(Part One)

Virtue

The first argument is from a virtue perspective. A theory of virtues is central to almost every religion, and to most of the Greco-Roman philosophies. It is also implicit in some Enlightenment thought, although that is a discussion for a different time. Examining the world's virtue theories there are some virtues that are present in all, and some that are idiosyncratic. Two that are almost universal are the virtue of self-control or temperance, and the virtue of intelligent decision-making, practical wisdom or prudence.

​Before the spread of the ADD diagnosis kids with the ADD profile were considered simply slow and incorrigible. My ADD was diagnosed because I wasn't learning to read and got into an unusual number of fights on the playground. Whenever I would get into trouble the first question would be "Did you take your pill?" because my choice to take the pill that allowed self-control and practical decision-making throughout the rest of the day was my first and most important moral decision.

All the virtues – compassion, honesty, fairness - depend upon self-control, and they all are exercised through prudent decision-making. Methylphenidate and Adderall enhance both capacities. While ADD is associated with an increased risk of substance abuse and criminal behavior, stimulant therapies reduce the risk of subsequent development of substance abuse and criminal behavior. Moreover they have the effect of improving executive function not only for the ten percent of children and adults who fit the ADD diagnosis but for a much broader range of “normal” brains. Non-ADD adults given stimulants like methylphenidate, modafinil or caffeine have a lower risk of errors and accidents, which is in itself very morally consequential for tasks like driving, medical diagnoses and soldiering.

There is a cognitive fallacy known as the status quo bias in play. If we know that we have a moral obligation not to drink when we drive, work, or take care of children because it makes us stupid, why do we not have an affirmative obligation to take a drug that makes us smarter at doing those tasks? The bias is that being naturally dumb is OK, but smarter with a drug is wrong.

Another moral consequence of greater executive control is probably – and this is speculative - that these drugs reduce the influence of emotive biases in our judgment. There is now substantial evidence that the strength of our frontal cortex in relationship to our amygdala is one of the keys to our capacity to exercise moral reasoning, and override aversion impulses from the amygdala. For instance when people are sleep deprived or drunk they are more likely to be bigoted. My hypothesis is that the converse can be demonstrated: that the increase in executive function from stimulants and cognitive enhancement drugs increase our capacity for rational moral deliberation and reduce emotive biases. One small piece of evidence is that caffeine has been shown to increase the likelihood that people will change their mind in a debate.

Exercise of the virtues of self-control and prudential decision-making are general obligations. But there are also virtues specific to specific social roles. The physician should heal impartially, the scientist should record their methods and publish their results, and the student should commit themselves to learning and not to cheat. Since a central virtue of the student is to be dedicated to learning, we should be impressed that the research on the use of stimulant drugs without a prescription shows that they are almost always taken in the aid of studying and writing, and not recreationally or to stay awake for other activities. These drugs are generally being used to fulfill virtuous obligations. The student could perhaps have spent time during the week in a more judicious way, studying more and partying less; changing those dysfunctional behaviors is also an obligation. But that does not make the compensatory use of stimulants to study and perform immoral.

But what of the accusation that taking a cognitive enhancing drug is cheating. First, why is this charge not leveled against caffeine, which has the same benefit, if to a lesser degree? Second, education is not a sport, an activity with a prior set of agreements about the appropriate ways to prepare for the competition. The ban on performance enhancing drugs in sports is equally problematic I think, but at least all the athletes have entered into an agreement not to use drugs to enhance their abilities before or during a competition. Students have not made such a commitment, and are free to be as mentally sharp as they possibly can be. They have only committed to do their own reading, and write their own papers and exams.

A final consideration of the virtue approach is the virtue of authenticity, since some consider any accomplishment achieved with the aid of a drug to be inauthentic. But consider the diabetic. It is possible to control blood sugar through diet alone. Yet most diabetics take insulin and other drugs to regulate blood sugar. Some people prefer to climb mountains with bare hands and feet, and others use boots, pitons and safety harnesses. Some people prefer to manage depression with Prozac and others with non-medical means. Authenticity is not a priori, it is a subjective matter of personal definition. Many eschew the use of cognitive enhancement drugs on the grounds that they feel inauthentic, and for them perhaps they would be, but only for them.

Between 2008 and 2010 Ilina Singh interviewed 150 British and American children taking stimulant medications and asked them about the threat to moral agency and authenticity posed by their use of the drug. She concluded that the majority of the children believed the drugs improved their moral agency, such as their ability to perform in the classroom and manage aggressive behavior, and that they did not pose a threat to their authenticity.

Cognitive Liberty and Autonomy

A second moral frame for the right to cognitive enhancement is based on the liberal individualist rights logic that emerged in the Enlightenment, that we all have a right to control our own bodies and brains and use them as we see fit so long as we don't harm others. In a liberal democratic society the grounds for interfering in someone's right to self-determination is if their actions harm others, or if they are sacrificing their own self-determination. We don't permit people to sell themselves into slavery, both because the existence of slavery harms everyone, and because it violates our fundamental right to autonomy. The argument against self-enslavement is also advanced as a key reason to ban addictive drugs.

But as I've indicated, the stimulant medications have a low risk of addictiveness. In fact, they enhance autonomy, since self-control and executive function are the basis for exercising autonomy. Insofar as we have an obligation to respect our own and one another's autonomy we should not only respect the right of others to take drugs that increase self-control, but even encourage it.

Utilitarian

A third ethical framework for considering the ethics of taking these drugs is consequentialism, the greatest good for the greatest number. The problem with all consequentialist arguments is boundary-setting; how can we possibly know what all the ramifications of an action are until the end of time? So we adopt rules of thumb that are based on general consequentialist intuitions. Instead of arguing for individual liberty as an a priori right of self-possession we can argue John Stuart Mills case, that the society that allows its citizens the greatest possible freedom to find their own lifeways will generate the greatest happiness. Or that in general killing and theft will reduce social well-being, so we need especially strong consequentialist rationales to warrant acts of killing, such as self-defense and deterrence.

Applied to cognitive enhancing drugs what is our moral intuition about the general consequences of students taking drugs that permit them to study and perform at a higher level? In the first place the drugs have a slight mood-elevating effect, although not enough to usually be addictive, so at least in that small way they have a beneficial effect on social well-being.

More importantly my presumption is that the improved performance of social roles by people using these drugs will in general lead to more social well-being. Although I am not as sanguine about the effect on social well-being of their use by the stock broker or DEA agent, the benefits generated by their use by the truck driver, the airline pilot, the medical intern, the harried mother, and the fatigued teacher all make up for the occasional occupation where a little less diligence might be a good thing. So I believe the student considering whether to use the drug should not only consider that it may improve their own virtue but that it may also, in the long run, be good for society.

Another argument against the use of the drugs however is that they contribute to a competitive environment that penalizes others for not using the drugs, that they have a negative social externality. There is an important difference to be made here between positional goods and intrinsic goods. A positional good, like extra height on the basketball court or extra speed on the field, is something that no longer provides an advantage if everyone has it. In that case, taking whatever risks there are to gain the advantage does create a competitive world in which eventually there will be only the pains and no gains. An intrinsic good however is one which may create competitive pressure, but which is still a good for everyone who has it once it is achieved. Cognitive enhancement is an intrinsic good, which is why no one complained about the unfairness of the spread of literacy. Certainly the spread of literacy meant that the illiterate felt compelled to learn to read or be left behind, and some were. But literacy, like the capacity for attention and self-control, is a good in itself. The goal is to ensure that as many people as possible have access to the good, not to forbid its spread.

Capabilities Approach

Finally, I have been increasingly drawn to the capabilities approach advanced by the philosophers Amartya Sen and Martha Nussbaum, as an ethical framework that overcomes some of the weaknesses of the traditional utilitarian argument. If social well-being is defined in terms of happiness – whatever that is – then we will soon be in a future in which neurotechnologies, likely some fusion of pharmaceuticals and nanotechnology, will be able to provide whatever moods and experiences we choose. Defining the good as “happiness” in that future will then mean that everyone have their dopamine, endorphins and serotonin turned up to 11, regardless of their life situation. That is a deeply unsatisfying definition of the good life or the good society.

Instead, what Sen, Nussbaum and the capabilities theorists suggest is that we define the good in terms of the capabilities that we think everyone should able to enjoy, and that we should have social policies to maximize those capabilities in society, whether they make people happy or not. Some of the capabilities that Nussbaum considers basic are the capacities for reason and self-control, which brings us back to virtue theory as Nussbaum intends. Even if the spreading use of cognitive enhancing drugs don't make the users or society happier, I would contend that they do increase the aggregate capacities for reason and self-control. And as John Stuart Mill charged, 'It is better to be a human being dissatisfied than a pig satisfied; better to be Socrates dissatisfied than a fool satisfied."

Conclusion

Surveys of student use of cognitive enhancement drugs in the United States have varied widely, from 4% to 35% using the drugs in the last year. The recent shortage of Adderall convinced many that non-prescription use among adults was soaring, although numbers are scarce. In a survey of 1600 academics in 60 countries conducted by Nature magazine in 2007 they found 20% of the academics were taking cognitive enhancement drugs including methylphenidate - the most popular – as well as modafinil and Adderall, to improve concentration. Of all the respondents 80% thought that healthy adults should be able to take the drugs if they want to, and 70% said they would risk mild side effects to take such drugs themselves.

In recent years a growing number of bioethicists and neurologists have argued for a more liberal approach to the use of cognitive enhancing drugs by adults. These arguments largely rest on the claims of cognitive liberty and autonomy. I think there is a stronger claim, that it can be a moral obligation to enhance our capacities for reason, intelligence and self-control. Even if the risks of liberalizing the use of the amphetamine analogs are considered too great, the likely introduction of safer and more effective cognitive enhancement methods in the future will make this an even stronger argument.

(Part One)

Images:

http://www.deviantart.com/art/Central-Neuron-28080169

http://www.deviantart.com/art/Utilitarian-Drug-155859114