Neuroethics & Law Blog

Drugs, Praise, and Creativity (Gavin Enck)

It is generally accepted that a person is permitted to use a drug to augment their creativity ranging from coffee, alcohol, to psychotropic and hallucinogenic drugs. People using drugs often create beautiful paintings, pieces of music, or write great literature. While these people’s creations are still considered beautiful, an interesting question to consider is the degree to which the creators can be praised. While these persons should be praised for creating great paintings, music, or literature, might this praise be mitigated because the person is on drugs? Consider cases where a person is using drugs and does something bad, while the person is regarded as being blameworthy, in some instances this blameworthiness is mitigated by their being under the influence of drugs. Although this person is blameworthy having done something bad, their being on drugs is at least considered as being a reason that, under certain conditions, lessens their responsibility. Yet, if being under the influence of drugs mitigates, even if to a minor degree, a person’s responsibility for a bad action, it then seems reasonable that being under the influence of drugs would also mitigate the degree of praise given to someone for creating a work of art. The drug and the effects it has on a person do, to some degree, play a role in the creation of the work of art.

To be clear, I am not arguing that persons under the influence of drugs should not be praised for creating great paintings, music, or literature, or that being under the influence of drugs exculpates the wrong-doer. Instead, I am pointing out that in regards to the use of drugs there is an asymmetry between drug use and the degree of being blamed for a wrong action and the degree of being praised for a creative action. It is interesting and difficult to figure out why this is the case. In part, a reason for this asymmetry might be because of the complexity of really knowing how to assess the degree to which altering our neurological capacities plays a role in our assessment of people’s actions, as evident by arguments concerning the use of pharmaceuticals and authenticity. It might also turn out that my claim of an asymmetry makes a kind of attribution error. My assessment of a person’s creative action under the influence of drugs credited the drug as playing a bigger role in the creative process than they really had. For example, the use of drugs may be to “loosen up” or “relax” the person, but the creative impetus comes from the individual, not the drug; alternatively, the use of drugs “loosened up” or “relaxed” a person and the bad actions were done of their own accord.

Whether or not my assessment of a person’s creative action under the influence of drugs is incorrect, it would be interesting for future investigations to not only look at the role pharmaceuticals and other substances have in the creative process but also the role they play in the assessment of a person’s creative action.

Klaming & Koops on Neuroscientific Evidence in the Netherlands

Recently Posted to SSRN:

"Neuroscientific Evidence and Criminal Responsibility in the Netherlands" 

INTERNATIONAL NEUROLAW: A COMPARATIVE ANALYSIS, pp. 227-256, T.M. Spranger, ed., Heidelberg etc, Springer, 2012 

Laura Klaming, Tilburg Institute for Law, Technology and Society (TILT); Tilburg University - Private Law Department                                                                                                                       

Bert-Jaap Koops, Tilburg Institute for Law, Technology and Society (TILT)

Insights from neuroscientific research are increasingly advancing our understanding of the neural correlates of human behaviour, cognition and emotion and can therefore be of significant practical use in a legal context. One of the most fundamental legal applications of neuroscience refers to the assessment of criminal responsibility. Recent empirical studies have established links between certain brain structures and antisocial or criminal behaviour. Three areas of brain abnormalities that are relevant for assessments of criminal responsibility can be differentiated: (1) impairments in the frontal lobes and associated problems with impulse control, aggressiveness and the processing of information that is evocative of moral emotions, (2) abnormalities in the limbic system and associated problems in affective processing, and (3) the potential side-effects of neurotechnologies and associated problems with impulse control, aggressiveness and disinhibited behavior. This chapter addresses recent research findings in these three areas and how these could affect responsibility assessments. In addition, eight cases are discussed in which insights from neuroscientific research have been used by Dutch courts in responsibility assessments. By illustrating how neuroscientific evidence has already entered the courtroom in the Netherlands, the possible conditions and implications of such practice are addressed.

Video: Richard Benthall on Treating Psychosis

The Institute of Art and Ideas in London has recently released a video of clinical psychologist Richard Benthall discussing conventional methods for Treating Pyschosis.  The video was released at the Institute's annual Philosophy and Ideas Festival, HowTheLightGetsIn.

For access to the video, please click here.

Law & Science Young Scholars Informal Symposium

The 2013 Law & Science Young Scholars Informal Symposium will take place on June 18th, 2013 at the University of Pavia (Italy).  "The Symposium creates a forum for post-graduate scholars, PhD students and early-career researchers working in the area of Law & Science."

Please click here for more information on the Symposium and to learn how to apply.

WWVPD (What Would a Virtuous Person Do?) (Gavin Enck)

(work in progress)

    Imagine an ideal virtuous person named Edith. She not only possesses certain virtues, but also has the practical wisdom to act accordingly in a given situation for the right reasons. Edith (or any person like her) has never existed. Now, although Edith has never existed, ask yourself the following question: “Would Edith ever choose to use a cognitive, memory, or moral enhancer?” I think (and argued elsewhere) that Edith would, in certain circumstances, choose to use a neuroenhancement. In a given situation, she would assess the relevant considerations pertaining to rules, consequences and motivations and there are likely to be times when she would choose to augment her capacities of focus and concentration, or attenuate her memories, or stabilize her attitudes towards others.

    While some may scoff at such a notion, considering the reasons as to why Edith would choose to (or choose not to) use a cognitive enhancer does illuminate the use of neuroenhancements in a different way. First, as I have argued elsewhere, it might provide grounds for the permissible use of enhancement being determined by a person’s motivation (Enck 2012). Second, it may be helpful in providing a way for people to think about neuroenhancements. In certain situations, a person may not be sure whether to use a neuroenhancement or not. In these situations, a person might reflect upon whether a virtuous person (Edith) would use an enhancement. This is not as crazy or impractical as some would think. People already rely on similar ideal conceptions to guide their conduct in difficult circumstances, e.g., asking, “What would Jesus do” or, for me, “What would Christopher Hitchens do?” 

    This is important for discussions about neuroenhancement because many (myself included) are often so focused on issues of permissibility that we fail to see that the use of enhancement is more than benefit vs. risk, benefit vs. burden, or solely about improving an individual’s own well-being. The reasons that a person might use a neuroenhancement often reflect something significant about the person or their situation. The reasons a person uses a neuroenhancement may reflect on that person’s motivation and character. In the end, relying on a notion of an ideal virtuous person might demonstrate that the sort of person one should strive to be is not one who uses neuroenhancements. However, thinking about Edith in these situations also demonstrates the complexity and ambiguity that is inherent within any discussion about the use of neuroenhancements.   

ELSEWHERE

Enck, Gavin G.. "Ideals of Student Excellence and Enhancement ." Neuroethics, 2012. DOI: 10.1007/s12152-012-9164-6

Symposium: "Law & Policy of the Developing Brain: Neuroscience from Womb to Death"

The Hastings Law Journal has published a symposium issue, entitled "Law & Policy of the Developing Brain: Neuroscience from Womb to Death." You can find links here.

Kolber on "Against Proportional Punishment"

It's not especially neuro-related, but here's a forthcoming paper of mine (Vanderbilt Law Review, Vol. 66) that I recently posted to SSRN. I'm still editing it, and feedback is welcome. You can download the full text here:

"Against Proportional Punishment"  
Abstract: The Supreme Court has held that pretrial detainees are presumed innocent and that their detention does not constitute punishment. If convicted, however, detainees usually receive credit at sentencing for the time they spent in detention. We reduce their punishment by time spent unpunished.

Crediting time served conflicts with the commonly-held view that punishment should be proportional to blame. Offenders who deserve to be punished by one year in prison but are detained for a year before trial may be released immediately upon conviction and technically receive no punishment at all.

One way to solve the mystery of credit for time served is to recognize that people don’t care about proportional “punishment” in the narrow way the Supreme Court and many theorists use the term. Rather, they seek to dispense proportional “harsh treatment.” Even though pretrial detention is technically not punishment, it is harsh treatment inflicted by the state, and most believe offenders deserve credit for it.

Shifting our focus to proportional harsh treatment, however, solves one problem at the expense of several others. For once we broaden the notion of proportionality to encompass the harsh treatment of detention, we must consider other harsh treatment we inflict that, like detention, may not technically be considered punishment. Such harsh treatment depends on: (1) the particular facilities to which inmates are assigned; (2) how inmates experience those facilities; (3) how confinement harms them relative to their unpunished baselines; and (4) how they are affected by the collateral consequences of incarceration for decades to come. While we could try to salvage proportionality by better measuring all of this harsh treatment, I explain the sometimes absurd consequences of doing so.

Even though retributivist notions of proportionality are central to sentencing systems around the world and are widely thought to undergird core notions of criminal justice, when looked at closely, both proportional punishment and proportional harsh treatment have profoundly counterintuitive implications. Revealing the weaknesses in retributivist proportionality makes consequentialist punishment theories look correspondingly more appealing.

The Tension Between Philosophy and the World (Gavin Enck)

    In certain areas, such as the neuroscience of moral judgment, philosophers have a tendency to overextend the claims that recent research and advances in neuroscience are taken to support. Yet, in other areas, such as metaphysics of free will or ethics, philosophy makes incorrect presuppositions about the world. In the following, I illustrate this tense between philosophy and the empirical world and, tentatively, offer that one thing this suggests is the need for philosophers to consider working with others outside of their own field.

    To illustrate the former, consider Joshua Greene and Jonathan Haidt’s work on the neuroscience of moral judgment. Greene relies on fMRIs of participants when they are providing answers to moral dilemmas (Trolley and Footbridge cases), and Haidt has examined students’ responses to moral violations from across different cultures and educational levels (Greene, et al. 2001; Greene 2003; Haidt, Koller and Dias 1993; Haidt 2003; Schnall, et al. 2008). Both Green and Haidt have argued the basis of their research on the neuroscience of moral judgment, what Neil Levy refers to as deflationary account of morality (Levy 2007). On Haidt and Greene’s accounts, morality is reducible to intuition, which in turn is only an affective, not rational, response that is the result of biological and evolutionary hardwiring. If moral judgments are based upon intuitions, which are emotional and part of evolutionary hardwiring, then Haidt and Greene’s claim it is not evident that moral judgments in fact track morally relevant features in the world. If this is the case, then theories of morality that are rationally-based, such as deontology or Kant, or theories that hold there can be reflective equilibrium between theory and intuition, such as Rawls, seem to be unjustified. If a person’s moral intuitions are merely the product of evolutionary hardwiring, then deontologists or Kantian thinkers cannot hold that morality and moral judgment are fundamentally reason-based. If a person’s moral intuitions are merely the product of evolutionary hardwiring then it seems there cannot be, as Rawls (1999) claims, reflective equilibrium between our theories and intuitions. For Greene and Haidt, a deflationary account of morality contends that being moral is merely a part of our evolutionary hardwiring.

    Nevertheless, while Greene and Haidt’s work shows that intuitions are often the result of biological and evolutionary hardwiring and affect moral judgments, it is not clear how this research supports Greene and Haidt’s conclusions about morality and moral theories. Kahane and Shackel argue that Greene has methodological flaws that result in his work not sufficiently appreciating the “step from philosophical discourse to the ascription of belief to lay persons” (Kahane and Shackel 2010, 580). Neil Levy (2007) contends that neuroscience has shown that intuitions, even if emotional and not rational, are relevant considerations that guide decisions and moral judgments.

    While I remain neutral on this debate about the neuroscience of moral judgment and moral theory, Greene and Haidt’s work is interesting and important, but is it also indicative of the potential for using neuroscience to make bold philosophical claims. It is not yet clear if Greene and Haidt’s research does show deontological or Kant’s moral theory is not justified; it also does not showthat intuitions or a theory built up from intuitions cannot achieve reflective equilibrium.

    Yet, the tension is that philosophy often ignores the empirical before armchair theorizing. In discussion of the metaphysics of free will, a common assumption is that people’s ordinary folk conception of choice is inconsistent with a deterministic conception of free will. Yet, as illustrated by the recent work of Shepard and Shane (2012), Monroe and Malle (2010) and many others (such as Joshua Knoble) who have examined people’s folk conceptions of free will and discovered, in fact, that people’s folk conceptions of choice is not taken to be an unconditional ability to do otherwise or even as being a causal notion.

    In the case of ethics, it is often argued that palliative sedation is not any different from euthanasia or physician-aid-in-dying because it, like the others, directly hastens the patient’s death. However, empirical evidence does not conclusively show that opioids and sedation quicken the dying process in terminal patients (Sykes and Thorns 2003) (Morita, Tei and Inoue 2001), or that palliative sedation does not shorten the life of terminal ill patients (Maltoni, et al. 2009), or that 20 percent of palliative sedation patients actually are discharged from the hospital of their own accord (Elsayem, et al. 2009).

    This does not mean, however, that philosophy has no place in these discussions (because it does) or that it provides no insight (because it does). Rather this tension suggests, at least to me, that philosophers should be more willing to go outside their own field or academic discipline, such as understanding the relevant literature in medicine, neuroscience, and psychology, or, possibly, consider working with other disciplines on certain topics.

REFERENCES

Elsayem, Ahmed, et al. "Use of palliative sedation for intractable symptoms in the palliative care unit of a comprehensive cancer center." Support Care Cancer 17 (2009): 53-59.

Greene, J. . "From neural "is" to moral "ought": what are the moral implications of neuroscientific moral psychology ." Nature Reviews Neuroscience 4 (2003): 847-50.

Greene, J. , R. B. Sommerville, L. E. Nystrom, J. M. Darley, and J. D. Cohen. "An fMRI investigation of emotional engagement in moral Judgment." Science 293 (2001): 2105-8.

Haidt , J. , S. H. Koller, and M. G. Dias. "Affect, culture, and morality, or is it wrong to eat your dog?" Journal of Personality and Social Psychology 65 (1993): 613-628.

Haidt, J. "The Emotional Dog and its Rational Tail: A Social Intuitionist approach to Moral Judgment." Psychological Review 108 (2003): 197-8.

Kahane, Guy, and Nicholas Shackel. "Methodological Issues in the Neuroscience of Moral Judgement." Mind & Language 25 (2010): 561-582.

Kant, Immanuel. Groundwork of the Metaphysics of Morals. Edited by Mary Gregor. Cambridge University Press, 1997.

     —. The Metaphysics of Morals. Translated by Mary Gregor. New York: Cambridge University Press, 1996.

Levy, Neil. Neuroethics: Challenges for the 21st Century. Cambridge: Cambridge University Press, 2007.

Maltoni, M. , et al. "Palliative Sedation Therapy Does not Hasten Death: Results from a Prospective Multicenter Study." Annals of Oncology 20 (2009): 1163-1169.

Monroe, Andrew E., and Bertram F. Malle. "From Uncaused Will to Conscious Choice: The Need to Study, Not Speculate About People's Folk Concept of Free Will." Review of Philosophy and Psychology, 2010: 211-224.

Morita, T., Y. Tei, and S. Inoue. “Effects of High Dose Opioids on Surivival in Terminally Ill Cancer Patients.” Journal of Pain Symptom Management 21 (2001): 282-289.

Rawls, John. A Theory of Justice. Cambridge: The Belknap Press of Harvard University, 1999.

Shepard, Jason, and Reuter Shane. "Neuroscience, Choice, and the Free Will Debate." AJOB Neuroscience 3, no. 3 (2012): 711.

Sykes, N., and A. Thorns. “The Use of Opioids and sedatives at the End of Life.” Lancet Oncology 4 (2003): 312-8.

Weisberg, Deena Skolnick, Frank C. Keil, Elizabeth Rawson, and Jeremy R. Gray. "The Seductive Allure of Neuroscience Explanations." Journal of Cogntive Neuroscience, no. 3 (2008): 470-477.

A Free Choice that Wasn’t (Gavin Enck)

(This is a work in progress) In medicine a patient has both the ethical and legal right to refuse medical treatment even if denying such treatment are to lead to the patient’s death. At least one of the conditions for the permissibility of such a choice is that the patient, generally speaking, freely chooses it. This broadly means the patient decision was made without external or internal coercion or manipulation. Yet, advances in neuroscience have painted a rich but complex picture of the human decision-making. There are many instances in which a choice appears to be freely chosen but, in fact, is the result of internal coercion. In this post, I want to examine the intersection between patient’s medical decision-making and internal coercion from a psychiatric condition or disorder in cases where psychiatric conditions or disorders become a terminal condition. In these extreme and rare cases a patient’s psychiatric condition or disorder is categorized as being terminal. Campbell and Aulisio (2012) have written on the subject in the context of anorexia nervosa. In that particular case, the patient’s condition and their ciricumstances were enough to warrant categorizing their psychiatric condition as being terminal and allowing the patient to be put into a hospice facility.  This case contains many different and relevant ethical issues. However, I want to specific examine whether the issue of whether the patient’s choice to refrain from eating was freely chosen. This investigation is not meant to be viewed as a criticism of the healthcare providers involved, for I believe they made the correct ethical recommendation but rather to consider the ethical implications on decision-making capacity, medicine, and the responsibility of clinicians if the patient’s choice was not freely chosen.    

To begin, my inquiry is not aimed at the level of philosophical conceptions of free will, although I do presuppose that to choose freely means a conditional ability to have chosen otherwise and at least some degree of control is fundamental for a person being responsible for an action or behavior (Shepard and Shane 2012; Fischer and Ravizza 1998). I also take freely choosing (volitional control) as constitutive of decision-making capacities in the practice of medicine (Beauchamp and Childress 2009; Jonsen, Siegler and Winslade 2010).

It is not all that surprising that in many cases people lack volitional control over their actions and behavior (Levy 2007; Wegner 2002; Bargh and Chartrand 1999). For example, consider personal self-control, the ability to refrain from certain behavior. In what is referred to as ego-deletion, a person refraining from one kind of action such as not eating a cookie or keeping a straight face while watching a funny video, has a marked decreased ability for self-control in other situations, such as grip strength or problem-solving (Baumeister, et al. 1998; Baumeister 2002; Schmeichel and Baumeister 2004; Vohs and Heatherton 2000). Self-control is only a finite resource. Certain conditions or disorders (Tourette’s syndrome, anorexia nervosa, and in some instances of borderline personality disorder) involve instances where it is not simply a matter of self-control to avoid eating a cookie but a matter of volitional control over doing broader, more intentional actions. For Tourette’s syndrome, anorexia nervosa, and borderline personality disorder, it has been suggested that compulsive impulses build up and, crudely put, override the patient’s volitional control, forcing them to perform certain behaviors or intentional actions. Patients suffering from these conditions or disorders may also only possess a finite amount of volitional control over these intentional actions. So, for example, patients with Tourette’s syndrome at a certain point have to express a tic, while for patients with anorexia nervosa and borderline personality disorder at a certain point they express more complex intentional actions such as not wanting to eat or to ingest or insert sharp objects in themselves (Leckman, King and Cohen 1999; Klein 2012; Kwok, Matorin and Kahn 2012; Campbell and Aulisio 2012; Henderson 2005). For these patients, even though they know that they should eat or that not eating or ingesting or inserting of sharp objects will result in severe health problems and/or death, they still perform these intentional actions. Moreover, these patients may even regard these actions as being authentic and freely chosen decisions of their own accord.

Returning to the case of the patient with anorexia nervosa who decides to stop eating and wants admittance to hospice, the problem becomes clear. It may not be clear that this patient freely chose to stop eating. That this patient did not freely choose to stop eating suggests that she did not have the decisional capacity to decide to consent to go to hospice. If the patient didn’t freely choose then the implications are deep and troubling. In terms of assessing decisional-capacity, it would be difficult to pinpoint the threshold level of volitional control necessary for a patient to be considered as having the capacity to make a choice for a treatment option. In regards to psychiatric conditions or disorders being categorized as terminal, the implication is that clinicians may have a responsibility (an almost unfair burden) to deny what appears to be an autonomous decision to refuse treatment.

Whether or not it turns out to be true that the patient’s decision was freely chosen, considering the implications of the patient’s choice being the result of internal coercion suggests that clinicians, neuroscience, and philosophers need to closer examine the intersection of free will, assessment of decisional-capacity of patients, and responsibilities of patients and clinicians.  

REFERENCES

Baumeister, R. F. . "Ego Depletion and Self-Control: An Energy Model of the Self's Executive Function." Self and Identity 1 (2002): 129-36.

Baumeister, R. F., E. Bratslavsky, M. Muraven, and D. M. Tice. "Ego-Depletion: Is the active self a limited resource." Journal of Personality and Social Psychology 74 (1998): 1252-65.

Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. 6th Edition. Oxford: Oxford University Press, 2009.

Campbell, Amy T. , and Mark P. Aulisio. "The Stigma of "Mental" Illness: End Stage Anorexia and Treatment Refusal." International Journal of Eating Disorders 45 (2012): 627-634.

Fischer, John Martin , and Mark Ravizza. Responsibility and Control: A Theory of Moral Responsibility. Cambridge : Cambridge University Press, 1998.

Henderson, Scott. "The Neglect of Volition." British Journal of Psychiatry 186 (2005): 273-274.

Jonsen, Albert R., Mark Siegler, and William J. Winslade. Clinical Ethics: A Practical Approach to Ethical Decisions in Clinical Medicine . 7th Edition . New York: McGraw-Hill Medical , 2010.

Klein, Carolina A. . "Intentional Ingestation and Insertation of Foreign Objects: A Forensic Perspective." Journal of the American Academy of Psychiatry and the Law 40 (2012): 119-126.

Kwok, Stephanie I. , Anu A. Matorin, and David A. Kahn. "Clinical and Ethical Dilemmas in the Psychiatric Care of Patients Who Norder on the Edge of Being Able to Live Safely and Independently." Journal of Psychiatric Practice 18 (2012): 213-220.

Leckman, J. F., R. A. King, and D. J. Cohen. "Tics and Tic Disorders." In Tourette's Syndrome -Tics, Obessions, Compulsions, edited by D. J. Cohens and J. F. Leckman, 23-41. New York: John Wiley and Sons, Inc, 1999.

Levy, Neil. Neuroethics: Challenges for the 21st Century. Cambridge: Cambridge University Press, 2007.

Schmeichel , B. J. , and R. F. Baumeister. "Self-Regulatory Strength." In Handbook of Self-Regulation, edited by R. F. Baumeister and K. D. Vohs, 84-98. New York: The Guilford Press, 2004.

Shepard, Jason, and Reuter Shane. "Neuroscience, Choice, and the Free Will Debate." AJOB Neuroscience 3, no. 3 (2012): 711.

Vohs, K. D. , and T. F. Heatherton. "Self-Regulatory Failure." Psychological Science 11 (2000): 249-254.

Wegner, David M. The Illusion of Conscious Will. Cambridge: MIT Press, 2002.

Sydney Conference on "Rationality + Consciousness= Free Will"

See below for information from the organizers:

Rationality + Consciousness = Free Will: Legal and Philosophical Reflections

4 May 2013

Registrations open shortly

____________________________________________________________

David Hodgson's final book,Rationality + Consciousness = Free Will(Oxford University Press 2012), published in the year of his death, focuses on two of his most significant philosophical interests, consciousness and free will, but it also considers the significance of these topics for the law. On Saturday 4 May 2013, a conference will be held at Sydney Law School at the University of Sydney, which sadly must mark his passing, but on a more positive note will critically analyse legal and philosophical themes in the book.

Often the topics of consciousness and free will have been treated in separate literatures and one of the interesting features of this book (and this conference) is the bringing together of these two areas of philosophy. However, the book and David Hodgson's work more generally is unusual in that it benefits from his work as a philosopher and his career as a legal scholar, legal practitioner and ultimately a Judge of Appeal of the New South Wales Supreme Court.

The conference will be of interest not just to philosophers and legal scholars, but to solicitors, barristers and judges, as the sections of book that consider the implications of Hodgson's view for law will be a significant part of the conference. Other presentations will focus on the themes of consciousness and free will.

Speakers include:

Christopher Birch, SC (University of Sydney, NSW Bar)

Glenn Carruthers (Macquarie University)

David Chalmers (Australian National University and New York University)

Neil Levy (University of Melbourne and University of Oxford)

Allan McCay (University of Sydney)

Michael Sevel (University of Sydney)

Nicole Vincent (Macquarie University and Delft University of Technology)

Time: 9am-5pm

Location: Sydney Law School, Building F10, Eastern Avenue, University of Sydney

Cost: TBC

Contact: PLaCE Coordinator

Phone: (02)9351 0323

Email: [email protected]

ADHD might not be a “real” medical condition or disorder, but neither is Erectile Dysfunction; and that’s okay (Gavin Enck)

Medicalization is defined as “a process in which non-medical problems become defined and treated as medical problems, usually in terms of illness and spending” (Conrad, Mackie and Mehrotra 2010, 1943). According to Peter Conrad (2007; 2010), medicalization is a social process, and in-principle, is neither good nor bad. Whether medicalization is judged to be good or bad depends on many considerations, such as consequences, rules, motivations, and relevant impact on economics and institutional practices. I think examining claims about the medicalization and validity of ADHD has, in a rather circuitous way, interesting implications for the ethics of neuroenhancement, specifically arguments for use of pharmaceuticals to augment a person or their neurological capacities. 

To begin, I think that medicalization does raise many concerns. I think that there are problems with remedying the disposition of shyness or sadness with medical treatments. Yet, it is the concern that medicalization does not raise for me that is interesting. I am not concerned that medicalization is more of a social process and less of an empirical and scientific process. Consider that for a long period of modern medicine homosexuality was considered a psychiatric condition or disorder. It was not until a majority of psychiatrists voted it as not being a mental disorder that it was removed from the medical canon as a condition or disorder. In this case a majority of psychiatrists agreed, and correctly so I believe, that being a homosexual was not a condition or disorder requiring medical treatment. Yet, notice that while these psychiatrists’ votes were cast on the grounds of their professional experience, it is not as if this decision, for lack of a better term, was based on empirical findings of the time.

I am also not concerned that medicalization of a condition or disorder is often founded on complex and deeply ingrained societal norms and values. The recent prominence of erectile dysfunction (ED) as a medical condition or disorder illustrates the complexity and ambiguity of societal values and biomedical technologies and medical procedures working indirectly to medicalize something. ED, unlike what was traditionally regarded as impotence for psychological reasons, occurs when a man is physiologically not able to develop or maintain an erection for sexual intercourse. It is clear that having the ability to develop or maintain an erection is rather important for society and for most men. There are many conditions under which ED is a medical condition or disorder, resulting from prostate cancer or diabetes. However, considering human evolution, it is not at all evident that human males past their reproductive prime were physiologically meant to be able to develop and maintain an erection. ED was not a problem until society advanced to the point where men living beyond their reproductive prime were common. That there was a pharmacological treatment for ED and the value of still being able to have a sexual relationship even past a man’s reproductive prime, led to the medicalization of ED.

As the examples of homosexuality and ED demonstrate, societal norms and values in conjunction with advances in scientific understanding and biomedical technologies and procedures often indirectly (or directly) dictate what things are to be medicalized. This means that one could, for sake of the argument, hold that the validity of Attention Deficit Hyperactivity Disorder (ADHD) as a medical condition or disorder is irrelevant. That reading, writing, and academics are highly valued by our society is enough to warrant ADHD as being considered a medical condition or disorder. That there was a pharmacological treatment for those to reach certain levels of being able to read and write and the value that these skills have in our society warrants the medicalization of ADHD. That this is not a “real” medical condition or disorder seems, like certain instances of ED, not all that important. Although I think that ADHD is, in fact, a real medical condition or disorder, one need not hold this view to argue for its medicalization.

At least one interesting implication from medicalization and the validity of ADHD as a medical condition or disorder for neuroenhancement is that it illustrates that the permissibility of an enhancement may be dependent not only the particulars of a person’s situation but also on norms and values of that society. Thus, some arguments about the permissibility of neuroenhancements might want to restrict or move away from claims that rely on reasons for enhancement to be about increasing human well-being in general and focus on reasons relating to increasing well-being for persons in a particular society. This narrowing of focus, in turn, may allow for a deeper investigation of the norms and values that underwrite the reasons for, or against, the use of neuroenhancements.  For example, that the U.S. does value education for its ability to develop the intellectual capacities of persons —despite the claims of a state legislator in Tennessee who seems to think that education is about making students gay— is a strong and tangible reason for permitting cognitive enhancers. It is the more fundamental societal norms and values, particular to a certain society or community, that underwrite the permissibility of neuroenhancements and this need to play a greater role in the enhancement discussion.  

REFERENCES

Conrad, Peter. The Medicalization of Society: On the Transformation of Human Conditions into Treatable Disorders. Baltimore: The Johns Hopkins University Press, 2007.

Conrad, Peter, Thomas Mackie, and Ateev Mehrotra. “Estimating the Costs of Medicalization.” Social Science and Medicine 70 (2010): 1943-1947.

 

 

Introduction (Gavin Enck)

Hello to readers of the Neuroethics and law Blog. My name is Gavin Enck and I am going to be the guest blogger for the month of February. I thought it would best to provide an introduction. I received my MA in philosophy from Ohio University in 2007 and, on February 15^th, will be defending my doctoral dissertation in philosophy at the University of Tennessee. During graduate school, I served as an ethics committee member and on-call clinical ethicist at the University of Tennessee Medical Center in Knoxville. Currently, I am doing a Post-Doctoral Fellowship in clinical ethics at the University of Texas MD Anderson Cancer Center (MDACC). As the clinical ethicist fellow in the MD Anderson Cancer Center my duties involve weekly rounding in the acute palliative care unit and critical care unit, as well as rounding with other alternating departments and services, and serving as an on-call emergency ethicist for the institution.

My dissertation, “Enhancing the Virtues of Students,” centered on approaching the issues and questions about student (specifically undergraduate students) use of cognitive enhancers in education using the ideals of human excellence or virtues. Instead of asking, “Is a student who uses a cognitive enhancer cheating”, I suggest another question, “What kind of student do we want in our academic institutions?” I then take a virtues-based approach and argue that in some instances because an idealized virtuous student would use enhancements. Thus, I argue that a virtues-based approach provides guidance for students and revising our institutional rules in respect to the ideals of human excellence or virtues. Ultimately, my goal is to argue for motivation and character being regarded as relevant considerations in any normative assessment of enhancements. From this dissertation, the paper “Ideals of Student Excellence and Enhancement” was published in the journal Neuroethics However, my interest in pharmaceutical enhancement stretches beyond the theoretical to the clinical. In conjunction with John Bossaer, PharmD and Robert Enck, MD, we have a forthcoming article in the journal Academic Medicine “The Elephant in the Room: The Use (and Misuse) of 'Cognitive Enhancers' by students at an Academic Health Sciences Center” which is a first-of-its-kind study on the use of prescription stimulates by students pursuing professional healthcare science degrees. At MDACC, one of my research projects is on studying physicians’ attitudes about pharmaceutical enhancement and their views of the treatment-enhancement distinction.  At least for me, the ethics of pharmaceutical enhancement is a fascinating topic because it ranges across the philosophical, psychological, social, and institutional domains. However, during this month of blogging the topics presented here will cover a range of issues in neuroethics beginning on Monday February 4^th.  

Before proceeding, I need to say the following. First, all of the positions and views put forward are my own and do not represent (or are meant to be representative of) MD Anderson position or policy. Second, while the views in this blog are my own, I would not be able to contribute to this blog were it not for the support and encouragement provided by MDACC. So I want to thank MDACC, specifically my colleagues in the Section of Integrated Ethics for this.

Cheers,

Gavin Enck