Added Stakeholders, Added Value(s) to the Cognitive Enhancement Debate: Are Academic Discourse and Professional Policies Sidestepping Values of Stakeholders?

Abstract

Background: The debate on the non-medical use of prescription medication for the enhancement of cognitive function (e.g., attention, memory, concentration, vigilance), accompanied by heated public discussions in the media, has spurred the interest of scholars and the public. Methods: In this paper, we present qualitative data from a focus group study with university students, parents, and healthcare providers. We identified ethical, social, and legal issues related to the non-medical use of methylphenidate for cognitive enhancement (CE) and closely examined the positions taken on these issues and their supporting arguments. Results: The ethical, social, and legal issues we identified (e.g., authenticity, cheating) were similar to those identified in a previous discourse analysis of the bioethics literature but indicate the existence of moderately and highly contentious issues as well as factors and values underlying these issues. The model we generated from these findings shows how interplay between values (e.g., effort and honesty) and external factors (e.g., regulation and access) may lie at the root of contentious ethical issues in CE. Conclusions: Our discussion points to an unsuspected complexity in understanding values of stakeholders and their unclear relationship to academic discourse and professional societies. We propose deliberative or other democratic processes as a way to recognize and incorporate the complexity of the CE debate.

Empirical Support for the Moral Salience of the Therapy-Enhancement Distinction in the Debate Over Cognitive, Affective and Social Enhancement

“…Distributive justice is one of the cardinal concerns of the enhancement debate, mentioned as an important issue by nearly all commentators [22,23,57]. One interpretation of our results is that they contradict a large body of empirical research focused on concerns regarding inequality of access to pharmacological CAS enhancement [22,46,[58][59][60][61][62][63][64]. It is worth noting that the key difference between our results and these previous studies is that participants were unprompted as to potential causes of their discomfort towards the use of pharmacological CAS enhancement.…”

Wish-fulfilling medicine in practice: the opinions and arguments of lay people

“…The work that has been done on the perspectives of the lay public or stakeholders in the area of wish-fulfilling medicine and enhancement has often focused on specific types of enhancement such as cognitive enhancement4 11 12 or life extension 13. In other instances, the opinions of the public have been sought on biomedical technologies more broadly 14…”

“…This requirement is more demanding than is the case in The Netherlands where medical assistance is covered by insurance when needed irrespective of the reason. Although the concern of the public with justice and cheating has been uncovered before,3 12 the concern is usually with the unfair beneficial outcomes of enhancement. In our study, in contrast, the concerns arose particularly about the issue of limited resources for medical care, which should be allocated fairly.…”

“…As Forlini and Racine have reported before, the values of stakeholders add a layer of complexity and do not allow for quick answers 12. When the normative reasoning of stakeholder is incoherent or based on incorrect facts, it is impossible to translate it directly to normative stances for policy-making.…”

Empirical Research on Attitudes Toward Cognitive Enhancement Is Essential to Inform Policy and Practice Guidelines

“…Forlini and Racine present qualitative data from a focus group study with university students, parents, and health care providers in Canada (Forlini and Racine 2012). Franke and colleagues (Franke et al 2012) report quantitative data from self-report questionnaires completed by German high school and undergraduate university students.…”