The ethics of elective psychopharmacology

Abstract

Pharmacological cognitive enhancers (PCEs) are used to improve cognitive functions, such as attention, learning, memory and planning in patients with impairments in cognition resulting from traumatic brain injury (TBI) or from neuropsychiatric disorders such as Alzheimer's disease (AD), mild cognitive impairment, schizophrenia, and attention deficit hyperactivity disorder (ADHD). Moreover, PCEs have been shown to improve cognition in healthy volunteers with no psychiatric disorders. This article describes the rationale behind the need for their use in neuropsychiatric patients and illustrates how PCEs can ameliorate cognitive impairments, improve quality of life and wellbeing, and therefore reduce the economic burden associated with these disorders. We also describe evidence that PCEs are being used as cognitive enhancers by healthy people. Crucially, as the lifestyle use of these drugs becomes very popular in the healthy population, a final aim is to present an overview of the current and future neuroethical considerations of enhancing the healthy brain. As information regarding their actual use, benefits and harms in various healthy populations is currently lacking, we propose research that aims to obtain relevant empirical data, monitor the short- and long-term effectiveness and side-effects, and initiate accurate surveys to determine current patterns and quantity of usage of PCE drugs by healthy people. Furthermore, in order to instigate a dialogue between neuroethics and neuropsychopharmacology, we urge scientists to explore and communicate the social and ethical implications of their research to the public. Finally, we discuss and highlight other means of enhancing cognition in both patients and healthy adults, including education and physical exercise.

Patterns of non-medical use of methylphenidate among 5th and 6th year students in a medical school in southern Brazil

“…[1][2][3] This growth is explained by an increase in the diagnosis and treatment of attention deficit and hyperactivity disorder (ADHD) and also by the non-medical use (NMU) of MPH. 1,4,5 According to the U.S. National Survey on Drug Use and Health, the NMU of substances is defined as "the use of prescription-type psychotherapeutic drugs not prescribed for the respondent by a physician or used only for the experience or the feeling they caused." 1 For convenience, the term NMU will be used in this work only to refer to individuals that use MPH without a medical prescription for the treatment of a given neuropsychiatric disorder.…”

“…4,6 Several studies show that MPH has been used nonmedically especially for hedonistic purposes (e.g., to "get high") [7][8][9] and in the expectation of cognitive enhancement by healthy individuals. 5,10 The NMU of MPH seems to have grown in proportion to the number of prescriptions for the treatment of disorders such as ADHD; in some groups, the NMU of MPH seems to be actually greater than the use with therapeutic purposes. 9,11 Therefore, there is a call for further study and discussion of the topic.…”

Transhumanismo, neuroética y persona humana

“…This can be defined as the amplification or extension of the mind's basic capabilities through the improvement or expansion of internal and external information processing systems 19 .…”

“…The aura of high technology by which such "improvements" would be developed could lead many people to accept them without any criticism 19 ; it must, however, be taken into account that involved systems are far more complex than the simple synaptic interaction of neurotransmitters, which would put the subject at risk of unanticipated problems, so its real impact could be very unpredictable and involve unwanted cognitive and personality changes 17 . For example, in Transcranial Neurostimulation, when power is applied to any part of the cerebral cortex, other areas causing adverse effects in the long term could be included.…”

The Effects of Modafinil on Motivation and Salience of Pleasure in Healthy Individuals: Quantitative Evidence From the Cognitive Neurosciences

“…Despite the high level of reported off-label use of modafinil as a putative cognitive enhancer (Mohamed and Sahakian 2012), the mechanisms by which modafinil modulates cognitive and affective processes in healthy non-sleep-deprived neurotypical individuals are currently unknown (Mohamed 2014a) and need to be thoroughly investigated (Mohamed 2012a;Mohamed 2012b;Mohamed 2014b;Mohamed 2014c).…”