In my paper “Principles of justice as the basis for public policy on psycho-pharmacological cognitive enhancement”, I analyzed the debate on cognitive enhancement drugs. The conclusion was that some arguments (e.g., authenticity, posthumanist, “playing God”, etc.) instead of being convincing merely lead to a strong disagreement. That is because they presuppose religious, ethical or metaphysical comprehensive doctrines. So what kind of argument could help us sort the disagreement? To answer that question, it is important to understand what the debate entails. Ultimately, it is about the regulation of cognitive enhancement (CE), not about what individuals might prefer, meaning that not every kind argument has equal weight. Only arguments that appeal to the interests and values of society as a whole (as opposed to only part) are strong enough. So what options for regulation are available?
Proponents of enhancement insist that new substances offering enhancement are similar to old ones, and base their argument on the appeal to the fairness of treating like cases alike. Nevertheless, policy options in a democratic society are not limited to taking a laissez faire approach (like in the case of coffee), as pro-enhancement authors want, or to banning the technology (like in the case of cocaine), as opponents of enhancement want. There is also the option of regulating the technology so that individual use is encouraged via government incentives or discouraged via taxation. An additional option is to make the technology mandatory.
These policy options rest on the familiar distinctions in moral philosophy between actions that are a) morally required, b) morally desirable and permissible, c) morally neutral and permissible, d) bad but nevertheless still morally permissible, and e) morally impermissible. The fairness of treating like cases alike depends on defining sufficiently like cases. Are new cognitive enhancement drugs more like coffee or more like cocaine? That depends on the drug in question (and I'll have more to say about that in later posts), but it is also important to stress which principles should guide our arguments.
How not to argue
Why is coffee allowed and cocaine prohibited? Does that have something to do with authenticity, human nature or the good life? Not really, these are generally adequate criteria for individual choice, but not adequate for public policy. Furthermore appeals to comprehensive doctrines like some religious or political ideologies will not work, because they are not shared by everyone. Mid-level principles of beneficence, non-maleficence (i.e. non-harm), autonomy and justice show more promise.
How to argue
However, not all of them are strong enough to support a certain policy. Let's take beneficence for example. If something is good for you, perhaps this should be mandatory. Maybe coffee is good for concentration but we can't make coffee mandatory because that would conflict with the principle of autonomy – the right to choose. This is also the case with prohibited substances. The case must be very strong indeed to prohibit something, because that would infringe on the right to choose. So why is cocaine prohibited? With a measure of simplification, it is prohibited because it is very harmful (non-maleficence) and infringes on autonomy by itself (by causing unreal perceptions about one's abilities and addiction).
Is regulation of smoking hypocrisy? The rights of smokers and non-smokers
But what about smoking? That's harmful and can also cause addiction, right? Yes, but the picture is more complicated here. Again, to simplify things, tobacco is not a mind altering substance. It might be harmful in the long run and it might cause addiction, but a democratic state can only discourage its use with taxation and other measures, not prohibit it entirely. There is one other important issue: there is no injustice involved in smoking if you do it in your home and the rights of non-smokers are protected in public places.
How does this relate to CE?
All this has set the stage for the issue of regulating CE drugs, in both the relevant principles and policy options. I argued that justice is the relevant issue to have in mind for regulating use of CE drugs for the healthy. That does not mean that other issues are irrelevant – merely that justice is really important. The common claim of authors opposing enhancement is that treatments are obligatory and permissible while enhancements are not. The principle of justice explains why this is the case in CE. Using Ritalin (or some other drug) for enhancement is not an issue of providing basic necessities for those who are lacking, benefiting the least advantaged or restoring citizens to a position of equal opportunity and liberty, while in the case of citizens suffering from say ADHD it certainly is.
Furthermore, providing drugs as a means of enhancement to gain positional advantage could cause erosion in the fabric of society - people would see that medical resources are diverted into controversial enhancements, while clear cases of disease and impairment are left untreated. This means that justice could be used to draw the line between cases in which it is permissible and obligatory to provide drugs in private or public health insurance schemes and those that it is not. Moreover, as resources in most societies are too limited to meet all needs for the treatment of disease or impairment, justice requires that we meet most important medical needs first. Only if all medical needs are taken care of could any public finance for enhancements be allowed.
“Justice Trumps Beneficence”
This can be neatly summarized with the version of the “Justice Trumps Beneficence” Argument:
Enhancement is not required by justice but only by the value or principle of beneficence;
The widespread use of enhancement would create a serious risk of injustices to citizens choosing not to enhance due to their comprehensive doctrine;
Justice trumps beneficence (when the pursuit of beneficence creates a risk of serious injustice, the avoidance of injustice should take precedence);
Therefore, public funds should not be allocated to enhancement purposes, and/or measures should be taken to compensate those citizens likely to suffer injustices.
The rights of non-enhancers
As non-smokers are sometimes very upset about smoking, so non-enhancers are upset about the use of CE in certain contexts. The issue of justice explains what they are upset about – they might think CE is unjust because it undermines the equality of rights and liberties of citizens wishing to enhance and those that do not. Furthermore, they could claim that using CE is cheating in certain instances, such as exams, as it violates fair equality of opportunity, and that the use of drugs might be justified in instances of poor health, but not when seeking positional advantage. So far so good. But does this mean that CE must be entirely prohibited?
What kind of policy?
Not really. Like smokers, people that want to use CE have rights. Smoking is regulated in public spaces and discouraged with taxation and other measures. Some non-smokers call for a total ban, but that is overkill, and not really legitimate. Similarly to that, the analysis of requirements of justice points to a conclusion that discouraging the use of CE would be the most legitimate public policy. Taxation and other measures could appropriately protect the interests of all citizens and even generate funds for medical needs. So what might that look like? In another article I provide the answer. In the meantime, stay tuned for more...