Ethical Considerations for Emergent Neuroprosthetic Technology

By Emily Sanborn

Image courtesy of Wikimedia Commons

In the 21st century, there is a push towards producing neurotechnology that will make our lives easier. A category of these technologies are neuroprosthetics, devices that can supplement or supplant the input or output of the nervous system to obtain normal function (Leuthardt, Roland, and Ray, 2014). In the emergence of these technologies, there are ethical issues presented and a question is formed: are we fixing what is not broken? (Moses, 2016). 

A recent article from the Smithsonian magazine reported a technology that will allow humans to develop a “sixth sense” (Keller, 2018). David Eagleman, an adjunct professor at Stanford University’s department of Psychiatry and Behavioral Science, invented a sensory augmentation device called Versatile Extra-Sensory Transducer (VEST), which is a vest covered with vibratory motors that is worn on the body. VEST works by receiving auditory signals from speech and the surrounding environment and translating that signal via Bluetooth to vibrations. The vibrations are transmitted to the vest in dynamic patterns that correlate to specific speech and auditory signals. The user is then able to feel the sonic world. In time, they may be able to use this new touch sensation to understand spoken word (Eagleman, 2015). 

If VEST works as intended, it has a therapeutic value. Since its invention in the mid-80’s, the cochlear implant has been the most prevalent hearing device for the deaf and hard of hearing (cochlear implant, 2017). However, these devices are surgically embedded and can cost up to $100,000. VEST offers a nonsurgical alternative, with an estimated cost of $2,000 (Keller, 2018). This technology has the potential to alter the current market for medical devices that assist those who are deaf. Some say that technology such as VEST or cochlear impacts being viewed as treatments, rather than enhancers, can be problematic, implying that being deaf is abnormal (Moses, 2016). This raises the question: what is normal, and who decides? 

A cochlear implant

Image courtesy of Wikimedia Commons

In our society, we have been taught certain norms and have adapted ways to police each other to conform to these norms. One of these taught “normalities” is the idea that there are five senses that function in a specific way, and one mind that responds to external and internal stimuli in a specific manner (Moses, 2016). For example, some in the deaf community fight against the use of cochlear implants, as deaf individuals view themselves and their community as fully functional individuals who can function without these neuroprosthetic devices (Gupta, 2014)—they do not need devices to obtain normality. In fact, these individuals who fall below “normal range” in their lack of hearing suggest that differences and diversity of abilities and skills can all fall within a typical range of variation (Moses, 2016). Redefining normality, while a tremendous task, could be a next step instead of producing more neuroprosthetics. 

The creators of VEST are also looking to take their technology a step further beyond therapeutic contexts. In people with fully functioning senses, there is a goal to create a new form of sensation. Dr. David Eagleman is looking at how all types of data can be translated into interpretable sensation. The forefront of this idea is turning stock market data into sensation, so a person wearing VEST could be able to predict whether to buy or sell stock by feeling the market (NeoSensory). If VEST users are successfully able to feel and predict the stock market, they will gain an advantage over those who do not have this added sense. This can lead to two types of coercion: implicit and explicit. Implicit coercion is feeling the need to “maintain or better one’s position in some perceived social order” (Chatterjee, 2014). Workers in trading firms may feel they need to use this sensory technology in order to keep up with their coworkers and competitors. Explicit coercion is an “explicit demand of superior performance by others” (Chatterjee, 2014). In the future, firms may only hire staff who have the augmented sensory system. However, this is not the only dilemma that arises. 

Due to the nature of the enhancement technology, there is concern of an opportunity gap. Insurance agencies are most likely not going to pay for VEST for use as an enhancer for the stock market, or other enhancement applications, so only those who can personally afford to pay  will have access to the technology. This increases the gap between the rich and the poor, as the rich will have greater access and means to the technology (Hyman, 2011).

Overall, there are still many questions to be asked as VEST and other neuroprosthetics and cognitive enhancements are being made. The concept of what is normal must be readdressed, and the presented ethical dilemmas must be taken into consideration. Even if VEST does not yield the expected results, a new technology will take its place, so these questions and concerns remain relevant. 

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Emily Sanborn is entering her fourth year of undergraduate study at Emory University where she is pursuing a double major in Neuroscience & Behavioral Biology and Environmental Science. Her academic interests focus on exploring ecological processes, and how they can influence the spread and creation of diseases – particularly neurological diseases. This year, she will be completing an honor’s thesis in the Caudle Lab at Emory University’s Rollins School of Public Health, where she’ll be using in vitro and in vivo techniques to investigate the neurotoxic effects of insecticides and flame retardants. 

References

Chatterjee, A., (2004), Cosmetic neurology: The controversy over enhancing movement, mentation, and mood. Neurology, 63: 968-974.

Cochlear Implants, (2017) NIDCD NIH. Retrieved from https://www.nidcd.nih.gov/health/cochlear-implants.

Eagleman D., (2015), Can we create new senses for humans? Retrieved from https://www.ted.com/talks/david_eagleman_can_we_create_new_senses_for_humans?lan guage=en

Gupta, S., (2014), "The Silencing of the Deaf", Medium.

Hyman, S.E., (2011) Cognitive Enhancement: Promises and Perils. Neuron, 69: 595-598. 

Keller, Kate, (2018) Could this futuristic vest give us a sixth sense? Retrieved from https://www.smithsonianmag.com/innovation/could-this-futuristic-vest-give-us-sixth-sense-180968852/.

Leuthardt E., J. Roland, W. Ray, "Neuroprosthetics", The Scientist, 2014.

Moses T., (2016), Emerging technologies: the ethical dangers of fixing what is not broken. ETHICS, DOI: 10.1109/ETHICS.2016.7560048

NeoSensory. Retrieved from https://neosensory.com/. 

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Sanborn, E. (2018). Ethical Considerations for Emergent Neuroprosthetic Technology. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2018/10/ethical-considerations-for-emergent.html

Regulating Minds: A Conceptual Typology

By Michael N. Tennison 

Image courtesy of Wikimedia Commons.

Bioethicists and neuroethicists distinguish therapy from enhancement to differentiate the clusters of ethical issues that arise based on the way a drug or device is used. Taking a stimulant to treat a diagnosed condition, such as ADHD, raises different and perhaps fewer ethical issues than taking it to perform better on a test. Using a drug or device to enhance performance—whether in the workplace, the classroom, the football field, or the battlefield—grants the user a positional advantage over one’s competitors. Positional enhancement raises issues of fairness, equality, autonomy, safety, and authenticity in ways that do not arise in therapy; accordingly, distinguishing enhancement from therapy makes sense as a heuristic to flag these ethical issues. 

These categories, however, do not capture the entire scope of the reasons for and contexts in which people use drugs or devices to modify their experiences. Consider psychedelic drugs like psilocybin and LSD that induce mystical-type experiences. Studies show that these drugs also have the potential to treat depression, anxiety, and addiction. They can even lead to positive changes in the personalities and behaviors of healthy subjects, such as increased openness and altruism, that can persist long-term without retaking the drug—effects that are neither therapeutic in the sense of treating a diagnosable condition, nor are they positional enhancements akin to taking steroids to gain a leg up on one’s athletic competition. 

Legal regimes that regulate drugs in the United States present a different dichotomy for distinguishing uses of drugs, ostensibly based on their risk/benefit ratios. In general, FDA laws and regulations authorize the therapeutic use of drugs proven to be sufficiently safe and effective, and controlled substance laws criminalize the use of drugs determined to lack medical value or that are obtained and used outside the scope of medical treatment. Unfortunately, the “War on Drugs”—the laws and policies implementing controlled substance restrictions—produces myriad side effects. These include unintuitive, unscientific, and politically-motivated drug classifications, interference with medical research, misinformation about the risks and benefits of drugs, stigmatization of non-problematic drug use, and the privileging of medical value as the only redeeming benefit an illegal drug can have, not to mention the panoply of harms imposed by criminalization. 

In a step toward developing a robust assessment of drug harms, a UK study ranked drugs based on their harm to users and others, using physical, psychological, and social criteria.  The findings, later endorsed by a panel of experts from across the EU, suggest a mismatch between the legal treatment of drugs and their comparative harms.  

Although ensuring the safety and effectiveness of drugs is an absolutely essential government function, generalizing and criminalizing non-medical use as “recreational drug use” or “drug abuse” fails to account for, and stifles, the other ways drugs can and do benefit individuals and society. Again, consider psilocybin, a drug designated in the United States as having no accepted medical value, a high potential for abuse, and no capacity to be used safely under medical supervision—a stricter legal classification than for cocaine, methamphetamine, and fentanyl. Even if conclusively proven safe and effective for medical or enhancement purposes, it would still be illegal to obtain and use psilocybin to enhance insight, catalyze personal development, and cultivate altruism and openness. Short of congressional action, there is no legal mechanism to acknowledge the scientific evidence of a scheduled drug’s safety and effectiveness for enhancement, and therefore authorize its non-medical use. 

The legal classification scheme fails, therefore, to accurately represent and respond to rapidly-accumulating, novel evidence about the actual risk/benefit ratios of certain drugs like psilocybin, while the neuroethical enhancement/therapy paradigm fails to account for the uses of drugs and devices that fall outside the boundaries of medicine and positional enhancement. I propose creating a single framework of functional categories that serves as both a descriptive typology and a normative spectrum that balances a higher level of precision and accuracy with the categorical bundling of thematic clusters of ethical issues. Ordered from the most to least ethically-justified, based on risk/benefit ratios at individual and collective levels, this framework comprises therapy, virtue enhancement, utility enhancement, and recreation enhancement. 

Therapy 

Therapy aims to restore the health and “normal” functions of individuals impaired by disease or injury. In discussions about enhancement, therapy tends to be the normative baseline against which enhancement is compared and contrasted because, over time, we have accrued a set of familiar attitudes, norms, and legal structures that drive our understanding of medical treatment. We understand that health and healthcare are prerequisites to flourishing as individuals and societies. 

Virtue Enhancement 

Image courtesy of Flickr.

Studies show that the controlled and supervised administration of psychedelics reliably induces a “peak” or “mystical” subjective experience of altered perceptions, mood, and cognition characterized by feelings of oneness, transcendence, and ineffability. Anxiety and fear are not uncommon elements, but careful management of the “set and setting” of the experience successfully protects the psychological safety of study participants. In a 2006 study, most subjects rated their psilocybin experience as “either the single most meaningful experience of his or her life or among the top five most meaningful experiences of his or her life.” Further research recently demonstrated that this may lead to sustained, positive changes in personality, worldview, or behavior that may benefit society, especially if reinforced by personal development practices such as meditation. 

I differentiate virtue enhancement from the kind of “moral enhancement” envisioned by bioethicists that would neurologically force the expression of a pro-social behavior, such as honesty, and that would only be effective so long as the individual is under the enhancement’s neurochemical influence. By contrast, studies show that psychedelic experiences may prompt a more “natural” or authentic pursuit of personal development that persists long after the drug experience itself has passed. 

Utility Enhancement 

This category refers to the use of a drug or device to enhance performance in an outcome-based endeavor. Whereas virtue enhancement is valuable in itself and in consequence for individuals and society, utility enhancement is valuable primarily in consequence. And despite enhancing performance on collectively-valued activities, such as work, academics, and sports, the overall value of utility enhancement is limited by the myriad of ethical issues raised. 

Utility enhancements are typically positional enhancements that grant leverage in zero-sum endeavors where people are competing for limited resources. For example, it is generally considered unfair for an athlete to use steroids to enhance performance in sports, because a better outcome for the enhanced individual or team automatically means a worse outcome for the opponent. Additionally, players may not have equal or affordable access to the most effective, least detectable, and safest enhancements, and many athletes may not want to risk professional or legal penalties if they are caught. Yet to remain competitive, they may feel forced to enhance themselves, thereby reducing their freedom and autonomy. 

Recreation Enhancement 

Image courtesy of Pxhere.

On one hand, recreation enhancement entails the use of a drug or device to enhance one’s experience of a recreational activity. Using a transcranial stimulation device to enhance video game performance, for example, provides some individual benefit without raising substantial ethical issues at the collective level. Studies now show that psychedelics can enhance the emotional appreciation of music, a finding that spans recreation, virtue enhancement, and even therapy—depending on the context and intent of use—and could have both individual and collective benefit. 

On the other hand, people also modify their minds with drugs and devices as a form of recreation itself. This parallels the concepts of “recreational drug use” and Robert Nozick’s “experience machine”—a critique of hedonism—entailing escapism or “tuning out” from reality. By chemically or electrically inducing a desired state, such as satisfaction or pleasure, one circumvents the natural process of effort and achievement, raising concerns about authenticity and the prospect of an unfavorable ratio between benefits and health risks. If a user seeks a change in consciousness as a short-term end goal in itself, without harnessing it to pursue other ethically-sound ends, it may provide little overall benefit to the individual or society. However, it is not necessarily harmful if not pursued to the point of interference with health or responsibilities. 

None of the above categories should be conflated with use disorders. In fact, a use disorder could result from the inappropriate pursuit of any of the above categories of substance use. According to SAMHSA, the DSM-5 defines a substance use disorder as being present when “the recurrent use of alcohol and/or drugs causes clinically and functionally significant impairment, such as health problems, disability, and failure to meet major responsibilities at work, school, or home.” Despite the prevalence of use disorders revealed by the nation-wide opioid crisis in the United States, it is important to remember that 80-90% of users of illegal drugs do not have a drug problem, according to Dr. Carl Hart, neuroscientist and chair of psychology at Columbia University. Similarly, data from a 2017 report of the UN Office on Drugs and Crime show that globally, almost 90% of people who use internationally-controlled drugs do not have substance use disorders. Indeed, by taking seriously the studies that demonstrate the non-problematic and even beneficial uses of drugs legally-classified as necessarily harmful, we are better equipped to identify risk factors of addiction and problematic use. 

Laws should encourage activities that benefit individuals and society and discourage those that do not. Creating a unified and coherent approach to understanding how and why people manipulate their consciousness with drugs and devices is a first step toward systematically incorporating intuitive, evidence-based risk/benefit analyses into our ethical, legal, social, and policy discussions. This facilitates the accurate identification and assessment of the unique clusters of ethical issues associated with different purposes and outcomes of drug and device use. Such assessments could be translated into laws and regulations that promote the discovery and application of beneficial manipulations of consciousness, even if non-medical, while implementing structures and processes to reduce their risk of harm. The next steps entail sorting out how drugs and devices could be approved and administered for different kinds of enhancement, including the requisite thresholds of scientific proof of safety and effectiveness and the proper context of use to minimize risks—whether inpatient, over the counter, by prescription, or after demonstrating sufficient knowledge and competence, as with obtaining a driver’s license. A model like the one proposed above can enhance our neuroethical analyses and help us to overcome our dangerous experimentation with harmful drug laws and policies.

_______________

Michael N. Tennison is a Senior Law & Policy Analyst at the University of Maryland Center for Health and Homeland Security. His research interests focus on the ethical, legal, social, and scientific issues associated with drug policy. The opinions expressed are the author's own and do not represent the view of the Center for Health and Homeland Security or the University of Maryland. Portions of this post are adapted from the author’s poster presentation at the 2017 Annual Meeting of the International Neuroethics Society. 

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Tennison, M. (2018). Regulating Minds: A Conceptual Typology. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2018/05/regulating-minds-conceptual-typology.html

Grounding ethics from below: CRISPR-cas9 and genetic modification

By Anjan Chatterjee

The University of Pennsylvania

Anjan Chatterjee is the Frank A. and Gwladys H. Elliott Professor and Chair of Neurology at Pennsylvania Hospital. He is a member of the Center for Cognitive Neuroscience, and the Center for Neuroscience and Society at the University of Pennsylvania. He received his BA in Philosophy from Haverford College, MD from the University of Pennsylvania and completed his neurology residency at the University of Chicago. His clinical practice focuses on patients with cognitive disorders. His research addresses questions about spatial cognition and language, attention, neuroethics, and neuroaesthetics. He wrote The Aesthetic Brain: How we evolved to desire beauty and enjoy art and co-edited: Neuroethics in Practice: Mind, medicine, and society, and The Roots of Cognitive Neuroscience: behavioral neurology and neuropsychology. He is or has been on the editorial boards of: American Journal of Bioethics: Neuroscience, Behavioural Neurology, Cognitive and Behavioral Neurology, Neuropsychology, Journal of Cognitive Neuroscience, Journal of Alzheimer’s Disease, Journal of the International Neuropsychological Society, European Neurology, Empirical Studies of the Arts, The Open Ethics Journal and Policy Studies in Ethics, Law and Technology. He was awarded the Norman Geschwind Prize in Behavioral and Cognitive Neurology by the American Academy of Neurology and the Rudolph Arnheim Prize for contribution to Psychology and the Arts by the American Psychological Association. He is a founding member of the Board of Governors of the Neuroethics Society, the past President of the International Association of Empirical Aesthetics, and the past President of the Behavioral and Cognitive Neurology Society. He serves on the Boards of Haverford College, the Associated Services for the Blind and Visually Impaired and The College of Physicians of Philadelphia. 

In 1876, Gustav Fechner (1876) introduced an “aesthetics from below.” He contrasted this approach with an aesthetics from above by which he meant that, rather than defining aesthetic experiences using first principles, one could investigate people’s responses to stimuli and use these data to ground aesthetic theory. Neuroethics could benefit with a similar grounding by an ethics from below, especially when ethical concerns affect public policy and regulation.

We are in the middle of a scientific revolution (Doudna & Charpentier, 2014) that will transform biological research by profoundly affecting agriculture, animal husbandry, and medicine. It also has profound implications for neuroethics. Genetic modification using CRISPR-Cas9 (clustered regularly interspaced short palindromic repeat–CRISPR-associated protein), a system of adaptive immunity discovered in bacteria, has become feasible and cheap. Described in 2015 as “Science’s breakthrough of the year”, CRISPR-Cas9 offers promises as well as perils. In addition to modifying somatic cells, we can now modify germline cells. We might be able to eliminate single gene neurological disorders like Huntington’s disease, among many others. At the same time, intentional selection of genes for physical and mental traits might reify social inequities and resurrect the possibility of eugenics. Specifically, genetic manipulation could become a deep tool for cognitive and mental enhancement that selects and manipulates genes that contribute to intelligence, attention, memory, and even creativity.

Image courtesy of Wikimedia Commons.

Scientists and ethicists are aware that the public should be involved in discussions about these technologies and their applications. Think tanks, bioethics groups, and scientific societies call for public engagement. For example, in December 2015, the US National Academies of Sciences, Engineering and Medicine held a summit on the regulation of CRISPR-–Cas9 gene-modifying technology (Travis, 2015). PHD physicist and Congressman Bill Foster (D-IL) opened the summit with a reminder that gaining public acceptance of what can be done with CRISPR-Cas9 is critical. The meeting opined that it would be irresponsible to proceed with germline modification without broad societal consensus about the appropriateness of possible uses. The final report from the National Academy of Sciences (National Academies of Science, 2017) walked back from their early call for broad societal consensus (Baylis, 2017), but did offer condition under which germ line genetic modification might be considered. Nonetheless, the report advocates for public involvement as stated on pages 7-8,

“Public engagement is always an important part of regulation and oversight for new technologies. As noted above, for somatic genome editing, it is essential that transparent and inclusive public policy debates precede any consideration of whether to authorize clinical trials for indications that go beyond treatment or prevention of disease or disability (e.g., for enhancement). With respect to heritable germline editing, broad participation and input by the public and ongoing reassessment of both health and societal benefits and risks are particularly critical conditions for approval of clinical trials.
At present, a number of mechanisms for public communication and consultation are built into the U.S. regulatory system, including some designed specifically for gene therapy, whose purview would include human genome editing. In some cases, regulatory rules and guidance documents are issued only after extensive public comment and agency response.” 

Given CRISPR-Cas9’s technical ease, low cost, and potentially wide spread application, knowing current public opinion is crucial to ongoing engagement. The “public” is not a monolithic entity, and understanding how different groups differ in their attitudes becomes critically relevant to any outreach efforts. 

Public opinion on In Vitro Fertilization (IVF) has changed

dramatically since its introduction.

Image courtesy of Flickr user Image Editor.

With these considerations in mind, we investigated what “the public” thinks about genetic modification research by querying 2,493 Americans of diverse backgrounds (Weisberg, Badgio, & Chatterjee, 2017). Respondents were broadly supportive of conducting this research. However, demographic variables influenced the robustness of this support– conservatives, women, African Americans, and older respondents, while supportive, were more cautious than liberals, men, non African American ethnicities, and younger respondents. Support for such research was also muted when the risks, such as unanticipated mutations and possibility of eugenics, were made explicit. We also presented information about genetic modification with contrasting vignettes, using one of five frames: genetic editing, engineering, hacking, modification, or surgery. The media, it turns out, uses different framing metaphors than academics when describing this technology. Journalists, more often than scientists, use “editing” as a metaphor, perhaps not surprising in so far as they are professional writers. It would be useful to know if these metaphors affect people’s opinions. In the context of our vignettes, the contrasting frames did not influence people’s attitudes. Our data offer a current snapshot of public attitudes towards genetic modification research that can inform ongoing engagement. 

Our observations are hardly the last word on the topic. Rather, they are an initial survey of a dynamically changing landscape. Will public attitudes evolve as more people become aware of the possibilities and problems of these technologies? What do we make of demographic differences? Conservatives, women, African Americans, and older people do not group together in an obvious way. Surely the reasons for caution among these groups vary. We did not find an effect of metaphoric framing in our study. This absence of an effect is reassuring in so far as journalists and scientists typically write about genetic modification using different organizing frames. Perhaps the lack of effect was because of an insufficient “dose” of framing language. If we presented more extensive descriptions and reinforcing language, might we have found an effect of framing? The point is that the implications of our results are subject to ongoing refinement, further testing, and continuing discussion as is true of most empirical studies. 

In a rapidly changing world in which biological sciences have the potential to profoundly affect our physical and mental and cognitive lives, public opinion assessed from below may be critical to grounding policy shaped from above. 

References 



Baylis, F. (2017). Human germline genome editing and broad societal consensus. Nature Human Behavior, 1. Retrieved from doi: doi:10.1038/s41562-017-0103



Doudna, J. A., & Charpentier, E. (2014). The new frontier of genome engineering with CRISPR-Cas9. Science, 346(6213), 1258096.



Fechner, G. (1876). Vorschule der Aesthetik. Leipzig: Breitkopf & Hartel.



National Academies of Science, E., and Medicine. (2017). Human Genome Editing: Science, Ethics, and Governance The National Academies Press Retrieved from http://go.nature.com/2ooO6jx.



Travis, J. (2015). Inside the summit on human gene editing: A reporter’s notebook. Retrieved from doi:https://doi.org/10.1126/science.aad7532



Weisberg, S. M., Badgio, D., & Chatterjee, A. (2017). A CRISPR New World: Attitudes in the Public toward Innovations in Human Genetic Modification. Frontiers in Public Health, 5, 117.

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Chatterjee, A. (2017). Grounding ethics from below: CRISPR-cas9 and genetic modification. The Neuroethics Blog. Retrieved on
, from http://www.theneuroethicsblog.com/2017/07/grounding-ethics-from-below-crispr-cas9.html

Dangerous Love and Anti-Love Drugs: Neuroethics & Public Health Problems

By Kelsey Drewry

Kelsey Drewry is a student in the Master of Arts in Bioethics program at the Emory University Center for Ethics where she works as a graduate assistant for the Healthcare Ethics Consortium. Her current research focuses on computational linguistic analysis of health narrative data, and the use of illness narrative for informing clinical practice of supportive care for patients with neurodegenerative disorders.

The half-priced heart-shaped boxes of chocolates lining grocery store shelves serve as an undeniable marker of the recent holiday. Replete with conceptions of idyllic romance, Valentine’s Day provides an opportunity to celebrate partnership, commitment, and love. However, for those experiencing heartbreak or unrequited love, Cupid may be a harbinger of suffering rather than giddy affection.

The transition from love to pain is an incredibly common experience, and one that is formative for many. The extent of character building in heartbreak and other negative affection experiences is bounded, though, by certain types of “dangerous love”. According to Brian Earp and colleagues, this classification might include domestic abuse, pedophilia, or even jealousy-induced homicide (Earp et al 2013). The suffering associated with these cases surpasses any beneficial emotional development, leading instead to potential enduring physical and psychological harms. Instances of “dangerous love” might become the targets for “drugs that manipulate brain systems at whim to enhance or diminish our love for one another” (Young 2009, 148), which seem to be a reasonable potential product of current trajectories of neuropharmocological research.

Image courtesy of Flikr

These “anti-love” drugs are certainly beneficently intended, and may indeed be of great value in some instances. An example of neuroenhancement by diminishment, the ability of an individual to rise above the influences of attraction-causing neurochemicals and adhere instead to reason may give rise to a more morally capable person, at least in a Kantian sense. Additionally, decreasing the instances of sexual abuse and physical harms are aims that cohere with lauded public health endeavors across the globe. It is not unreasonable to consider future anti-love biotechnology as a valuable interventional tool in the effort to diminish the incidence of negative health outcomes associated with “dangerous love” on both the individual and community scale.

To this end, Earp and colleagues cite domestic violence as a promising substrate. The context is sensible, if you accept the view that love causes one to enter a state that is “literally not normal” (Marazziti et al 1999), or akin to drug or behavioral addiction (Burket and Young 2012). Under this framework, love may be understood as a neurochemically induced loss of autonomy (to some degree) that causes abuse victims to justify the sacrifice of second-order desires like leaving on account of first-order romantic bonds (Earp et al 2013). The authors proceed to lay out the framework for a “maximally promising” application of anti-love technology in human relationships under the context of domestic abuse:

1. “The love in question is clearly harmful and needs to dissolve one way or another.


2. The person would conceivably want to use the technology—and if she did want it, there would be no problematic violations of consent.


3. The technology would help the person follow her higher order goals instead of her lower order feelings.


4. It might not be psychologically possible to overcome the perilous feelings without the help of anti-love biotechnology.” (Earp et al 2013, 11-12)

Looking past some of the potentially problematic implications of language like “clearly harmful” and “higher order goals”, these measures seem to provide a reasonable first attempt at outlining a paternalistic anti-love drug administration schema. But returning to our recognition of domestic violence as a public health issue raises unique ethical refinements to even the “maximally promising” scenario for these drugs.

Image courtesy of Flikr

Epidemiology literature shows that domestic abuse disproportionately affects vulnerable populations, specifically women, racial and ethnic minorities, and those of lower socioeconomic status (Sokoloff and Dupont 2005). In the specific “maximally promising” case of domestic abuse where the woman knows the relationship is detrimental or harmful and wants to leave, but remains only due to her autonomy-impairing neurochemical love, an anti-love drug may lead to increased harms unless applied in conjunction with other supportive measures. In their considerations, Earp and colleagues neglect the practical circumstantial issues very often associated with domestic abuse—if the victim is for some reason unable to remove themselves from the physical space of the relationship, paternalistically administering anti-love medication is eliminating any psychological capacity to tolerate the circumstance. The vulnerabilities associated with domestic violence may also predispose victims to a lack of social support, community and financial resources (Barnett and LaViolette, 1993; Iyengar and Sabik 2009; National Coalition Against Domestic Violence 2007). Removing the neurochemical basis for making some sort of transient positive meaning from an abusive relationship without providing the means for the victim to physically leave that relationship space seems incredibly irresponsible. It seems very possible that a person no longer experiencing feelings of love (or attachment, affection, lust, etc.) in these circumstances, but unable to physically escape abuse, would be predisposed to increased psychological harms—perhaps even suicidality (Cavanaugh et al 2011; Afifi et al 2009; Golding 1999; Sato-DiLorenzo and Sharps 2007).

Thus, in order for Earp’s framework to be considered ethical on the public scale, which it must if the “maximally promising” context is a preexisting concern of public health, a fifth criterion is necessary:

5. The person can conceivably remove herself from the relationship upon diminishment of love.

The justice or access emphasis of public health ethics would extend this idea further to argue that paternalistic administration of such a drug would necessitate the provision of additional supportive interventions for particularly vulnerable individuals meeting criteria 1-4 but not 5. Such a stipulation converts an act of moral permissibility (paternalistic administration of anti-love biotechnology to individuals meeting 1-4) to a moral obligation to provide community-based support in fulfillment of a positive right of assistance for individuals who do not meet criterion 5.

Now, to avoid becoming entangled in an overly specific refinement of a single speculative framework for a hypothetical drug, let us step back from my concerns with the criteria laid out by Earp and colleagues in “If I Could Just Stop Loving You: Anti-Love Biotechnology and the Ethics of a Chemical Breakup”. Arguing abstractly in such an uncertain space is unlikely to be of any benefit other than mental exercise. However, I think my refinement of Earp’s proposed criteria may be a useful case study in the specificity of neuroethical discourse, especially in the context of enhancement. The shear volume, richness, and novelty of information that exists at this intersection of neuroscience, psychology, medicine, philosophy, and public health provide a medium for incredibly nuanced discussion. Certainly, the implications of developing neurotechnologies demand careful ethical consideration distinct in kind—thus the evolution of neuroethics as a field. But becoming mired in the specific novelty of uniquely neuroethical considerations is a hazard of the discipline. It is essential that, even at its most speculative and futuristic, neuroethical discourse retains consideration of the non-neural physical and social limitations of its work. The eventual application of developing neurotechnologies to issues of public health necessitate recognition of and dialogue with the embodied context of the neuroethical question. Such considerations will both enhance the practicality of recommendations, and ensure that they are completely ethical, not just neuroethical.

References



Afifi T.O., H. MacMillan, B.J. Cox, G.J.G. Asmundson, M.B. Stein, and J. Sareen. 2009. Mental health correlates of intimate partner violence in marital relationships in a nationally representative sample of males and females. Journal Of Interpersonal Violence 24(8):1398–1417.



Barnett O.W. and A.D. LaViolette. 1993. It Could Happen to Anyone: Why Battered Women Stay. 178 pp. Sage Publications Inc. Newbury Park, CA.



Burkett, J. and L.J. Young. 2012. The behavioral, anatomical and pharmacological parallels between social attachment, love and addiction. Psychopharmacology 244(1): 1-26.



Cavanaugh, C.E., J.T Messing, M. Del-Colle, C. O’Sullivan, and J.C. Campbell. 2011. Prevalence and Correlates of Suicidal Behavior among Adult Female Victims of Intimate Partner Violence. Suicide Life Treat Behavior (41)4: 372-383.



Earp, B.D., O.A. Wudarczyk, A. Sandberg, and J. Savulescu, 2013. If I Could Just Stop Loving You: Anti-Love Biotechnology and the Ethics of a Chemical Breakup. The American Journal of Bioethics 13(11): 3-17.



Golding, J.M. 1999. Intimate partner violence as a risk factor for mental disorders: A meta-analysis. J Fam Violence 14(2):99–132.



Iyengar, R. and L. Sabik. 2009. The Dangerous Shortage of Domestic Violence Services. Health Affairs 28(6):w1052-w1065.



Mrazziti, D., H.S. Aksiskal, A. Rossi, and G.B. Cassano. 1999. Alteration of the platelet serotonin transporter in romantic love. Psychological Medicine 29: 741-745.



National Coalition Against Domestic Violence. 2007. Domestic Violence Facts. Retrieved Feb. 21, 2017 from here.



Sato-DiLorenzo A. and P.W. Sharps. 2007. Dangerous intimate partner relationships and women's mental health and health behaviors. Issues in Mental Health Nursing 28(8):837–848.



Skoloff, N.J. and I. Dupont. 2005. Domestic Violence: Examining the Intersections of Race, Class, and Gender—An Introduction. In Domestic Violence: Readings on Race, Class, Gender, and Culture, ed. N Skoloff and C. Pratt, 1-13. New Brunswick: Rutgers University Press.



Young, L.J. 2009. Being Human: Love: Neuroscience reveals all. Nature 457(7226): 148.

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Drewry, K. (2017). Dangerous Love and Anti-Love Drugs: Neuroethics & Public Health Problems. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2017/02/dangerous-love-and-anti-love-drugs.html

Is memory enhancement right around the corner?

By Ryan Purcell

“Everyone has had the experience of struggling to remember long lists of items or complicated directions to get somewhere,” Dr. Justin Sanchez of DARPA said in a recent press release. “Today we are discovering how implantable neurotechnologies can facilitate the brain’s performance of these functions.” The US Department of Defense is interested in how the brain forms memories because hundreds of thousands of soldiers – or “warfighters” as they are now called – have suffered from traumatic brain injury (TBI) and some have severe memory problems. Beyond the military, TBI is a major public health concern that affects millions of Americans as patients and caregivers and is incredibly expensive. A breakthrough treatment is needed and for that, ambitious research is required.

But does this research agenda end at treating disease, or could these findings also be applied to memory enhancement goals?

Beyond helping us to grab all the items on the grocery list and find the car in the parking lot, our memories fundamentally help us to form our sense of identity and personal narrative. It is a common observation in profound dementias and Alzheimer’s disease, that family members feel like their loved one who has lost the ability to recall recent events or names or to form new memories is no longer the same person they once were. While this basic truth about the importance of memory is persuasive as an argument for the significance of this research, it also brings the risks involved sharply into focus: tinkering with an individual’s memories and their ability to form them can have the effect of profoundly altering their identity and sense of self.

In the past, DARPA has been very open about its goals for human enhancement so it is fair to consider the development of memory enhancement as a possible, if not likely, outcome of this research. The umbrella program at DARPA, called RAM for Restoring Active Memory (and invoking the term for computer memory) is what Dr. Sanchez was commenting on in the opening lines of this post. Examples of RAM projects can be found here and here and the stated goal of the project is to develop an implantable (i.e. inside-the-skull) device that can restore an individual’s memory abilities. This is notable because to the public, restoring impaired memory and enhancing memory function are seen as very different aims. In a recent Pew Research survey, 67% of US adults taking part in the study felt that a device that enhances ability far beyond that of any human known to date is taking technology too far and 69% are worried about technology like this.

An improved, sharper, more reliable memory would be a useful improvement, right? If you give me the option between two computers and one has a much better memory, that one will always be my choice. The reality for human beings is probably not so simple. Consider Jill Price, one of only a few people in the world known to have Highly Superior Autobiographical Memory (HSAM). In the original description of her case, Price seems surprisingly ordinary in many ways. She earned mediocre grades in school and worked off and on as an office assistant after college. However, her autobiographical memory is astounding. Name a date after 1974 and she can tell you what day of the week it was, what she did that day, if any notable public events occurred on that date, and what the weather was like. Most of us would struggle to recount what we did on any given day last month, let alone decades ago. It is surprising, then, that her incredible memory did not make her extraordinarily successful in school or her career and, in fact, she described her memory as being rather burdensome, preventing her from letting anything go. After Price’s case became known to researchers, others came forward to be studied as well. After thoroughly vetting the volunteers, and studying the most likely HSAM cases, researchers concluded that these extraordinary autobiographical memory abilities were not paired with a more generalized genius or even improved memory in other areas. These cases highlight the critical balance between remembering and forgetting that probably goes a long way in helping us get through our daily lives.

We also know from nonhuman animal studies that enhanced memory does not always lead to positive outcomes. At brain synapses, NMDA receptors are critical mediators of neuroplasticity. Genetically increasing the expression of a subunit of the NMDA receptor, NR2B, in mice improved the animals’ learning and memory across multiple paradigms. However, further testing demonstrated that these animals were also were more sensitive to some painful stimuli, highlighting the possibility that it may be difficult to selectively augment one neural process in a purely positive way. This, however, is just one example of a memory enhancement study. Additional studies in rodents have found that spatial memory can be enhanced by stimulating the entorhinal cortex and some of the negative effects of TBI on learning and memory can be ameliorated with stimulation of the medial septal nucleus, an input to the hippocampus. Patients suffering from intractable epilepsy have made an enormous contribution to neuroscience for several decades by volunteering for intracranial cortical and deep brain stimulation studies. Evidence from human studies is now emerging to suggest that stimulation of memory structures and pathways in the medial temporal lobe can also enhance certain types of memory.

If an intracranial memory-enhancing device is developed in the near future, who should get it (and who would get to make that call)? To me, the risk benefit calculation is much easier than a similar one on cognitive enhancing pills. Opening up the skull is a rather significant barrier that will likely keep all but those who need it the most from considering such an intervention for enhancement (versus therapeutic purposes). Regarding enhancement, if soldiers were to receive implanted devices aimed at improving their performance in combat, what happens when their tour of duty is completed, or when they retire? Moreover, during initial testing of any devices in healthy subjects, there are significant and unique consent issues in the military due to power imbalances between officers and subordinates. Even in relatively recent history, there have been serious problems in human subjects research in the military, which have come to light as documents are de-classified.

There are other, non-invasive neurotechnologies also in development that have been discussed here and elsewhere before and it’s likely that the technology will only become less invasive, smaller and, like everything else, wireless in the near future. In addition to helping TBI patients recover memory abilities, DARPA’s warfighter enhancement goals probably center around improving memory under combat conditions of extreme stress and fatigue, factors that can obviously impair memory performance. “Military personnel carry a growing responsibility to recount, report and act upon knowledge gleaned from previous experiences, and how well those experiences are recalled can make all the difference in how well these individuals perform in combat and other challenging situations,” Dr. Sanchez explained in a recent press release on the program. Human errors were blamed for the deadly US airstrike on a Doctors Without Borders hospital in Afghanistan last year that claimed 42 lives. Clearly, there are also potential costs for not pursuing enhancement technology.

Military personnel are not the only professionals who need to perform at a high level under difficult conditions. Could surgeons and airline pilots also benefit from memory enhancing technology? These examples are often invoked in enhancement discussions because this type of work impacts other people’s lives and mistakes can be fatal. Therefore, technology that the military finds to be useful will likely have applications elsewhere in society. Consider another DARPA project, the Internet. Also as the technologies are improved (smaller, less invasive, more affordable), it’s likely that there will be a nontrivial consumer market.

Other DARPA-funded neuroscience research has also been discussed previously on this Blog. That time, the researcher was studying the way the brain interprets narrative storytelling and seemed genuinely uneasy about the possibilities for advanced (neuro)propaganda coming from his work. Here, there is a clear potential medical benefit to a group of people who currently have a dearth of treatment options. Nonetheless, the synopsis from DARPA’s own PR team is as follows:

“The study aims to give researchers the ability to “read” the neural processes involved in memory formation and retrieval, and even predict when a volunteer is about to make an error in recall. The implanted electrodes also provide a means of sending signals to specific groups of neurons, with the goal of influencing the accuracy of recall.”

I, for one, am not overly thrilled about the idea of government scientists “influencing the accuracy of [my] recall” but maybe I just went a bit overboard with Stranger Things. To be clear, understanding the neural signatures of memory encoding, and how that process goes awry after brain injury, is fundamentally important work for basic and clinical neuroscience. Yet as memory enhancement research moves forward, it will be important to continue to keep neuroethics in mind which, surprisingly, is not the norm. A recent review article of the field never once even gives a nod to current or future ethical concerns. Given the fundamental link between memory and identity, research in this area should proceed with consideration of potential nonphysical harms of memory interventions. Finally, as noted above, the Internet as we know it today is in large part thanks to DARPA research, which is a bit ironic because now, with the Internet at our fingertips, who needs to remember anything anymore?

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Purcell, R. (2016). Is memory enhancement right around the corner? The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2016/12/is-memory-enhancement-right-around.html

The Physical, Social, and Societal Consequences of “Smart” Drugs

By Sunidhi Ramesh

This post was written as part of a class assignment from students who took a neuroethics course with Dr. Rommelfanger in Paris in Summer 2016.

Sunidhi Ramesh, an Atlanta native, is entering her third year at Emory University where she is double majoring in Sociology and Neuroscience and Behavioral Biology.  After experiencing an educational environment in high school that was so competitive that it practically forced students into taking study drugs, cheating, and cutting corners, she founded “The Prism Project,” an initiative that revolves around anonymous stories that highlight the problems that exist within the American education system. She plans to pursue a career in medicine and has served on College Council’s Admissions and Scholarships committee, is presently active on Emory’s Committee of Academic Integrity, and is involved in the Indian Cultural Exchange organization at Emory. 

“I remember the night I first took one. A friend of mine had some extra, so he handed me one the night before a big test. This test was important; I was doing pretty badly in the class, and I knew that my performance on it would decide my final grade. I wasn’t the type to take Adderall to get ahead. But I was desperate. And I thought it was only going to be this one time.

My grades skyrocketed. Like, you don’t understand. I played football and had to take care of my mom after school; the main reason I did so badly before was that I didn’t have the energy to put into school that I wanted to. But these pills… these pills gave me that. The energy I didn’t have.”

This quote is from an anonymous submission to The Prism Project, a page that shares the stories of students who feel as if the education system in the United States does less than it should. The topic of the quote is a subject of heated debates—“smart drugs.”

“Smart drugs,” also known as “nootropics,” are “supplement[s] that [are] ingested primarily for [their] effects on the brain [such as] an increase in cognition, focus, alertness, or well being (1)” in healthy individuals. Although the vast majority of these drugs were initially produced to treat symptoms of attention deficit hyperactivity disorder (ADHD) (2), the global demand for them (primarily for use in schools and work settings) has created a massive, up-and-coming “billion dollar business of being smart (3).”

Image courtesy of Deviant Art

And while most studies and scholars disagree on the actual effects of these drugs (ranging from “none” to “modest” improvements (4)), most researchers have expressed concern regarding their ethical implications and the consequences we may face when similar, more effective compounds are developed in the future (5).

One of the primary concerns involved is “challenging what it means to be normal.” Picture this: one student begins using these drugs to focus more and perform better on exams. He succeeds. The next student, feeling disadvantaged and conflicted, begins doing the same to keep a level playing field. And, suddenly, within weeks, a cycle of frustration and competition forces these little pills to become rampant around an entire school. This is the slippery slope that surrounds cognitive enhancements—the pressure that “normal” individuals begin to feel to become “enhanced.”

And what does this say about the future of our workforce? If our students are primed to only perform well under “enhanced” conditions, will they be able to work efficiently in their future jobs without these “smart” drugs?

Furthermore, the long-term effects of these drugs are largely unknown. A study done in doctors that “deprived [them] of sleep overnight and [gave them] a dose of 200 milligrams of Modafinil or placebo” found that “the doctors taking Modafinil had cognitive improvements, including flexibility of thinking, and reduced impulsivity.” (6) These are the positive (?), known, short-term effects. But what are the consequences of taking such medication often— for months or years at a time? Because these drugs are fairly new, nobody knows. So, should we be concerned? Of course.

Consider, also, the social consequences of a “pressure to perform” and the temptation that workers and students will face “to risk their own health to gain a competitive edge.” Is that a problem of it’s own? Taking into account the trust issues, mild paranoia, and mental stress that would inevitably ensue, I’m willing to bet it is.

What is odd and disturbing about this new trend is how idealistic people seem to be about its infectious spread. “Why would this be bad?” some people seem to claim. “One day, we will all be taking this medication to become smarter and more intelligent than ever before!” The core problem not addressed in this argument is that these medications cost money—money that only a small percentage of the American (or world) population can afford to spend on cognitive enhancement methods such as this one. This then becomes a justice problem. Is it fair to produce and allow products that, realistically, can only enhance a portion of the population?

Image courtesy of Flickr user eliz.avery

Advocates and opponents of these enhancers disagree significantly as to what exactly constitutes these “smart drugs.” Can caffeine products, such as coffee, be considered brain enhancers as well? Well, coffee and its stimulating effects are natural products of the coffee bean. More importantly, it is readily available to the masses, legal for public consumption, and free from most forms of stigma. On top of the fact that coffee has been consumed since the 10th century, there is ample evidence to ensure that its consumption does not come with any unwanted, long-term side effects. And, from a neuroethics standpoint, coffee does not bring into question concerns of justice, readiness, public involvement/understanding, integrity, and governance/ regulation. Convinced? Good.

With all this in mind, I can’t help but wonder why we (including myself!) have such a large problem with expanding our own potential as human beings. When would “smart drugs” be something desirable? Can we make our doctors more alert during 15 hour surgeries? Or soldiers more active in battle? Our pilots more attentive during international flights? Would we want this any more than we would want enhancements to the general population? I would think so. But why? What does this say about our values and our society?

Frati et al. (2015) may get into answering these questions (7), claiming that “the vast abuse of [these drugs] rises from the mental association between the therapeutic use for ADHD treatment and its misuse in order to improve learning skills in healthy subjects.” Frati’s group further states that “[the medication’s] improper use is based on exceeding the marked borderline between health and disease, which appears in the eyes of abusers increasingly blurred until it disappears (7).” So, as a result, “treatment” starts becoming synonymous with “enhancement” to dissenters around the country.

In terms of getting to the roots of the questions presented here, that’s a start.

We must stay alert when it comes to any large-scale changes that challenge what it means to be “normal” and “human” in modern society. And although larger studies on these drugs still need to be conducted to even begin to tackle the dozens of issues surrounding this topic, the “smart drugs” of today need to be discussed, debated, and monitored to avoid serious, undesirable consequences in the world of tomorrow.

References 



1. Nootropic - Scientific Review on Usage, Dosage, Side Effects. (n.d.). Retrieved June 11, 2016, from https://examine.com/supplements/nootropic/



2. Larimer, M. P. (2005). Attention deficit hyperactivity disorder (ADHD) research developments. Nova Publishers.



3. Chinthapalli, H. U. K. (2015). The billion dollar business of being smart. bmj, 23.



4. Arria, A. M., Wilcox, H. C., Caldeira, K. M., Vincent, K. B., Garnier-Dykstra, L. M., & O'Grady, K. E. (2013). Dispelling the myth of “smart drugs”: Cannabis and alcohol use problems predict nonmedical use of prescription stimulants for studying. Addictive behaviors, 38(3), 1643-1650.



5. Cakic, V. (2009). Smart drugs for cognitive enhancement: ethical and pragmatic considerations in the era of cosmetic neurology. Journal of medical ethics, 35(10), 611-615.



6. Sahakian, B. (n.d.). The Ethics of Smart Drugs. Retrieved June 11, 2016, from http://www.cam.ac.uk/research/discussion/the-ethics-of-smart-drugs



7. Frati, P., Kyriakou, C., Del Rio, A., Marinelli, E., Vergallo, G. M., Zaami, S., & Busardò, F. P. (2015). Smart drugs and synthetic androgens for cognitive and physical enhancement: revolving doors of cosmetic neurology. Current neuropharmacology, 13(1), 5.





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Ramesh, Sunidhi. (2016). The Physical, Social, and Societal Consequences of “Smart” Drugs. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2016/07/the-physical-social-and-societal.html

Responsibility: Revis(ion)ing brains via cognitive enhancement

By Shweta Sahu

The Statue of Liberty, an iconic symbol of

American opportunity; courtesy of Wikipedia

Most every parent wants their child to grow up to be a neurosurgeon, a lawyer, or the next gen Mark Zuckerberg. That was especially true in my case, as a first generation child. When I was two, my parents came to the United States, "the land of opportunity," seeking the success that they had only heard about in India. I grew up hearing their stories of hardship when they first moved here with an infant, without a car, without any extended family, and knowing very little working English. I witnessed them struggle tirelessly to make a life for themselves and they always said that without education you are nothing and will be no one. As a child, while my friends would go to sleepovers and camping trips with friends, my dad would spend time checking my math problems on the white board at home and my mom would make me spell 50 words correctly every night. But even with all that pressure, I never had the best GPA, I had to work incredibly hard to stay above the class average, and I almost always fell short of their expectations. So given the opportunity, would my parents have tried to enhance my cognitive ability?

Transcranial direct current stimulation (tDCS) is one intervention, particularly in the DIY community, which is becoming increasingly popular in hopes of achieving enhancement of cognition, though it is not available clinically for this express purpose. While it has been deemed safe in the short term from 10,000 trials of adults, studies (like this one and this one) indicate that tDCS does not result in significant enduring improvements in cognitive performance.

To do or not to do

Dr. Anjan Chatterjee asks, “If we have the ability to make brains better, should we do so when there is no acute 'disease?'” He calls such enhancement administered by the neurologist “cosmetic neurology.” In his article, Chatterjee contemplates “ways in which medicine might make bodies and brains function better by modulating motor, cognitive, and affective systems.” The definition of “enhancement” is a moving target: what is deemed worthy of treatment is characterized as disease, whereas that which is only modified is known as enhancement. Ideas about the line between enhancement and therapy are dictated not only by medical professions, but also influenced by culture.

Dr. Chatterjee suggests that one of the ethical dilemmas surrounding the issue of enhancement is manifested in safety, since most medications and treatments have side effects. He notes that “in disease states one weighs risks [like death] against potential benefits,” but asks whether enhancement is worth the risk in healthy patients who simply wish to become even better.

However, in reality, little is known about the long term effects and true benefits of interventions like tDCS in typically-performing (not considered diseased or disabled by the medical community) individuals. Dr. Martha Farah, a renowned cognitive neuroscientist, notes that much of the research currently published on existing pharmacological enhancers may need to be taken with a grain of salt, because a) many studies used small sample sizes that could have easily led to false conclusions and b) enhancement outcomes *in laboratory experiments* differ based on biological and psychological traits of the user.

Schematic of transcranial magnetic stimulation,

courtesy of Wikipedia

Even less is known about effects on children, though there are experiments indicating potential success. In one experiment in London, 12 children with mathematical learning disabilities were given nine 20-minute training sessions, 6 of whom wore the cap (but did not receive stimulation) while the other 6 received transcranial random-noise simulation (tRNS), which is a newer transcranial stimulation method that utilizes a randomly varied current. “In this case, the children moved their bodies from side to side to guide a ball on a screen to land at a certain point on a number line, with the difficulty increasing as they progressed.” Results indicated that “children who received stimulation showed greater progress in performance [and reached a 20% higher level on the game] than did the controls, as well as significant improvements in general mathematics test scores.”

But whose responsibility is it to decide whether one receives treatment?

In their article, Brain stimulation for treatment and enhancement in children: an ethical analysis, Dr. Hannah Malsen et al. argue that because such intervention may include “compensatory trade-offs” or functional cognitive losses, more emphasis should be placed on parental judgment of the child’s best interest if the child has a neurological disease and is in need of treatment. However, in absence of disease, then more weight should be placed on the child’s autonomy, since one cannot justify the need for enhancement as was deemed necessary in the treatment case.

But how do you know a child would have wanted enhancement in the first place? At age 10 is he/she equipped with the information necessary to make such a decisions with such potentially profound impacts? I know I sure wasn’t as a 10 year old. Even now, I still cringe every time class registration time comes around because I know that small choices like what classes to take and when have enduring impacts on my career. Say the child took the opportunity and turned out successful—would he/she be glad he/she received enhancement? Would his or her quality of life be the same or better?

Would the child be the same person, at the end of the day?

This is another dilemma Chatterjee addresses—one of “eroding character” and “altering an individual,” and if “such interventions threaten essential characteristics of what it means to be human.” Taking a step back, most of us can relate to this and wonder, if we do modify a person’s state or prescribe antidepressants and other drugs, then aren’t we fundamentally altering a person and keeping them from being who they are, or are we instead enabling them to become their best selves? When someone is chronically on a drug, who is to say they would make different decisions if they weren’t always on said drug? If we believe that our actions define us, then how do we know that we are not, in fact, slowly changing the person and not just their temperament or their personality? I personally think that prolonged use of a drug does change a person. Take, for example, the case of antidepressants, which are known to protect people from the adverse effects of stress. The prolonged use of antidepressants could cause someone to make different decisions than they normally might have when they felt stress, and if these different decisions lead to different actions, then yes, I think you are altering a person by prescribing them a chronic drug. Others, however, do not share my opinion. In a qualitative case study done by interviewing parents of children with and without cognitive disabilities, it was found that some parents actually justified their child’s use of [ADHD] medication and felt that the “drugs were facilitating the expression of their child’s identity, not changing it.” Again, in the case of enhancing children, we’re led to wonder how we might be altering the trajectory of the development of the child’s personality and temperament: some believe that personality is set at a young age, which leads us to question whether there is an age after which enhancement may be less likely to alter personality, since the brain and personality, are less malleable after youth.

Is the decision to choose something like tDCS actually a choice?

First generation students sometimes feel pressure to succeed

academically; image courtesy of flickr user Tim Pierce

Linda Geddes reports, “There are currently no laws in either Europe or the US to regulate the use of tDCS in people merely hoping to enhance cognition, and companies now sell the tDCS headsets online,” thus enabling those who choose the DIY route. In fact, with a bit of science background, coming up with your very own tDCS invention is a surmountable feat with common household materials, since it is essentially two sponges hooked up to a battery/ power source! In the competitive culture today, might parents feel the need to utilize any intervention they can to improve their child’s chance of succeeding? Perhaps the stakes are too high? Parents raising first generation American children like my own for instance, might feel additional pressures. A first generation student myself, I used to always question why I received so much pressure from my parents. Now, I realize it’s because they just want me to succeed and to not have to struggle the way they did just to put food on the table, so pushing me to succeed in academics was their utmost priority. They knew I wasn’t the brightest Crayon in the box, but given the chance, would they have considered enhancement? Has society influenced our need to enhance ourselves or our children because we know that, as Chatterjee suggests, “to not take advantage of cosmetic neurology might mean being left behind?” Is it a parental responsibility to enhance their children? Are we creating a new culture of millennials who will one day want to similarly enhance their children?

I asked my parents if they would have done so and somewhat surprisingly, they said no. At first they agreed and said there’s always the risk of further complications and you potentially risk more than you can gain. Moreover, they noted that since I didn’t have any known deficits or explicit neurological shortcomings, then no they would not go for it because it wouldn’t be worth it. Finally, my mom stated that every parent’s main wish is that their kids just be safe and happy, and that academic success was only a means to achieve happiness. She would never do anything to threaten that (and she viewed that such enhancement might do so), even if it means having an “ordinary” daughter when she wanted an extraordinary one, because to her, I am extraordinary.

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Sahu, S. (2015). Responsibility: Revis(ion)ing brains via cognitive enhancement. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2016/01/responsibility-revisioning-brains-via.html