|PBJ vol1.iss1 The
Brain and Beyond...
Ethical Implications of Pharmacological Enhancement of Mood and
With advances in the molecular biology
of neuroscience, there is an increased understanding of neurotransmitter
systems and the biological basis of memory and mood. This has lead
to the research and development of highly selective drugs that serve
to alter the brain for treatment and enhancement. Many ethical concerns
arise about the use of pharmacological agents to alter the brain
solely for enhancement. Safety, alteration of personhood, distributive
justice, and the medicalization of the human condition will be discussed.
However, the potential to increase one’s memory and efficiency
in the workplace, to eliminate socially undesirable behaviors, and
to strengthen the military provides a strong argument in favor of
pharmacological enhancement. In conjunction with the ethical concerns,
this paper explores recent research and current and developing drugs,
ultimately arguing that pharmacological enhancement is acceptable
as long as certain policies are implemented.
Most of us have, at some point in time, attempted to control or
alter our mood or cognitive functioning. Whether it be sipping coffee
in the morning to wake up, devouring chocolate as a pick-me-up,
or drinking alcohol to become relaxed and sociable, humans constantly
introduce foreign substances into their bodies to achieve a desired
state of mind or level of performance. In the past, society relied
on chance for the development of these substances (Farah & Wolpe,
2004, p. 40). For example, an antihistamine drug candidate happened
to calm schizophrenics and an antipsychotic drug candidate happened
to be a better antidepressant (Farah & Wolpe, p. 40). However,
molecular neuroscience has increased our understanding of neurotransmitter
systems as well as the biological basis of memory and mood, which
has led to the creation of drugs that are highly selective and created
for a specific purpose (Farah & Wolpe, p. 41). Currently, many
promising drugs have been created for the specific treatment of
Alzheimer’s disease (AD), Schizophrenia and middle-age / elderly
cognitive decline, yet many of these drugs also improve cognitive
functioning and mood of non-afflicted individuals (Wolpe, 2002,
p. 388). Thus, one must consider that psychopharmacology could be
used to enhance the brain of individuals who are not clinically
ill. Since the brain is the biological foundation of who we are,
many ethical concerns arise regarding the use of drugs to alter
the brain solely for enhancement (Farah & Wolpe, p. 35; Farah,
Illes, Cook-Deegan, Gardner, Kandel, King, Parens, Sahakian, Wolpe,
2004, p. 423). Concerns about safety and personhood arise, in addition
to concerns about coercion, distributive justice, and the medicalization
of the human condition. On the other hand, imagine the potential
to eliminate socially undesirable behaviors, increase efficiency
in the workplace, and increase one’s memory. Moreover, in
our society one must not overlook the personal freedom to choose
to utilize, or not utilize, the latest technology. By familiarizing
ourselves with recent research and current and developing products,
and examining the ethical reasons in support for pharmacological
enhancement, personal and societal objections to it, and respective
counter-arguments to the objections, pharmacological enhancement
becomes more apparently ethical and should be allowed, given that
vigilant policies are implemented. However, some questions must
be addressed and definitions presented in order to fully understand
For clarification, ethicist Paul R. Wolpe asks: How
does one differentiate between the terms “treatment”
and “enhancement (Wolpe, p. 388)?” It could be said
that treatments remedy the sick, those below average, the subnormal.
Enhancement is then the improvement of individuals who are not sick,
those who are average, normal (Wolpe, p. 388-90). One could argue
that no individual is “normal” and thus pharmacological
intervention can be considered treatment, potentially eliminating
the controversy of enhancement. As one can imagine, a deep philosophical
discussion could pursue because one would then need to define “normal”
and “average” in order to differentiate these terms
(Wolpe, p. 388). Furthermore, who is responsible for formulating
the definitions? For example, in most Western societies, traits
that are deemed valuable, such as happiness, are normal, well, and
accepted and any increase in such a trait would be considered enhancement.
Traits that people want to do away with, such as criminality or
depression, are usually characterized as illnesses or subnormal
and can be “treated (Wolpe, p. 388).” Any definition
of “normal” will fail to be universal because it is
the result of compromised values which are culturally derived and
influenced by particular societies (Wolpe, p. 390). Thus, for this
discussion, enhancement shall be defined as improving the psychological
functions of individuals who are not clinically ill, as defined
by medical specialists. Furthermore, cognition shall be defined
as thinking skills that include perception, memory, awareness, reasoning,
judgment, intellect, and imagination. Mood shall be defined as a
psychological state of feeling. Exploring the present state of research
gives the context needed for further understanding the debate.
Current research targets enhancers for mood, memory
and executive functions, sleep, libido, and appetite (Farah et al,
p. 421). Although military and private research for cognitive and
mood enhancing drugs is ongoing, “smart pills are not around
the corner (Hall, 2003, p. 56).” They are years away from
government approval but several are in clinical testing or are under
development (Hall, p. 57). In fact, several drugs that target other
cognitive functions are currently available including Dextramphetamine
for wakefulness, Adderall and Ritalin for increased attention and
working memory, and Modafinil for wakefulness, increased attention,
and alertness (Hall, p. 60-2; Turner, Robbins, Clark, Aron, Dowson,
Sahakian, 2002). Also, Donepezil, Rivastigmine, and Galantamine
have been shown to prevent cognitive deterioration and slow memory
loss in AD patients and show neuroprotective effects over the long
term (Hall, p. 56). Moreover, drugs like Selective Serotonin Reuptake
Inhibitors (SSRI), such as Prozac, exist to reduce negative moods
and increase affiliation behavior without serious short-term side-effects
(that cannot be treated with other drugs) (Farah & Wolpe, p.
41). And with the help of molecular biology in understanding and
identifying neurological processes, novel approaches are being implemented
to create new drugs for treating diseases and enhancement (Farah
& Wolpe, p. 41). Drugs are being developed to target the initial
cascade for memory by utilizing ampakines to initiate long-term
potentiation which is implicated in memory formation (Farah &
Wolpe, p. 42). In addition, MEM1414, a CREB enhancer, targets the
CREB gene with the intent of enhancing memories (Farah et al., p.
422; Hall, p. 62, 64-5). Benzodiazepines and CREB suppressors are
under development to repress traumatic memories (Farah & Wolpe,
p. 42; Hall, p. 62, 64). With additional research, drugs are becoming
increasingly selective and risk-averse (Farah & Wolpe, p. 41).
Thus, current drugs that exhibit effective treatment of clinical
ailments and developing drugs that show promise are becoming increasingly
suitable for enhancement.
Aside from solely understanding the promising laboratory
tested effects of current drugs, there are numerous ethical reasons
in support of pharmacological enhancement. Living in an increasingly
skill-driven and socially interactive society, one must be focused
and have an efficient memory to be successful (Rose, 2002, p. 975).
Ritalin and Adderall are two drugs that enhance attention and improve
performance in problem-solving and other tasks requiring the executive
function use (Farah & Wolpe, p. 42). Those who are average or
below average for certain memory tasks may find these drugs helpful
in advancing careers, making a better living, or surmounting career-threatening
circumstances. Furthermore, drugs, like Donepezil, could be used
as a prophylactic (Farah & Wolpe, p. 41). Donepezil slows memory
loss in AD patients and could be used to slow age-related gradual
cognitive decline that ultimately affects everyone, thus improving
the quality of life as one matures (Hall, p. 63). In addition, several
careers could benefit from enhancement—society could have
safer flights, safer medical encounters, and a stronger military
(Wolpe, p. 392; Hall, p. 57, 60).
Society could further benefit from pharmacological
enhancement if it is implemented in the criminal justice system
(Farah, 2002, p. 1125). For instance, although controversial in
its own right, convicts could potentially be sentenced to take enhancement
medications in order to suppress further devious, criminal behavior.
Some may object to forced medication, but anti-androgen drugs are
already used to treat convicted aggressive persons (Farah, p. 1125-6).
Allowing convicts the choice of either medication or jail time may
be as effective and less controversial. In addition, enhancement
could serve as an equalizing force in society (Farah et al., p.
423). It has the potential to eliminate inequalities accumulated
in other sectors of society. For example, in a cognitive test, a
poor education could be augmented with brain enhancing medication.
Understanding the objections to pharmacological enhancement
of cognition and mood is important in this debate and further enables
one to formulate counter-arguments to these objections. These objections
and counter-arguments can be separated into issues users face and
issues society face. Issues that individuals face include the concept
of personhood; many believe that it is unnatural to modify the brain.
Furthermore, it is argued that people are characterized by their
cognitive abilities and by altering the brain one alters the person’s
values, moods, and perspectives and ultimately that person becomes
unrecognizable to others (Farah & Wolpe, p. 36, 43; Farah et
al., p. 423-4). Although valid, this argument is not sound and as
Arthur Caplan explains, people who make this argument have modified
themselves in some other way, using eye-glasses, artificial hips,
electricity, and automobiles (Caplan, 2003, p. 105). Also, do people
not drink alcohol and caffeine, take Ritalin and Prozac, and use
nicotine or even marijuana to alter their cognitive states (Wolpe,
p. 388)? Enhancement via “drugs” is already a part of
life (Farah & Wolpe, p. 41). There is already a general acceptance
of other enhancement techniques like cosmetic surgery in addition
to non-neuroscientific cognitive interventions like meditation and
psychotherapy. Could using pharmacological enhancers help individuals
attain self-actualization rather than assuming that the individual
is being altered?
Another moral issue is the belief that people should
earn their achievements, the colloquial “no pain, no gain”
argument. Leon Kass, a member of President Bush’s Bioethics
Panel, states that achievements via drugs are equivalent to cheating
(Hall, p. 57). It is further argued that accomplishments are meaningful
because of the effort put forth and that reducing effort will reduce
meaning (Farah & Wolpe, p. 43). But who says that taking cognitive
enhancing drugs reduces effort? Individuals still need to take time
to learn information, although the effort may be more concentrated,
efficient, and less time consuming. In addition, is the meaning
of the experience of walking a few miles lost just because someone
drives to work everyday and never walked such a distance? That person
still understands the meaning of walking and can imagine how difficult
it would be to walk such a distance everyday.
Although common to bioethical debates, an individual’s
safety is an important issue here as well. When manipulating very
complex systems like the brain, there is great risk of serious and
unanticipated side-effects, especially in the long-term (Farah et
al., p. 423; Farah, p. 1125). Perhaps taking memory enhancers will
lead to unforeseen premature cognitive decline (Farah et al., p.
423). Additionally, enhancers may affect the selectivity of neurological
processes, enhancing traumatic memories and unimportant details
that are supposed to be forgotten. When one process is targeted,
other processes may be affected and unexpected linkages may arise
(Wolpe, p. 393). For example, an enhancer may increase memory but
negatively impact mood and attention. In an experiment in which
mice were given a memory-enhancing drug, they experienced increased
sensitivity to pain in addition to better memory (Wolpe, p. 393).
There are many risks and unknowns that seem frightening. However,
continual improvement has yielded newer, increasingly specific and
safer drugs with fewer side-effects (Farah & Wolpe, p. 41).
For example, SSRIs used as antidepressants are specific to mood
(Farah & Wolpe, p. 41). They have very good safety records and
even exhibit neuroprotective effects over the long term (Farah &
Wolpe, p. 43). Although some may have side effects, like Prozac
causing Erectile Dysfunction (ED), other specific drugs used in
conjunction can treat the side effects, like supplementing Prozac
with Viagra to treat ED (Farah & Wolpe, p. 41). So long as research
continues to reduce risk and Phase Trials prove promising, enhancement
will be increasingly tolerable and acceptable.
Implicit coercion is another concern regarding enhancement.
Since enhancement could increase the quality of executive functions, employers
may be enticed to hire individuals with greater skills and increased
efficiency while those who are not enhanced will be at a disadvantage
(Farah et al., 422; Farah, p. 1125). Thus, there may be a feeling
that if everyone else is enhancing their brain, others will be left
behind if they fail to do so. Although decision-making should be
free from coercion, one should realize that self-improvement is
commendable in Western society and many religions even preach that
it is a person’s moral obligation to improve one’s self
and one’s children (Caplan, p. 105). Thus, there should be
policies created that minimize implicit coercion so that individuals
can exercise their freedom to choose based on their values, free
Although issues individuals face are important to
consider, so too are issues that society faces. Explicit coercion
may arise in the workplace or in the academic arena. For example,
employers could require employees to enhance their efficiency through
pharmacological means in order to maintain their jobs; competitive
preparatory schools and universities may require their students
to enhance their cognitive functions so as to be the most competitive
institutions (Caplan, p. 104-5). Although one can argue that the
market-driven society is competitive and promotes improvement, accepting
the possibility of explicit coercion is turning a blind eye to ethics
and acquiesces to the pressures contributing to inequality (Caplan,
p. 105; Dees, 2004, p. 952). Yet, one cannot simply outlaw pharmacological
enhancement without infringing on personal freedoms and equality
since these same drugs used for enhancement would be allowed for
treatment (Farah et al., p. 423). Instead, it is important to have
laws and regulations extended to guarantee individuals the right
not to enhance themselves without being discriminated in the social
and economic sectors of society. With proper laws and regulations
to manage this rising technology, society can help guarantee free
choice and fair access. This, too, is true when considering distributive
justice. Because access to drugs has a clear economic factor, there
tends to be an unequal distribution of drugs among different socioeconomic
classes (Farah et al., p. 423; Farah, p. 1125). The cost barriers
compound the disadvantages of the lower class by restricting access.
We already live with inequalities in society where the upper and
middle classes can afford the latest advancements in health, yet
the government does not restrict access because of inequity (Farah
et al., p. 423). Once again, society must not deny enhancement because
it is not equally accessible, but rather address the gross inequalities
of society due to other factors and in turn grant fair access for
When considering how enhancement drugs affect society,
one must examine the possibility of creating more lifestyle drugs.
Pharmacological enhancement could potentially raise the standards
of being “normal” and variants of human behavior could
be medicalized (Flower, p. 183). For example, if most people enhance
their mood by taking Prozac, then “happy” becomes “normal.”
Thus those who do not take Prozac and are not perfectly “happy”
are considered subnormal and medically “sick.” In medicalizing
human behavior, society changes the “complaints of the healthy
to the conditions of the sick” and in doing so, alters the
definitions of competence, illness, mental health, and death, ultimately
changing the moral and legal understanding of accountability and
responsibility (Flower, p. 183). Imagine the impact this would have
on the criminal justice system. If committing crimes are abnormal
and this behavior is eliminated in individuals who enhance, such
behavior could potentially be perceived as sickness and consequently,
criminals may not be held accountable for their actions. Although
valid, I contend that lifestyle drugs already exist (Ritalin in
academics and Viagra enhancing libido) as evident in a $20 billion
market (Hall, p. 65; Flower, 2004, p. 182). Medicalization has already
occurred with mild depression and social anxiety. In fact, with
medical advancement, research for therapies leads to inevitable
enhancement and medicalization. Society welcomes advancement in
technology in which individuals are capable of adjusting in such
a dynamic society without terrible consequences. Based on this,
society will likely adjust accordingly in the future when new pharmacological
agents are introduced as evidenced currently with Viagra and Ritalin.
Neuroscience and molecular biology are amazing fields
of study that hold great promise for future pharmacological treatments.
Ethical concerns about morals, safety, personhood, coercion, distributive
justice, and the medicalization of the human condition are all noteworthy
and invaluable in this bioethical debate. However, with the potential
benefits of future and developing drugs, the increasing selectivity
that they exhibit, the decreasing potential risk they pose, and
the consideration that we live in a competitive market-driven society,
enhancement is increasingly acceptable and will likely be greeted
with open arms—but not without some skepticism. Furthermore,
it is imperative to create advisory and regulatory panels to devise
regulations on the ethical use of enhancement drugs and to decide
which ones are acceptable. Additionally, it is important to have
legislatures create laws that would limit any injustices or coercion
that might transpire. Furthermore, the criminal justice system should
continue to use pharmacological enhancement with novel drugs but
only on a voluntary basis and as an alternative or supplement to
Obviously, many additional questions arise in this
debate. For instance, what will be each party’s role (Farah
et al., p. 424)? Will physicians still act as gatekeepers? Will
parental consent uphold? How will employers and educators be affected?
Ultimately, further discussion is necessary to answer these and
other questions that arise in this debate.
Caplan, A.L. (2003). Is Better Best? Scientific American, 289,
F. Esposito is a Junior at the University
of Pennsylvania and is majoring in Biology.
Paul Root Wolpe, Ph.D
is the faculty sponsor for this submission. He is
the Senior Fellow at the Center of Bioethics and
an Assistant Professor of Psychology at the University
ADDRESS 3401 Market
St, Suite 320; Philadelphia, PA 19104
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