Paste your essay in here…Zara Cannon-Mohammed
Laura Sizer
Neuroethics
May 10th, 2017
The Role of Authenticity in Neurocognitive Enhancement
“There are times when I look over the various parts of my character with perplexity. I recognize that I am made up of several persons and that the person that at the moment has the upper hand will inevitably give place to another. But which is the real one? All of them or none?”
– W. Somerset Maugham
Recent biomedical and neuroscientific advancements have led us to an age in which augmentative technologies and pharmaceuticals are readily available to treat illnesses and ameliorate problems of functioning, but they also open the door to the possibility of enhancement, prompting multiple questions. Is it moral to use treatment interventions to extend one’s abilities and/or functioning beyond what is “typical”? Should individual betterment only come from hard work and the passing of time? If the whole of the population partakes in enhancement, does that change its moral significance?
It is human to strive to be better; a common colloquialism is “Be the best version of yourself,” with many articles and self-help books advocating to a universal audience exactly how one can achieve such a self. The opportunity handed to humanity, to alter our own brain functions and perhaps subsequently our character, is a far-reaching advancement that is accompanied by myriad ethical issues. In this paper, I will discuss both sides of the enhancement debate as it relates to authenticity and provide analysis in response to the previously posed questions, as well as to the one most largely looming – If you choose to enhance yourself, are you still really “you”? I contend that one’s choices, including the choice to enhance oneself, is an extension of the self and therefore authentic, and further, that anti-enhancement arguments that attest the possibility of losing our humanity might in fact be pretense for competition related concerns.
Enhancement Options and Technologies
“We worship at the altar of progress, and to the demigod of choice,” says Dr. Anjan Chatterjee, an associate professor of neurology at the University of Pennsylvania (Hammershlag, 2017). Stating that progress and choice are both very strong undercurrents in contemporary culture, Dr. Chatterjee refers to the rising use of brain stimulating drugs to improve performance as “cosmetic neurology” and predicts that its growth will mirror that of cosmetic surgery, which was heavily denounced in its beginnings but has become increasingly mainstream.
Scientific progress is ever-evolving, and if you wish to better yourself through laboratory-produced means, there are numerous choices at your disposal.
Myriad options for enhancement are available; many of them are pharmaceutical, though there are also social robotic technologies such as brain machine interface (BMI) technology which makes possible direct communication between the brain and a machine (such as a bionic limb) by means of electrodes, and while deep brain stimulation (DBS) is currently used solely as treatment of motor circuit disorders such as Parkinson’s Disease, some studies suggest that it could be utilized to modulate or enhance memory circuitry (Lipsman & Lozano, 2015).
For the purposes of this paper, I will be focusing primarily on psychopharmaceutical enhancements due to their ubiquity in modern society and the abundance of literature on the topic.
Donezepil, a drug used in the treatment of Alzheimer’s disease has been cited as having memory enhancing potential in healthy subjects (Wade, Forlini, & Racine, 2014). An acetylcholinesterase inhibitor, the drug acts by preventing the breakdown of the neurotransmitter acetylcholine so that more acetylcholine is available in the synapse. In the brain, acetylcholine alters neuronal excitability, influences synaptic transmission, induces synaptic plasticity and coordinates the firing of groups of neurons. It is considered a neuromodulator due to its many regulatory functions and is highly expressed in the hippocampus, which plays a significant role in the consolidation of memory.
One study oft used as a case example within the enhancement debate found that “Donepezil appears to have beneficial effects on retention of training on complex aviation tasks in non-demented older adults” (Yesavage et al., 2002). While the study had a small sample size (N=18), and the researchers stated that the applicability of their data is limited and should not be interpreted as a recommendation for the use of Donepezil to improve performance, that has not stopped scholarly discourse on the applicability and implications of the drug’s use for cognitive enhancement.
Another drug that, unlike Donezepil, is already in use for its enhancement purposes is that of Provigil. First approves for the treatment of narcolepsy, sleep apnea, and shift work sleep disorder, Provigil is used to sustain alertness, and unlike amphetamines like Adderall, does not result in sleep rebound, i.e., the physiological need to make up for lost hours of sleep during an individual’s next sleep period (Tourev, Sallanon-Moulin, & Jouvet, 1995). In the United States military, Provigil has been approved and advocated for use on certain Air Force missions, while several other countries have also expressed interest in the drug as an alternative to amphetamines; The United Kingdom’s Ministry of Defense has commissioned research into Provigil (Wheeler, 2006), and the Indian Air Force has stated that the drug was included in their contingency plans (Pandit, 2016). Additionally, the technology news site TechCrunch has speculated that it was becoming the “entrepreneur’s drug of choice around Silicon Valley”, responsible for powering 20-hour workdays (Arrington, 2008).
Provigil induces wakefulness by stimulating the release of the neurotransmitter histamine, and while its ability to sustain energy is well established, limited research suggests that it also boasts cognitive enhancement properties (Gill, 2006). The mechanisms involved are unclear, though researchers do know that it operates in a different manner than most other stimulants and it has been speculated that the drug affects neurotransmitters in the frontal cortex, well known for its role in higher order thinking.
Lastly there are the well-recognized enhancement agents Adderall and Ritalin of the amphetamine and methylphenidate families, both of which are known to enhance focus and executive functioning by increasing dopamine levels in the brain through blocking its reuptake, leading to an excess of supply in the synapse. Both drugs are used for the treatment of ADHD, and the demand is ever-growing. In 2012, 16 million prescriptions for stimulants such as Adderall were written in the United States, approximately triple the amount written in 2008 (Addiction Center, 2012). Separate from traditional prescribed use, in 2003 it was estimated that over 4 million people 12 and older in the United States had used methylphenidate without a physician's prescription at least once in their lifetime, and more recent research suggests that nonmedical use of stimulants is rising among young adults (Benham & Heath, 2016).
Against Enhancement
Some argue that achieved skills have a higher worth than those which are bought, meaning that skills attained through enhancement are less admirable than those attained through natural ability or sustained effort, and additionally would make any newly gained abilities inauthentic. Following this line of logic, societal virtues of dedication and perseverance would cease to exist, and individuals’ willingness to work for one’s goals might disappear if success required only money (Turner and Sahakian, 2006).
In the United States, there is extreme value placed on the concepts of individualism, authenticity, and authenticity, and we are informed by the prevailing values of personal autonomy and primacy of the individual. According to Charles Taylor, American society is committed to an ideal of authenticity, or even to an ‘ethics of authenticity,’ that has its roots in Puritanism. Early Americans used the term individualism to describe Jeffersonian ideals of self-government and the rights of man, radically breaking from the negative values of selfishness and social anarchy that were ascribed to the term in Europe (Brown, 1996). Individualism, within the Puritan tradition came to be synonymous with self-determination and moral freedom. This particular view of individualism entails sovereignty of the individual over oneself and this has been a central value for the country since its beginnings, exemplified by common Western narratives of individualistic and entrepreneurial self-starters rising to success through originality and hard work.
“No pain, no gain” is a common maxim in the West. Along with moral freedom, America values hard work. An article run in the publication The Scientist stated that "'No pain, no gain' is an American modern mini-narrative: it compresses the story of a protagonist who understands that the road to achievement runs only through hardship.” (Morris, 2005). Naturally, a lot of the arguments against enhancement cite the value of hardship and substantial efforts in obtaining success.
The issue of access is also crucial. If neurocognitive enhancements act as a shortcut to excellence, would access to these shortcuts not then act as the determining factor of success and failure? There is no doubt that there exists a sizeable amount of leverage in years of education versus an easily-bought pill, and access to these new forms of enhancement bears the risk of increasing class divides, keeping the privileged in a position of power and elevated status while those that the system neglects continue to struggle. If success can be attained through enhancements that are not available to everyone, inequality of opportunity is an inevitability. However, while there these are solid ethical concerns, realistically, it is doubtful that questions of accessibility will dictate market availability of enhancements, as the spoils going to the rich has always been part and parcel of living in a capitalist society, and not exclusive to cognitive enhancement.
Another concern often posed relates largely to our own humanity. Some critics view enhancement as “A worrying route to mutations of the essence of human nature and emblematic of a technocratic mindset that will flatten our souls, undermine dignity, and sap moral fiber and individuality,” (Sandel, 2002). These ideas – that we will become less than human, that hubris is leading us down a dangerous path, that we are trying to make ourselves into gods, they all stem from the same ideology: that humanity, as it currently exists, is sacred and any pursuit to alter it is disconcerting and will change life as we know it.
I do not agree with the claims that cognitive enhancement will radically alter society, though if it were to, I believe that precedent suggests that its alteration will ultimately be viewed positively. The Industrial Revolution led to a number of technological advances that dramatically changed society and how one lives within it, while the introduction of the smart phone is an example of what philosopher Richard Heersmink (2013) would call a “cognitive artifact”, a physical object that functionally contributes to performing a cognitive task – for example, iPhones act as an extension of our memory so that we don’t have to exert needless energy remembering phone numbers, social engagements, or what to cook for dinner.
If we are already extending the mind, why is there so much fear related to cognitive enhancement? Setting aside arguments that cognitive enhancements may be wrong because it creates an un-level playing field, that hard work is important, and even that there could be long-term effects we are currently unaware of, the true concern seems to be that we are redefining the nature of what it is to be human, to which I query – Why must this be viewed as inherently negative?
For Enhancement
Shortcuts to excellence have always existed. Is it only when the intervention is technological or chemical, that we constitute the means as crossing an ethical boundary?
Some feel that there is nothing new about human enhancement and that any technological advancements are just one more step along an ancient path. Clark (2003) argues against the concept of humans as “locked-in agents” with minds and physical abilities of fixed quantity, positing that humans’ minds and bodies are open to many types of transformative restructuring, and that our best tools and technologies literally become us.
He states that “It is our basic, biologically grounded nature (or so I have suggested) to be open to a wide variety of forms of technologically mediated enhancement, from sensory substitution to bodily extension to mental extension and cognitive reconfiguration. If this picture is correct, our best tools and technologies literally become us: the human self emerges as a “soft self”, a constantly negotiable collection of resources easily able to straddle and criss-cross the boundaries between biology and artifact. In this hybrid vision of our own humanity, I see potentials for repair, empowerment, and growth.” (Clark, 2003).
Many pro-enhancement arguments cite both potential as well as present evidence of the benefits of cognitive enhancements towards societal gains; concerns about self-interest and hubris commonly arise in enhancement discourse, but it is indisputable that society has much to gain from the use of enhancement agents by individuals in professions that involve the well-being of human lives. In sleep-deprived physicians, emergency technicians, and pilots, wakefulness and executive function enhancements serve to increase productivity and diminish the likelihood of fatigue-related incidents, improving and/or saving many lives in the process.
In an area posed with less grave immediate consequences, the world of academia can also be served by the use of cognitive enhancements. Martha Farah, a cognitive neuroscience researcher at the University of Pennsylvania asserts that “In academics, whether you’re a student or a researcher, there is an element of competition, but it’s secondary. The main purpose is to try to learn things, to get experience, to write papers, to do experiments.” Following this line of thought, cognition-enhancing drugs bolster students’ ability to learn and researchers’ focus, and therefore are valuable to education, academia, and arguably, society as well.
Additionally, while it has been (rightfully) argued that those with access to enhancement options will be better able to elevate themselves intellectually, financially, technologically, and politically, there is also the possibility of leveling the playfield in response to societal wrongs and inequality. In brains that have already been damaged, e.g. by lead exposure, nootropics may alleviate some of the cognitive deficits (Zhou and Suszkiw, 2004) and therefore could be prescribed in a compensatory manner.
In the realm of human character, there is a case to be made that the virtues we value – such as compassion, honesty, fairness – depend upon self-control and are exercised through prudent decision-making, which are both capacities that are enhanced by Ritalin or Adderall (Hughes, 2014). So, in direct opposition to claims that we will become less human, there exists the possibility to amplify the human virtues we value most in society. The question however, is not whether we can, but whether we ought to. Whether it is moral to enhance oneself through modern technologies is a complex, and perhaps unanswerable question. I would argue that it is moral to increase executive function when doing so would have a direct positive effect on another individual’s life or wellbeing, and further that it is not immoral to exercise the freedom to alter one’s nature when it does not harm others; harm being a nuanced concept that I will return to. Arguments for a more liberal approach to the use of cognitive enhancing drugs rest primarily on the claims of cognitive liberty and autonomy, but one could even argue that we have a moral obligation to enhance our capacities for reason and self-control, towards a safer and more advanced society.
The Morality of Enhancement
In one paper by computational neuroscientist Anders Sandberg and philosopher Nick Bostrom, it is pointed out that we accept a host of “conventional” means of cognitive enhancement such as calculators, computers, and mental training techniques while “unconventional” methods such as drugs, social robotics, and brain-computer interfaces provoke moral objections (Bostrom & Sandberg, 2009). They take issue with the inconsistency in response to different forms of enhancement, with the argument essentially taking the following form: Enhancement method A isn’t substantially different from enhancement method B; we don’t normally find method B to be ethically objectionable; therefore, we shouldn’t find method A to be ethically objectionable either. Ultimately, it follows that it is not logical to deny people access to new methods of cognitive enhancement as they become available, because such methods would not be categorically different from methods of cognitive enhancement that are currently legal and regularly used. Why are moral charges not leveled against caffeine, which boasts the same benefits, but to a lesser degree? Is it due to its method of intake, or is it feasible that an act is intimated to be moral once it is commonplace? Are we naturally less comfortable with the sight or idea of a pill than we are with a beverage, or is it the now ubiquitous nature of drinks like coffee?
Bostrom and Sandberg argue that “The demarcation between these two categories [conventional versus unconventional cognitive enhancement] is problematic and may increasingly blur. It might be the newness of the unconventional means, and the fact that they are currently still mostly experimental, which is responsible for their problematic status rather than any essential problem with the technologies themselves. As society gains more experience with currently unconventional technologies, they may become absorbed into the ordinary category of human tools.” (Bostrom & Sandberg, 2009).
History supports this claim, and we can look to how the process of writing was initially received – Socrates was famously critical of the supposed effect that writing would have on people’s mind, saying that “Writing would create forgetfulness in the learners’ souls, because they will not use their memories,” (Plato, & Scully, 2003). During Socrates’ time, writing was thought of an unconventional method of cognitive enhancement, but today no one would think to consider it a form of enhancement at all.
On the virtue of authenticity, many consider any action achieved with the aid of a drug to be inauthentic. How can we measure authenticity though? Philosopher Justin Hughes raises the argument that some people choose to manage their depression with Prozac and others with non-medical means, while some people prefer to climb mountains with bare hands and feet, and others use boots, pitons and safety harnesses – “Authenticity is not a priori, it is a subjective matter of personal definition. Many eschew the use of cognitive enhancement drugs on the grounds that they feel inauthentic, and for them perhaps they would be, but only for them”.
(Hughes, 2014). Recent research involving interviews of British and American schoolchildren taking stimulant medications found that the majority of the children believed the drugs improved their moral agency, such as their ability to perform in the classroom and manage aggressive behavior, and that they did not pose a threat to their authenticity (Singh, 2012).
Additionally, focus group studies explicitly related to attitudes towards cognitive enhancement have examined opinions around concepts of authenticity and effort, and found that the proportion of people who believe effort is discounted and authenticity violated when using cognitive enhancements is a little over half of the respondents in most studies (Schelle et al., 2014). This implies that little less than half of the public is not wholly concerned with effort and authenticity in relation to cognitive enhancement, one reason given being that effort must still be invested to achieve certain goals, even when enhancement agents are used.
Examining the question of enhancement using established ethical frameworks, liberal individualist rights logic claims that we have a right to control our bodies and brains and use them as we see fit as long as we don’t harm others, while another framework that would could be used to look positively at at the morality of cognitive enhancements is that of consequentialism, the greatest good for the greatest number. We can also argue the John Stuart Mills case, that the society that allows its citizens the greatest possible freedom of self-development will generate the greatest happiness.
Authenticity and Measurable Change
What is the self? This is one of the most challenging and contentious questions in philosophy, and for the purposes of this paper, it is necessary to keep in mind that definitions of the self and authenticity are far from universal. Assuming the importance of the self, as we tend to, what sort of changes can we undergo while still remaining ourselves? Must we remain ourselves? What is the value in temporal persistence of the self? The lack of answers to these questions pose difficulties in coming to any conclusion about the morality of neurocognitive enhancements writ large, but we can look to the precedent of approved and commonly-used psychopharmaceuticals for commentary.
Philosopher Felicitas Kramer (2010) cites accounts of psychopharmacological interventions such as Zoloft or Prozac that cause people to “Feel like themselves for the first time in their life”. In the article, the notion of emotional authenticity as it is intertwined with notions and naturalness and artificiality are explored within the enhancement debates and philosophy of mind. Kramer opposes the belief that an artificial means will always lead to an inauthentic result, proposing that artificial substances (such as SSRIs) do not necessarily result in inauthentic emotions.
Interestingly, even though SSRIS have the power to change someone immensely, and arguably more so in mood and character than most executive function enhancers, the societal view of individuals who take antidepressants and anti-anxiety medication is generally not one of distrust or disavowal of identity. If an antidepressant results in a greater noticeable effect of character than a cognitive enhancement drug, and we don’t condemn immense personal change catalyzed by an SSRI, can we really say we’re concerned with authenticity? I feel that while some anti-enhancement arguments are truly concerned with the transmogrification of humanity, others’ concerns about psychopharmaceutical enhancements essentially changing who we are may only be posed because they connote possible competition. It begs the question, are we afraid of losing ourselves, or losing our edge in a swiftly evolving society?
Authentic Choice, Coercion, and Harm
A common credo is that we should be free to do what we like as long as we don’t harm anyone; but what is harm? Generally when we think of harm, we are thinking of active harm – Malice and intent culminating in purposeful action with the goal of affecting another person. However, harm can occur without that being someone’s desired effect. Within the judicial system, negligence or manslaughter are examples of this. As much as we value individualism in the West, we must acknowledge that our actions do not exist in isolation and that our choices affect others. In terms of enhancement, passive harm would be the negative effects incurred among others due to one’s choice of enhancement. I would argue that when one makes a choice it is an authentic action, therefore their choice is authentic and a true expression of the self. However, there are exceptions. We can look to one case example to examine both authentic choice and coercion, the latter of which affects the former.
Consider the worker in a profession where it is beneficial to be up for many hours at a time, where nearly all coworkers take Modanafil in order to stay alert and vigilant – the worker is then in a predicament where they may be working at their highest capacities, but still not equaling the level of work of their enhanced colleagues. To sustain job security, it might be the wise choice to partake in the enhancement option, but not the choice one would make if the situation didn’t necessitate it. When implicitly coerced by environmental ubiquity, or even explicitly coerced by employers, does authentic choice still exist? I feel that most would argue that in this case, it would be considered a forced choice. Whether we can realistically put in place regulations to guarantee individuals the right not to enhance themselves without being discriminated in the social and economic sectors of society is up for debate.
Moving Towards the Future
Martha Farah has said "If it were possible to call for a moratorium on cognitive enhancement until the risks are better understood, that would obviously be the best thing to do, but the genie is already out of the bottle." (Szalavitz, 2009). Ultimately, while strong arguments against enhancement exist and will continue to be posed, use of enhancement agents will continue as well as proliferate. Numerous suggestions towards responsible regulation have been posed in response to the availability and inevitable use of enhancement agents, from commitment contracts on responsible use by students, to informative workshops by educators and physicians, and increased attention by policy makers.
Since interest and use of enhancement is poised for substantial growth, we must adapt to demand by addressing ethical issues through stringent policy and compensatory programs, as to address potential socioeconomic barriers as well as competition and coercion related concerns. Cognitive enhancement has much to offer individuals and society, and the just societal response will involve making enhancements available while managing their risks.