitive enhancement technologies – only fools and neo-Luddites would bother resisting – but that, in addition, we are ultimately concerned about something that, like death and taxes, is inevitable, and unlike death and taxes, does not even involve any morally significant sacrifices. In this talk we explain what blind spots prevent our critics from recognizing our point – a point which, paradoxically, we think they ought to accept – why the losses that we cite are not morally neutral, why we have reason to do something, but also why it is admittedly difficult to figure out precisely what to do.

References:

Vincent, Nicole A (2014) Cognitive Enhancement: the new “normal”? TEDx talk delivered on April 26, 2014 at the Sydney Opera House, Sydney, NSW, Australia.

Vincent, Nicole A and Jane, Emma A. (2014) Put down the smart drugs – cognitive enhancement is ethically risky business. Article published on June 16, 2014 at The Conversation.

 



 

THE ARGUMENT FOR COGNITIVE ENHANCEMENT FROM EXCUSES

Jan Willem Wieland

 

Sometimes, we’re excused for the wrong we do. Excuses exist because we’re limited in our options and knowledge. We’re not to be blamed, for example, if it’s not our fault if we cannot utilize certain kinds of information. Moreover, there seems to hold some kind of proportional relation between the degree of blameworthiness and the effort needed to utilize certain information. As Neil Levy puts it: “The relative inaccessibility of information seems to correlate with the degree of moral responsibility of the agent for failing to utilize it. Consider dementia patients. At least in the earlier stages of the disease, their memories may still be dispositionally available, but it would require more effort on their part or more cues in the environment to retrieve their memories than previously. The fact that such effort or external cues are needed – that is, the fact of relative inaccessibility – seems to diminish these agents’ responsibility for failing to recall and utilize their beliefs.”

Now, if CE makes us less limited (and provides the opportunity to be more focused, less forgetful, etc.), does CE make it harder for us to be excused? In this talk, I’ll evaluate the merits of the following argument for CE from excuses:

1. S is excused for O to the extent that it takes more effort for S to utilize available information about O.
2. CE makes it easier for S to do this.
3. Hence: CE makes it harder for S to be excused for O.
4. Hence: S should submit to CE in order to avoid blame for O.

 


 

STUDENT PERSPECTIVES ON COGNITIVE ENHANCEMENT DRUGS: A mix-method case study on perceptions, practices and ethics among academic youth in Amsterdam

Aleksi Hupli

 

Introduction: The use of (non)-prescription cognitive enhancement drugs (CED´s) by students to enhance their academic performance is a novel area of research especially in Europe. The phenomena has been recognised and studied in the United States for the last decade or so but only few empirical studies exist in Europe (Ragan et al. 2013).

Objective: The focus of this study was to see what kind of social practices and perceptions are involved in the non-prescription use of cognitive enhancement drugs (CED´s) among academic youth in Amsterdam. It also looked how students perceive the ethical issues of fairness, freedom and academic policy regulation around the use of CED’s in an academic setting. The main focus was on students who had tried chemical cognitive enhancers to have an effect on their studying and on students with a diagnosis who distributed their prescription medication for their peers.

Methodology: The data was collected by using semi-structured interviews of “users” and “providers” among university students (N=14) in Amsterdam. In addition a small web-based survey (N=113) provides additional information on the prevalence and purposes of the use of these substances.

Significant results: The students who tried prescription medication for study purposes without a diagnosis attained them from close friends or relatives with a diagnosis. The students with a diagnosis distributed their medication also mostly to their close friends. Most of the undiagnosed students found the effects to be mild or adverse and did not continue their use. Most of the students interviewed did not consider using cognitive enhancement drugs to be a form of academic cheating but felt that the drugs should not be freely available for everyone. 56 % (N=63) of the survey respondents knew someone had tried study drugs, while 21 % (24) reported trying them, immediate release methylphenidate (Ritalin) being the most common type of prescription drug used. Most common purpose for using study drugs was to improve concentration and academic performance.

Conclusion: This study shows that the use of cognitive enhancement drugs is a phenomena among academic youth in Amsterdam and although the findings of this research are not generalizable, they shed light on cognitive enhancement drug use in the Netherlands and adds information to the still scarce but increasing body of literature around the subject in Europe.

 



 

AGAINST PHONINESS: ENHANCEMENT, AUTHENTICITY, AND SELF-CREATION

Adam Kadlac

 

The notion of authenticity has played a prominent role in debates about the ethics of enhancement. One the one hand, some of those arguing for the permissibility of enhancement have argued that enhancement technologies either remove impediments that prevent individuals from living as their true selves or are legitimate tools in the project of self-creation. On the other hand, enhancement skeptics have voiced concern that certain uses of enhancement technologies pose a threat to our authentic selves. On this view, taking a drug may achieve the goal of changing my personality or giving me abilities I did not previously possess, but the results would not truly belong to me. That is, the resulting personality and abilities would not fully be mine but would instead be manufactured traits, foreign to who I really am.

Some philosophers have responded to this debate by arguing that there are multiple conceptions of authenticity at work. Thus, Erik Parens has suggested that proponents and critics of enhancement both “proceed from a ‘moral ideal of authenticity’” and that even though they differ somewhat in how they understand that ideal, they nevertheless “share more than they usually remember in the heat of academic battle.” In a similar vein, Neil Levy has recently distinguished between authenticity as self-discovery and authenticity as self-creation and argued that neither view entirely rules out the legitimate use of enhancements under certain circumstances. While their conclusions are somewhat different, Parens and Levy thus seem to agree that progress can be made in the enhancement debate without determining precisely what is demanded by the ideal of authenticity.

Without intending to needlessly muddy what are already fairly muddied waters, I want to introduce yet another conception of authenticity into the mix, one which challenges the conclusions drawn by advocates of both the self-creation and self-discovery views. On my account, what lies at the heart of authenticity is a disdain of phoniness or fakery—two notions which essentially concern the way we present ourselves to others and, in turn, the way we are viewed by those others. Being authentic thus requires that we not pretend to be something or someone we are not or otherwise represent ourselves falsely to the outside world. As far as authenticity is concerned, then, the primary ethical challenge to the use of enhancements is primarily to uses that are hidden—cases where individuals represent themselves as having achieved something without technological assistance when, in fact, the converse is true. One is not undermining one’s authentic self when one uses a cognitive enhancer to accomplish a particular goal. Rather, one is being inauthentic only to the degree that one works to hide this fact from others.

My case for this conclusion unfolds in three stages. I begin in Section I by considering what I take to be the primary weakness of both the self-creation and self-discovery views of authenticity, namely, that they fail to give sufficient weight to the manner in which our identities are shaped by the views and opinions of others. Because our identities as individuals are constituted by our particular histories, it is implausible to think that we can ever wholly create ourselves or that any stable self exists prior to our interactions with the world around us. Thus, any act of self-creation is highly constrained by the others’ perceptions of us and any notion of self-discovery must be understood very differently than advocates of self-discovery have allowed.

In Section II, I turn to offer a positive account of authenticity as an absence of phoniness and explore some implications of this account for the use of various enhancement technologies. If the argument of Section I is convincing, then it should be unsurprising that the challenge of living an authentic life is the primarily the challenge of presenting ourselves accurately to the outside world. And while I do not think that authenticity so construed renders all uses of enhancements unethical, neither do I think that it opens the floodgates to unmitigated and uncritical uses. I conclude in Section III with some suggestive remarks about how the view on offer relates to other considerations about the propriety of using various enhancement technologies, most notably, ideals of fairness.

 



 

BREACHING GLOBAL SOLIDARITY. THE CASE OF COGNITIVE ENHANCEMENT

Carissa Véliz

 

As the biomedical sciences continue to advance, the possibility of significantly manipulating and enhancing numerous traits becomes increasingly feasible. Over the last few years, the literature on human enhancement has grown exponentially within ethical debates. In this paper I will argue that current ethical debates pertaining to biomedical cognitive enhancement are dangerously overlooking some of the most crucial ethical issues at stake. Human enhancement has gained popularity at the expense of diverting attention from the most pressing ethical problems it should address, such as the possible effect of enhancement policies in global inequality. Bioethical debates on enhancement have thus far failed to offer an adequate account of the ethical aspects of biomedical enhancement by focusing the debate on ethical problems that solely concern affluent countries. In an ever more interdependent and globalized world, actions and policies carried out in one part of the globe are likely to have significant, and often harmful, effects on far away countries. Thus, denying responsibility for those effects amounts to ethical myopia. I will further argue that biomedical enhancement constitutes a breaching of solidarity towards the worst-off on the part of affluent countries, institutions, and citizens—and of pharmaceutical companies in particular.

In section I, I analyze the relationship between biomedical enhancement and global health inequalities. In section II, I argue for what I call “real-world bioethics”: taking into account actual states of affairs (e.g. global inequality) when coming up with theoretical frameworks to tackle ethical issues. In section II, I argue for an approach to solidarity based on Thomas Pogge’s theory of negative duties towards the poor and Peter Singer’s theory of positive duties towards the worst-off. I contend that, given the state of the world today, the development of enhancers would be a breaching of the solidarity affluent countries owe to the worst-off. Not only would enhancers lead to aggravating world inequalities, but they would also be spending scarce medical resources that are badly needed in developing countries. In section III, I discuss the ethical issues that arise from the relationship between cognitive enhancement and the pharmaceutical industry. I argue that the breaching of solidarity that would arise from developing biomedical cognitive enhancers would be especially unjustified in the case of pharmaceutical companies, which are the most likely candidates to develop enhancers. Pharmaceuticals acquire especially stringent duties towards the worst-off with regards to health disparities on account of a) their involvement in the creation and protection of patents, b) the tendency of conducting clinical research in developing countries, and c) the moral importance of the medical sphere.

 



 

THE NATURE-OF-ACTIVITIES APPROACH TO THE ETHICS OF COGNITIVE ENHANCEMENT

Filippo Santoni de Sio

 
In this talk I offer a general template to analytically reflect on the ethics of cognitive enhancement. I argue that in order to take a well-grounded ethical position on the permissibility/impermissibility/obligatoriness of various forms of cognitive enhancement in different circumstances, two things are needed: a) we need to reflect on the nature of the activity in which cognitive enhancement may be used, by identifying the different points of those activities (conceptual analysis); b) we need to reason on the ways in which different forms of cognitive enhancement may affect the realization of the different social values attached to the point(s) of different activities, by promoting or hindering the realization of these values (normative evaluation).
My conceptual analysis of the nature of activities is based on the distinction between prominently goal-directed and prominently practice-oriented activities, that is: activities the main point of which is an external state of affair v. activities the main point of which is some aspect of the practice itself; the normative evaluation consists of a balance of the social value of the different points achieved through the activities.
In my view, the decision on the permissibility/impermissibility/obligatoriness of different forms of cognitive enhancement in different activities should ultimately depend on the second kind of reflection, namely the normative assessment of the social values promoted or hindered by the use of cognitive enhancement in different activities. However, also the conceptual analysis is relevant to the ethical analysis of cognitive enhancement. On the one hand, my conceptual analysis may offer a richer picture of the different values embedded in different activities, as compared with the picture presented by some pro-enhancement ethicists; the proposed conceptual analysis makes way for a more comprehensive ethical evaluation. On the other hand, my conceptual analysis of the nature of different human activities also allows for a clearer understanding and a better assessment of the ethical relevance of some major ethical concerns about cognitive enhancement, that is: the concern for authenticity or personal identity, the concern for desert or responsibility, and the concern for fairness.

 



 

ARE ALL ENHANCEMENTS EQUAL? Examining the merit of distinguishing between enhancement effects in the cheating debate

Hannah Maslen

 

In many philosophical and ethical debates about cognitive enhancement, a hypothetical or exemplar drug is presented simply as one that improves an agent’s cognitive capacities, with references illustratively made to capacities such as memory, attention or wakefulness. Often in these debates, all purported cognitive enhancers are considered as more or less interchangeable for the purposes of the discussion at hand: conclusions drawn about the philosophical or ethical question are thought to hold for cognitive enhancers in general. In this paper, I am going to suggest that paying closer attention to the particular, distinct effects of different drugs could add a further, instructive dimension to some enhancement debates. I focus on the related debates about cheating and diminished achievement, examining whether different enhancement effects might be more or less problematic in this context.

Neuroscientists interested in enhancement have begun to investigate which drugs affect which underlying neuronal systems, to more comprehensively distinguish their effects on cognition (e.g. Lanni et al 2008; Smith and Farah 2011). Although care must be taken not to overstate the degree to which different substances map neatly on to different cognitive improvements (Husain and Mehta 2011), effects do seem to differ between drugs. Different drugs can differentially affect memory, attention, motivation and creativity, amongst other capacities. This raises the question of whether there are relevant distinctions to draw between enhancements that 1) allow an agent to produce more (or more efficient) work that is of his usual standard (e.g. enhancements of wakefulness, attention), 2) allow an agent to produce work that exceeds his usual standard (e.g. enhancements of creativity (and perhaps memory)) and 3) fuel an agent’s volition to work and/or make working more enjoyable (e.g. enhancements of motivation (and perhaps mood)). If there are distinctions to draw, is it the case that the use of some types of enhancement detract more from an agent’s achievements, or are all enhancement equally problematic/unproblematic? Some bioconservatives oppose the use of enhancements on the grounds that they remove the need for effort: ‘nothing good comes easily’ (Kass 2003; President’s Council on Bioethics 2003). In addition to this concern, it has also been suggested that the use of enhancements render achievements ‘unintelligible’ to us (ibid). I examine the plausibility of these and other arguments in light of the distinctions between different types of enhancement effects.

Of further relevance to the cheating debate, neuroscientific evidence which suggests that improvements in some domains of cognition are associated with impairments in others (e.g. De Jongh et al 2008) presents a challenge to the ‘no gain without pain’ criticism of enhancement use: might the side effect of impaired cognition constitute a valid and sufficient sacrifice? In this way also, closer attention to the precise effects of some enhancement drugs will allow a more nuanced assessment of the value we should ascribe to any resultant achievements.

 



 

ENHANCEMENT, AUTHENTICITY, AND AUTONOMY

Pei-hua Huang

 

It is widely accepted that being true to oneself is important. One should see through one’s mind and act upon one’s true self. However, what the notion of ‘true self’ means is unclear, which indirectly causes several disputes over enhancement. Among these debates lies the question of whether or not using enhancement technologies will diminish one’s authenticity.

Bioethicists answer these questions differently, often based on different conceptions of authenticity. Carl Elliott argues that authenticity is self-discovery; one should listen to her inner voice and discover her own uniqueness, living in accordance with it. David DeGrazia, however contends that authentic life is self-creation, that one should be free to pursue her ideal, even if by doing so, she will need to change her given personality or physical appearance greatly. These two conceptions of authenticity do not necessarily conflict with each other. Yet, when it comes to the means of realising authenticity, the two discord. Proponents of the former conception argue against enhancement because they consider it as an unnatural means of altering human beings; supporters of the latter argue that only autonomous decisions matter.

This paper focuses on cognitive enhancement and the notion of authenticity, of which I will make two points. First, the pro-nature account of authenticity overvalues ‘the given,’ i.e. the characteristics passed down biologically from parents, and second, cognitive enhancements, despite some of them are utterly artificial, could help individuals better understand themselves and conceive more realistic and authentic life-plans.

In the first section, I will address the worries of the inauthentic life and the arguments supporting these concerns. I will begin with Carl Elliott’s argument that one should consult her inner voice and identify who she is via recognition of her unique capacities and characteristics. Elliott contends that even if a person is genuinely better off via an enhancement, the enhancer will lead her astray from ‘who she really is,’ and therefore should not be encouraged. Michael Sandel and Leon Kass also argue for respects to the given. They believe that people should strive for fulfillment of their life-plan with efforts and their given talents, rather than seeking help from enhancement technologies. Authentic life, according to this view, can only be achieved without unnatural alterations.

Though these arguments capture our intuition that one should look inwards and conceive a unique life-plan based on the given characteristics, they are not flawless. The second section of this paper will then focus on challenges against pro-nature accounts. First, the given is not always beneficial. Our true nature might be that of a psychopath. Introducing of the distinction of treatment and enhancement to separate the undesirable characteristics from the normal functioning characteristics only shows that normative evaluation matters more, rather than biological inherence. Also, the obsession with inherent physiological properties may turn out to be an oppression to authenticity of individuals longing for transgender operation to fulfill their unique selves.

I will then reinterpret the pro-naturalists’ account and show that their deepest worry should be autonomy. Many think that enhancement endangers authenticity because it alters one’s true self. This argument misses the fact that alteration is not intrinsically vicious. For instance, the influence of education to a person’s self (also synapses) is greater and more persistent than enhancers such as Ritalin. What we should worry about, as I read from words of conservatives of enhancement, is coercion from social norms that might fool and force individuals to make non-autonomous, hence inauthentic, decisions.

Finally, I argue that the interpretation I made in the previous section implies that the self-discovery account of authenticity could be benefited from cognitive enhancement. Pro-nature philosophers like Elliott fears that enhancement might deceive people from their real self and impel people to conform the mainstream ideal. This worry is sensible, yet does not undermine the legitimacy of cognitive enhancement. Abilities of ‘listening to,’ ‘discovering,’ and ‘recognising’ one’s uniqueness are all cognitive faculties. Self-discovery requires sharpened critical reasoning and deliberation so as to explore and realise our true voice. It implies that cognitive enhancements, which aim to increase cognitive faculties, could also improve our understanding of ourselves.

To conclude, conservatives I mentioned in this paper failed to pinpoint the real issue of authenticity. They falsely focused on the means of pursuing authentic self and missed that discovering one’s true self requires critical thinking which in turn could be benefited by enhancement.

 



 

MORAL ENHANCEMENT AND POLITICAL REALISM

Marcelo de Araujo

 

The possibility of morally enhancing the behavior of individuals by means of drugs and genetic engineering has been the object of intense philosophical discussion over the last few years. (Douglas, T. 2008. “Moral enhancement”. In: Journal of Applied Philosophy 25(3): 228–245.; Persson, I., and Savulescu, J. 2012. Unfit for the Future: The Need for Moral Enhancement. Oxford: Oxford University Press; Walker, M. 2009. “Enhancing genetic virtue: A project for twenty-first century humanity?” In: Politics and the Life Sciences 28(2): 27-47). But, as I intend to show, although moral enhancement may turn out to become useful to promote cooperation in some areas of human interaction, it will not promote cooperation in the domain of international relations in areas which are critical to state security. Unlike some moral enhancement theorists, I argue that, due to the structure of the system of states, moral enhancement cannot be used to avert some major threats to humankind in the future such nuclear conflict. My analysis of the political implications of moral enhancement is pursued through a critical discussion of two different versions of political realism, to wit human nature realism and structural realism (Morgenthau, H. 1978 [1948]. Politics among Nations: The Struggle for Power and Peace. New York: Alfred Knopf, Fifth Edition, Revised; Waltz, K. 1979. Theory of International Politics. Reading, Mass.: Addison-Wesley, 1979; Mearsheimer, J. 2001. The Tragedy of Great Power Politics. New York: W. W. Norton). I conclude that, as far as major threats to the survival of humankind are concerned, moral enhancement can at most be used as a means to change the present structure of the system of states.

 



 

HOW TO REST CONTENT WITH WHO YOU ARE AND WHAT YOU’VE GOT

Pax Abad

 

Is cognitive enhancement a good idea? It would be if it enabled us to lead good lives. It would do that if it were either an instrumental good helping us achieve a constituent of the good life, or an intrinsic good, a constituent of the good life itself.

Whether cognitive enhancement is an instrumental good in this sense depends on what constitutes the good life. There are three main theories on this: hedonism, desire satisfaction theories, and objective list theories.

According to hedonism, the only constituent of the good life is pleasure. Whether or not cognitive enhancement leads to more or better pleasure is, in one respect, an empirical question that I can’t answer. There is, at least, no conceptual link between cognitive ability and amount or quality of pleasure. Mill, for one, thought that mental pleasures were of higher quality than other pleasures, and if that were true, a case might be made for cognitive enhancement enabling us to have better mental faculties which could give us the potential for higher pleasures and thus a better life. However, there is a longstanding criticism that Mill’s distinction between higher and lower pleasures is unfounded. Moreover, even if that distinction can be upheld, equating higher pleasures with mental pleasures rests, in Mill, on nothing more than a pro-intellectual bias. Hence, there is no philosophical reason to believe that cognitive enhancement will lead to more or better pleasure and thus to a better life.

According to desire satisfaction theories, the only constituent of the good life is the satisfaction of rational and informed desires. Obviously, some people have a desire to enhance themselves cognitively, they don’t seem to be irrational or uninformed in desiring that, and so, satisfying that desire makes their life better on these theories. However, that doesn’t answer my question: Is cognitive enhancement a good idea? It is no answer to that question that some people in fact desire it, I want to know whether they do well in desiring it in the sense that their life goes better precisely because they cognitively enhance themselves, and not just because that happened to be a desire that they satisfied.

According to objective list theories, there are several constituents of the good life, things like having enough food, shelter, clothing, freedom, social ties, a satisfying job, health, etc. Cognitive enhancement could be an instrumental good if it helped us achieve items on this list. One possibility is that it might help us stay healthy if it helps us reduce stress. Stress is something that more and more people seem to suffer from. In that case, yes, cognitive enhancement might help, but I shall argue that it would be better to alleviate the root of the problem and restructure demands on people in a way that cause them less stress in the first place.

Another possibility is that cognitive enhancement lets people compete better at universities or on the job market in general which helps them get better, and better-paid, jobs which in turn helps them get the other items on the list more easily or in better quality than they otherwise could. It is certainly true that money helps secure the items on the list, and it stands to reason that, having more or better items, makes for a better life. However, I shall argue that there is also a sense of having enough, a threshold above which a life doesn’t get all that better just because you pile on more or better items on the list, so that having more and more money to get those items doesn’t necessarily lead to a better life, which in turn means that cognitive enhancement as a means to get more money does not necessarily lead to a better life.

There is also the danger we need to be mindful of that sometimes more or better items on the list are not accumulated in order to secure a good life for oneself but in order to have a better life than one’s neighbour. If cognitive enhancement is used as a career enhancement with this motivation, then it is really not used as an instrumental good for achieving the good life, which would be alright, but used as a means to make oneself better off than others. I shall argue that this use of cognitive enhancement is morally repugnant, that we ought to look only to have enough for ourselves for a good life and be content with that.

So there are some doubts whether cognitive enhancement really can serve as an instrumental good for the attainment of a good life. But it might be an intrinsic good insofar as it might be one of the conditions of the good life. It could mean, in Aristotle’s terms, that we can have more theoretical wisdom with which to dedicate ourselves to the most eudaimon life of contemplation. If not that, self-improvement and knowing as many and as diverse things as possible is certainly also a modern ideal, if we follow von Humboldt, and cognitive enhancement helps with that.

This is true, but I shall argue that cognitive enhancement helps with only one particular kind of “wisdom”, and that there are others like emotional intelligence, aesthetic creativity, being a “woman of the world”, etc. This, of course, is no argument against cognitive enhancement. I just want to warn of the danger of focussing too much one this one aspect of wisdom and maybe enhancing this in excess, because it is relatively easy since there are pharmacological aids to that, instead of developing all of our mental faculties, if only in moderation, which probably will take more effort.

Moreover, for Aristotle, we should aspire to a life of contemplation, and this is the best life, because it is the life of the gods who can dedicate their lives to the examination of the eternal without any practical concerns. So, what drives his ideal is the wish to be as god-like as possible. I shall argue that we’re just not like that, we’re just human. We have limitations. And while I am all for self-improvement within our limits, I also want to argue that we should accept ourselves as we are.

 



 

SOCIAL PERCEPTIONS OF ENHANCEMENT IN THE WORKPLACE

Nick Fitz (presenting) & Peter B Reiner

 

A vigorous debate about the ethics of cognitive enhancement (CE) persists today. Opponents assert that CE is unnatural, immoral, and robs citizens of their dignity (Kass, 2003), while enthusiasts counter that CE is beneficial, widens the horizon of human potential, and may even be a moral obligation (Bostrom & Roache, 2009; Harris, 2005; Savulescu, 2006). One of the beguiling aspects of enhancement is that its use is perceived as demonstrating a commitment to hard work while simultaneously piquing concerns about shortcuts to success. Given the evidence that university students are using CE (Franke et al., 2010; Smith & Farah, 2011), we hypothesized that evidence of a history of CE usage would have a substantial effect upon the decision of potential employers to hire prospective employees.

To test this hypothesis, we designed an experiment employing the contrastive vignette technique to explore public perceptions towards hiring people who have used CE. Participants (n = 301) were randomly assigned to read one (and only one) of three contrastive vignettes. The vignettes all described an individual (Michael) who was applying for his first job after university; he was qualified and competitive with other applicants. Near the end of the interview, Michael is asked whether he or any of his fellow students used CE to improve their grades. Michael says that he certainly knew other students who used CE; his answer about his own use is the contrastive feature of the experiment. Michael either NEVER USED, OCCASIONALLY USED or OFTEN USED CE pills. We note that it is perfectly legal to ask this in an interview; in fact, there is no reason to expect that potential employers are not already asking such questions.

The results, gleaned from participants’ responses to sliding 100-point Likert scales, were analyzed using analyses of variance with Bonferroni post-hoc tests and multivariate regression. There were no demographic differences between the three conditions (F(297) = 1.08, p = 0.35). The primary outcome variable was the responses to question 1, which asked participants how likely they were to hire Michael. Participants who responded to the NEVER USED vignettes (mean = 78.2) were significantly more likely to hire Michael (F(298) = 26, p < 0.001) than those who responded to either the OCCASIONALLY USED (mean = 51.2) or OFTEN USED vignettes (mean = 48.8). There was no difference between the OCCASIONALLY USED or OFTEN USED groups (p = 1). The vignette condition explained 19% of the variance in hiring decisions (R2 = 0.19). After participants explained, in their own words, why they answered as they did (mean word count = 37.4), they responded to four more questions that probed how productive Michael might be, how trustworthy he might be, how honestly he had achieved his grades, and how likely he was to develop a substance abuse problem. For all but the substance abuse measure, the pattern of results was identical to what was seen in Q1 (p < 0.001). As expected, in the substance abuse measure, respondents in the OFTEN USED condition rated him as more likely to develop a substance abuse problem than respondents in the OCCASIONALLY USED condition (p < 0.05), who in turn rated him as more likely to develop a substance abuse problem than respondents in the NEVER USED condition (p < 0.001).

The data demonstrate that people view a history of using CE in university as a handicap rather than an advantage. One explanation fits within a general framework of attribution theory: CE usage prompts a deontological character evaluation, which influences hiring decisions. Indeed, participants’ ratings of trustworthiness and honesty were significantly lower when Michael used CE than when he did not. Another interpretation takes a more consequentialist angle: people view performance without CE as indicative of greater natural talents, and therefore such individuals are better candidates for employment. Participants’ ratings of productivity were significantly higher when Michael did not use CE; if he already performs well without relying on CE, he might perform even better with CE. Irrespective of the exact mechanism underlying these effects, the results inform the ongoing debate about enhancement. The data are particularly valuable in navigating concerns about enhancement in the context of the workplace (Royal Society, 2012), a topic for which is there is “currently little debate…or an academic research base to draw upon.” (Royal Society, 2012).