Pharmacological Human Enhancement: An Overview of the Looming Bioethical and Regulatory Challenges

Abstract

Cognitive enhancement, a rather broad-ranging principle, can be achieved in various ways: healthy eating and consistent physical exercise can lead to long-term improvements in many cognitive domains; commonplace stimulants such as caffeine, on the other hand, temporarily raise levels of alertness, attentiveness, and concentration; sedative substances are also used as an indirect form of enhancement to relax before an exam or an important meeting. Such approaches raise no ethical issue. Nonetheless, clinical research has led to the off-label use of drugs called nootropics or "smart drugs", which can, under certain conditions, elicit some degree of cognition-improving effects: methylphenidate and modafinil can enhance working memory and concentration in healthy individuals, although the significance and effectiveness of such applications are dubious. Such "cognitive enhancement" methods, however, do raise multiple ethical issues, and their contentious nature has caused bioethical authorities to lay out opinions and recommendations meant to regulate their use. Most notably, the Italian Committee on Bioethics has extensively dealt with the spread of nootropics, which resulted in the Italian Code of Medical Ethics including "cognitive enhancement" drugs and their prescription by doctors as critical points, along with cosmetic surgery (the latest version of the Code, updated in December 2017, deals with the two separately, in Article 76 and 76 BIS). The United States Presidential Commission for the Study of Bioethical Issues broadened the scope of cognitive enhancement techniques so as to include neural modifiers, i.e. mechanisms of brain and nervous system change: a much wider array of interventions, technologies, behaviors, and environmental conditions that may potentially affect several aspects of the human brain and nervous system. The potential of neuroscience to profoundly reshape society is nothing short of mind-blowing.

Effects of Appearance- and Performance-Enhancing Drugs on Personality Traits

“…In conclusion, APED use among the general population appears to be escalating into a major public health concern. It is therefore of paramount importance to lay out an objective assessment of their use by toxicological analyses (72,73) and, consequently, to foster prevention and intervention measures for the purpose of promoting a healthy and tenable perception and use of one's body, not only for athletes but also among the general population, and to promote psychological aid procedures for people with substance use issues and body image disorders (74).…”

‘Beyond’ Human Enhancement — Taking the Developing Country’s Perspective Seriously

“…Setting out a simple definition allows us to move past debates on the distinction between enhancement and therapy and focus on bioethical debates regarding the possible consequences of enhancement, and enhancement technologies (means or interventions by which enhancement is achieved) (Buchanan 2011). Enhancement technologies include cognition-enhancing pharmaceuticals like Adderall or more invasive interventions such as the genetic modification of embryos (Ricci 2020).…”

How does caffeine influence memory? Drug, experimental, and demographic factors

“…As past literature tended to treat memory as a subset of cognitive functions, the specific effect of caffeine on memory has not been thoroughly discussed. As with all other nootropics, research on caffeine faces many issues regarding ethical challenges in drug administration and treatment reliability across experimental settings (Crespo-Bujosa and Rodríguez, 2019;Ricci, 2020). Few studies have considered individual differences in caffeine tolerance and metabolism due to genetic, or demographic variations in the number of adenosine receptors (Nehlig, 2018).…”