Florida State University Libraries
Undergraduate Research
Honors Ethical Issues and Life Choices (PHI2630)
2013
Long-Term Ethical Issues and Logistics
Concerning Cognitive Enhancement
Jordan Brenneis
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1 Jordan Brenneis
Long-Term Ethical Issues and Logistics Concerning Cognitive Enhancement
bioethics, ethics, cognitive enhancement, cognitive enhancers
This paper explores the ethical issues surrounding cognitive enhancement, focusing on
the long-term societal effects and logistics of pharmaceutical cognitive enhancement use.
Pharmaceutical cognitive enhancements are being used at a startling rate, especially by college
students. These students are using enhancers despite their detrimental effects to the user and
those around them. This paper finds cognitive enhancement by the healthy to be ethically wrong,
as enhancement use by healthy individuals is unfair to many members of society, strains limited
health and medical resources which could be otherwise used to solve actual medical problems,
involves a wide range of health issues which are still largely unknown, would involve people
using unnatural means to improve their bodies, and would, against their better judgment,
encourage others to use harmful cognitive enhancements. Based on these findings, it is suggested
that prescription of these medicines be made more strict and drug tests be implemented for
cognitive enhancers at universities.
2 I. Introduction
Advancements in science have allowed the development of drugs and techniques that can
improve the function of the human brain, whether in focus, concentration, memory, alertness,
mood, anxiety, hyperactivity, and many other types of areas. Cognitive enhancing drugs are
already widely used to correct deficiencies in any of these areas. However, more controversial,
and far less widely used, are cognitive enhancements for those who are already healthy
individuals. The use of cognitive enhancements by those who are already healthy human beings
is ethically wrong, as this use is unfair to many members of society, strains limited health and
medical resources which could be otherwise used to solve actual medical problems, involves a
wide range of health issues which are still largely unknown, would involve people using
unnatural means to improve their bodies, and would, against their better judgment, encourage
others to use harmful cognitive enhancements. While some may argue that the productivity
increase cognitive enhancements bring about is beneficial, or that it is okay that cognitive
enhancements are unfair since many aspects of life already are, these arguments are faulty when
further examined.
II. What Is Cognitive Enhancement?
Cognitive enhancement is defined as the use of techniques to improve cognitive and/or
behavioral functioning and performance where cognitive and/or behavioral functioning is not
judged to be impaired.1 Essentially, enhancement occurs when a healthy individual utilizes a
method, or cognitive enhancer, to bolster their own cognitive performance. Methods of cognitive
enhancement include such basic forms as education, enriched environments, general health,
natural enhancers, and mental training, to more technological forms including drugs, transcranial
magnetic stimulation, genetic modifications, prenatal and perinatal enhancements, and brain-
3 computer interfaces.2 In this paper, I will focus on the ethics of using pharmaceuticals as
cognitive enhancers. Today, these include methylphenidate, better known as Ritalin or Concerta,
amphetamine, best known as Adderall,3 and modafinil, best known as Provigil.4 Methylphenidate
and amphetamine both increase the amount of dopamine, an important neurotransmitter, in the
brain. Methylphenidate enhances mood, energy, endurance, and concentration, while
amphetamine enhances alertness, energy, and concentration.5 Today, these medicines are
commonly used to treat attention deficit disorder (ADD) and attention deficit hyperactivity
disorder (ADHD).6
The exact way in which modafinil works, meanwhile, is currently not fully understood.
Its effects are likewise somewhat uncertain, but it has been shown to promote wakefulness, and
might improve working memory and general cognition. Furthermore, the use of modafinil seems
to enhance cognition especially well on the hardest of tasks for individuals with moderate to low
cognitive abilities.7 Today, the drug is used to treat sleep disorders.8 Though the exact extent to
which cognitive enhancing drugs augment cognitive ability in the healthy and the extent to which
this effect varies based on the individual's natural level of cognitive ability is currently
unknown,9 I will show that the following arguments hold regardless of this fact.
III. Why Cognitive Enhancement is an Issue
Cognitive enhancements are currently being used at a startling rate by those without
prescriptions, especially on college campuses. Current usage rates are anywhere from 1-11% of
all college students.10,11 In one study, 34% of students at a southeastern university reported using
cognitive enhancers.12 It appears that students may be especially likely to take enhancers when
studying for exams.13 Students who do use enhancers seem to be more likely to use them
infrequently. One study reported that 35.3% had used enhancers within the past year, 10% had
4 used within the past month, and 8% had used within the past week.14 Other findings suggested
that 33.9% use enhancers two to three times per month, while 15.5% use them two to three times
per week.15 Cognitive enhancement, then, is quite prevalent. This prevalence is especially jarring
when considering the ethical problems presented by enhancement use. Within the general public,
one survey found a usage rate of 8.5% lifetime nonmedical use of stimulants, though this survey
did not focus on only cognitive enhancers.16 20% of respondents, meanwhile, reported using
enhancers in a 2008 Nature poll. This poll probably inaccurately reflects usage by the general
public, however, since most readers are especially attuned to the sciences.17
IV. Ethical Concerns
Currently, there is an ongoing discussion about the ethical concerns surrounding
cognitive enhancement use. While considerations about short-term personal health issues and
societal effects have been well established, deliberation on the long-term societal and logistic
effects of cognitive enhancement use is lacking. These categories of ethical issues have been
mentioned but cast off as an afterthought without any real study,18 even though they are
extremely important, as I will argue.
A. Unfairness
Cognitive enhancers are unethical as relates to fairness. At this time, cognitive enhancers
are costly, and all cannot afford them.19 If cognitive enhancers were to be distributed to the
healthy free of regulations, the mental functioning of those who could afford them would be
improved, while those who could not afford them would remain at their original level of mental
functioning. This would further widen the gap between economic classes, making it harder for
the poor to catch up with the rich. Those who could not afford cognitive enhancers would be at a
disadvantage both in school and in jobs, thereby keeping them from obtaining work that pays as
5 well, and therefore preventing them from moving to a higher economic class, no matter how hard
they work. This is unethical since it would help some at the expense of many. Additionally, it is
improbable that cognitive enhancers would be paid for by the public, due to limited government
funds and limited health resources. Cognitive enhancers are currently both extremely expensive
and resource intensive,20 a fact which would inevitably prevent government subsidization of
enhancers for those who could not afford them. The government and general public would see
subsidizing other projects which solve problems and real diseases as more important, preventing
the availability of funds and resources for providing enhancements to the poor.
B. Limited Health Resources
Another problem with cognitive enhancement is that providing enhancers will strain
health care resources.21 Providing cognitive enhancers to the healthy will take resources away
from solving other actual medical issues, as there is a finite amount of medical resources
available. There is a limited supply of doctors, pharmaceutical companies, and researchers. For
example, according to Forlini, Gauthier, and Racine (2013), "Because health and social services
are currently hardly able to meet demands, health professionals might be inclined to promote
drug therapy by default so as not to leave people without care."22 This could potentially result in
cognitive enhancers being extremely easy to obtain, along with causing the possibility to arise
that people may begin to obtain them without any education on risks or what exactly cognitive
enhancers entail. This further complicates the health risks involved with cognitive enhancers. As
Racine and Forlini (2009) note, medical resources are already stretched thin trying to help those
who are unhealthy.23 Introducing a demand for cognitive enhancements would only exacerbate
these problems.
C. Health Issues
6 Although commonly overlooked due to want of the beneficial and performance
improving aspects of cognitive enhancers, there are many significant health issues associated
with using cognitive enhancers, including long term issues. Use of stimulants, for example, can
cause cardiovascular problems, addiction, and psychosis.24 Some of these issues, especially as
relates to long term use, are currently unknown or have been researched little.25 The brain is a
complex part of the body,26 and has come to work at a certain capacity. By using cognitive
enhancers, one is messing with the balance of the brain, and will almost certainly create new
problems in a healthy, balanced individual. Due to the harmful effects along with the unknown
effects of cognitive enhancements, it would be foolish to allow the general, healthy public access
to cognitive enhancers for performance improvement. This might very well result in people
being hurt more than helped over a period of time, thereby decreasing the utility and pragmatism
of enhancers. Furthermore, releasing enhancers to the general public could easily result in a flux
of people attempting to get cognitive enhancers without really researching the risks. People could
easily be so overcome by the desire to improve their performance, and keep up with others using
cognitive enhancers, that they would not stop to consider the risks, especially if these risks are
far-off or unknown, as is the case. Doctors, meanwhile, do not have time to go over the risks and
benefits of all methods with patients, as is also the case, due to limited health resources.
Therefore, since cognitive enhancers pose health risks which outweigh the benefits, they should
not be used by the healthy to improve performance or mental function.
D. Enhancers are Unnatural
Cognitive enhancers are unnatural.27 This argument is often played down by critics who
claim that enhancers do no different than coffee, alcohol, exercise, sleep, or food. However, the
health risks involved with the latter activities are comparatively insignificant.28 Furthermore,
7 cognitive enhancers are products that must be synthesized, unlike these other examples, and
affect the brain in a far more complex fashion. As previously stated, we still know relatively little
about cognitive enhancers and how they affect our minds, but do know for certain that they
essentially always come with side effects, some of which can be quite harmful in the long-term.
Looking at other examples, too, we see that unnatural aids are frowned upon and harmful.29 In
many sports, scandals and public outrage have occurred recently over athletes using performance
enhancing drugs. The media and fans discourage it due to the removal of the human element
from matches or events, the harm it can potentially cause athletes and those who try to emulate
these athletes by taking performance enhancing drugs, and the detrimental effect these drugs
have on fairness. Athletes, however, continue to use and get caught using performance enhancing
drugs due to the exceptional rewards of this use. The same can be said of cognitive
enhancements. Many, if not all, have detrimental side effects. Enhancers create an unnatural
element to our performance, and cause others to be relatively disadvantaged. And, like
performance enhancing drugs, people continue to use cognitive enhancers solely due to the
performance impact they create.
To further highlight the unacceptability of humans using unnatural performance
enhancers, consider the following example. Say a device was invented which a golfer could wear
that would allow him to always hit perfect shots. A squad of golfers was outfitted with these
devices, and then began a match. Presumably, this would not catch our interest at anywhere near
the level of a real golf match. The golfers would all constantly hit perfect shots without any
effort. There would be no human element, no chance for a mistake or disaster; no skill would be
involved. The excitement associated with a normal sports match would simply not be there.
These devices would relegate the game to a match between machines. If this situation, one in
8 which people's performance becomes entirely unnatural, is unacceptable and undesirable, it
makes no sense to take any steps in this direction. It would simply take away much of the sense
of accomplishment from our lives.
E. The Peer Pressure Effect
Another problem with cognitive enhancements becoming available for those who are
already healthy is that the use of cognitive enhancers by some would pressure others into using
enhancers who would not use them otherwise.30 Many would feel as though they are being left
out, and losing ground to, those using cognitive enhancements. People would feel as though they
are forced to take cognitive enhancers, whether they want to or not, to be able to stay relevant
productively. To keep up in terms of productivity and mental capacity, there would be no other
option. Cakic (2009) agrees with this idea, writing that a, " student [would feel as though they
must] make use of every possible advantage afforded to them, eg, nootropics, as failing to do so
might result in a relative loss of academic performance."31 Thus, allowing cognitive enhancers to
be used by the healthy would cause a bandwagon effect, whereby people would begin using
cognitive enhancements simply because everyone else is using them, even if this fact is
imagined.
V. Counterarguments
A. Productivity
One argument for the use of cognitive enhancers by those who are otherwise healthy is
that this use is highly economical. By taking drugs which improve mental capacity, performance,
and productivity, people can become the best they possibly can be at whatever tasks they are
working at. This would cause their productivity to rise, and therefore more to be produced for
9 society in general. This increased production would then improve the welfare of society, by
increasing the amount of resources and products available.
a. Productivity Response
One can easily assume here that this increased productivity would help all, including
those who are unable to purchase cognitive enhancers. However, this assumption is wrong -most of the wealth brought about would go back to those taking cognitive enhancers and
producing at a higher level, as their rewards and pay would increase. Those who could not afford
cognitive enhancements would still fall farther economically from those who could afford them.
While those taking cognitive enhancers would benefit from this increased productivity, this
further exacerbates the problem of unfairness presented by cognitive enhancers.
B. Unfairness
One could also respond by arguing that society and life is already quite unfair; that there
exist already differences in skills and ability levels between human beings, and that, because of
this fact, allowing healthy individuals to take cognitive enhancements is ethical. Some could take
this argument a step farther by asserting that not allowing healthy people to take cognitive
enhancers is akin to promoting absolute equality between all. Having a world of completely
equal, identical human beings is decidedly inhuman, these critics might argue, and we should not
even begin to move in this direction.
b. Unfairness Response
While it is true that there exist many points of unfairness in life, allowing the healthy to
take cognitive enhancers would do nothing but exacerbate this problem. As stated previously,
allowing healthy people to use cognitive enhancers would widen the gap between economic
classes of those able to afford cognitive enhancements, and those who could not, while
10 simultaneously making this gap harder to cross. Just because a problem is already in place does
not mean one should endeavor to make it worse, even if it does help some. Furthermore,
preventing this injustice is in no way moving towards a society of absolute equality and identical
human beings. This is a slippery slope argument; that one step in a direction, absolute equality in
this case, would lead inevitably in that end result. There are already functions in place to prevent
people from having unfair advantages, such as monopoly and pyramid scheme laws,
performance enhancing drug bans in sports, and college scholarships that accomplish the goal of
their creation well but have not caused our society to move to absolute, indistinguishable
equality, even after long periods of time.
VI. Cognitive Enhancements of the Future
In the future, it is possible that cognitive enhancements might be improved to the point
that they would be morally permissible. These future enhancements would have to successfully
avoid the aforementioned ethical issues current cognitive enhancers face. Enhancements would
be morally acceptable if they were affordable by all classes, void of almost all health issues,
interacted with the body in a purely natural way, and did not strain health resources. If these
conditions were met, the peer pressure effect would no longer be an issue since the enhancers
would have no downsides.
VII. Suggestions to Prevent Cognitive Enhancement
Due to the adverse affects of cognitive enhancement by healthy individuals, it makes
sense to take action to prevent cognitive enhancement, especially on college campuses, where
enhancement seems to be most prevalent. Drug testing before tests and randomly during the
semester seems to be the most effective prevention method in the long run.32 Colleges could
require students to sign a form when applying giving voluntary consent to adhere to the college's
11 drug testing policy, thereby meeting legal requirements.33 This approach currently is expensive,
but the ethical value justifies this expense. In the wider public, tougher screening for ADHD and
ADD should be adopted to prevent people from pretending they have these disorders in order to
obtain prescriptions for cognitive enhancers. This screening could potentially be implemented by
testing patient's cognitive abilities in the same way studies on the effects of cognitive enhancers
do.
VIII. Conclusion
In conclusion, cognitive enhancements have far more detrimental effects than they boast
beneficial ones. Cognitive enhancements should not be used due to their unfairness to a vast
amount of members of society, the strain they place on limited health and medical resources
needed to save the lives of others, the problems, currently largely unknown, that cognitive
enhancements cause in the short and long term, the unnatural effects cognitive enhancers have on
people, and the way in which they cause those who do not wish to use them to be forced to do so.
While some tout the beneficial effects of increased productivity brought about by people using
cognitive enhancers, this effect is more harmful than it is helpful due to how it hurts members of
the lower classes. Others maintain that it is alright for cognitive enhancement use by healthy
people to occur since many other aspects of life are already unfair, but this objection is mislead
since moral citizens should attempt to mitigate any unfairness between members of society, as
this is to the utilitarian benefit of society.
Endnotes
12 1
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2
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3
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Individuals. American Psychological Association, 137(5), 717. DOI: 10.1037/a0023825
4
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5
Smith, M.E., & Farah, M.J. (2011). Are Prescription Stimulants “Smart Pills”? The
Epidemiology and Cognitive Neuroscience of Prescription Stimulant Use by Normal Healthy
Individuals. American Psychological Association, 137(5), 718. DOI: 10.1037/a0023825
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13 9
Smith, M.E., & Farah, M.J. (2011). Are Prescription Stimulants “Smart Pills”? The
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12
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13
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