Table Of ContentRethinking Cognitive
Enhancement
Rethinking Cognitive
Enhancement
Edited by
Ruud ter Meulen
Ahmed Dahir Mohamed
Wayne Hall
1
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Preface
This multidisciplinary volume, including scientific, ethical, and legal perspectives, offers
a much needed reality check to the debate on cognitive enhancement. While there may
be potential benefits to human enhancement, and to cognitive enhancement in particu-
lar, there is a danger of slipping into a way of speaking about it that plays down potential
downsides. It may be implied or even asserted that enhancement is inevitable or that it is
by definition an improvement. Even if it is inevitable, however, that a person or persons
will seek to find means of cognitive enhancement, and even succeed in doing so, that
by no means settles the ethical, legal, and policy issues. Also, we should beware of mak-
ing enhancement an improvement by definition. Whether any particular enhancement
intervention is an improvement from an ethical point of view is an open question. For
whom will it be an improvement and in what way? We have to have regard to the respects
in which something is enhanced. As papers in this volume make clear, enhancement in
one characteristic may result in worse performance in some other characteristic or char-
acteristics: the associated risks need proper assessment and consideration of the extent to
which the trade- off is worthwhile.
While these remarks are true of enhancement in general, where cognitive enhancement
is concerned, there are specific issues to consider. On the plus side it might be thought
that cognitive capacities are good for whatever life plan an individual might want to fol-
low. Surely, it might be argued, greater cognitive capacities are associated with increased
probability of a successful career and all the benefits that flow from that, although it is
true that they do not guarantee happiness or well- being. Again, some people may argue
that we cannot, and do not think we should, avoid affecting our cognitive capacities by
education and other means such as meditation. Contemporary interest in practices such
as mindfulness and their effects on neuroplasticity is increasing. On the other hand, there
has been concern among paediatricians that some activities which people currently do
without a thought may affect our brains in a deleterious way, such as too much passive
consumption of screen time, especially in very young children. Given these facts, then
why should there be anything wrong with choosing to enhance our cognitive capacities
deliberately and in a targeted way, using pharmaceuticals and/o r other technologies?
First, however, we need to have regard to what exactly is envisaged in cognitive enhance-
ment, as this volume makes clear: how are we to understand the concept of cognitive
enhancement, precisely which characteristics of the brain are to be enhanced and by what
methods? Different technologies, including pharmaceutical products, brain stimulation,
and genetic technologies, are all candidates, and each of these has associated safety, ethi-
cal, and regulatory issues. The fact that manipulation of the brain is involved gives rise
vi PREfAcE
to multiple concerns discussed in this collection, including scientific evidence about the
significance, in terms of effectiveness, of the baseline cognitive potential in an individual
prior to an intervention; safety concerns about possible side effects such as addiction,
especially but not exclusively in relation to drugs; philosophical questions about identity
and disability; and ethical worries about the space for authentic autonomous choice. The
inclusion of the legal dimension in this volume is particularly refreshing, as the potential
implications of cognitive enhancement for professional responsibility and the laws of tort,
and for other areas of law such as product liability, could be considerable.
So the issues about when, how, and where cognitive enhancement should be introduced
require considered thought, and input from different disciplines, in order to address the
pertinent questions. In particular what needs to be asked includes the following: What are
the purposes of any given enhancement intervention? Is there a moral difference between
introducing a cognitive change as a remedial measure as opposed to enhancing some-
one who already has high cognitive capacity, perhaps even beyond the current limits of
human cognition? Among other dimensions to this issue which have been given perhaps
less attention elsewhere, the question of potential biological constraints, relating to the
way in which the human mind has evolved, is considered in this volume.
Given the importance of the human brain to human identity, the current stage of
research into its complexity, and the uncertainty about consequences of some of the
enhancement interventions envisaged, it is very timely to have a note of caution injected
into the debate, in order to facilitate the introduction of any potential future programmes
of intervention in accordance with scientific, ethical, and policy considerations which are
in turn informed by rigorous academic debate. This is to be welcomed in this collection.
Ruth Chadwick
University of Manchester
Editorial
This book came about because of unease of the editors, and of many of their colleagues,
with the current debate on the possibilities of human enhancement by the use of pharma-
cological drugs or other technologies impacting on the brain. They felt that the optimistic
view of human cognitive enhancement as presented in the bioethics and transhumanist
publications was not matched by evidence in the neurosciences about what these drugs
could accomplish, and did not consider their harmful effects, including addiction and
dangerous overconfidence. Moreover, they were not happy about the way critical views
from the field of ethics, law, public health, and social science are ignored or pictured
as conservative and Luddite responses that stand in the way of scientific and societal
progress.
When the three editors met in Bristol a few years ago at a presentation by Wayne Hall
on deep brain stimulation and addiction, they agreed to work together on this edited
volume. The ground work was already prepared by Ahmed Dahir Mohamed, who had
drafted an initial proposal to Oxford University Press. The editors are grateful to Oxford
University Press for their willingness to publish the book and for their support during the
process of collecting and editing the chapters. They feel particularly indebted to Martin
Baum for believing in this project and for Charlotte Green for her invaluable help during
the editing of the book.
The book Rethinking Cognitive Enhancement tries to present a critical reflection on
the possible benefits and harms of the efforts to enhance the cognitive functioning of
human individuals by the use of psychopharmacological drugs. This reflection is led by
evidence from neurological and neuropsychological research, philosophical and ethical
analysis, legal approaches, and perspectives from public health and drug policy. We hope
that this multidisciplinary approach will help to “debunk” the high expectations of these
drugs in academic circles but also the hype in the popular press about what these drugs
could bring to people. What are needed are not exaggerated fantasies, but plain evidence
and critical debate as the basis for sensible policy-m aking regarding the use of so-c alled
cognitive- enhancing drugs.
The editors would like to acknowledge some people who have been important in the
editing of this book. Ahmed Dahir Mohamed is indebted to Anthony Holland and Simon
Baron Cohen, who respectively supervised and advised his doctorate in psychology at the
University of Cambridge, Marilyn Williams his mentor and undergraduate supervisor, his
friend Jenny Lewis, and finally Evianne Van Gijn and Anthony Edward Phillips, who were
working alongside him when he was finishing his doctorate at Clare Hall, Cambridge.
They have followed his progress with enthusiasm and curiosity and have been supportive
all along the way.
viii EDitoRiAl
Wayne Hall would like to thank his colleagues at the Centre for Youth Substance Abuse
Research at the University of Queensland, particularly Stephanie Bell, Jayne Lucke, and
Brad Partridge, for helping to refine his thinking about the topic of cognitive enhance-
ment. He also thanks Sarah Yeates for her invaluable assistance in conducting literature
reviews and preparing manuscripts for publication over many years.
Ruud ter Meulen would like to thank his colleagues and post- graduate students at the
Centre for Ethics in Medicine for their discussions about human enhancement, par-
ticularly Sylvie Allouche, Alex McKeown, and Heather Bradshaw. He also thanks the
many colleagues he worked with in European projects on human enhancement, like the
ENHANCE project and the EPOCH project. Their contributions from the field of ethics,
law, social science, and public policy-m aking have strengthened his belief in a multidis-
ciplinary approach to the ethical issues of human enhancement as the basis for policy-
making. Finally, he wants to thank Ruth Chadwick for writing the preface to this volume.
Bristol, Otago, Brisbane
January 2016
Contents
Contributors xi
Part i Introduction
1 Introduction 3
Ruud ter Meulen, Ahmed Dahir Mohamed, and Wayne Hall
2 The ethical debate on human enhancement and cognitive enhancement
by way of biotechnologies 15
Ruud ter Meulen
Part ii Risk and benefits of the use of neuropharmacological
drugs for cognitive enhancement
3 Overclocking the brain? The potential and limitations
of cognition- enhancing drugs 37
Reinoud de Jongh
4 Neuroenhancement: a call for better evidence on safety and efficacy 57
Charles F. Massie, Eric M. Yamga, and Brendon P. Boot
5 Exaggerating the benefits and downplaying the risks in the bioethical
debate on cognitive neuroenhancement 69
Andreas Heinz and Sabine Müller
6 The effects of modafinil on creativity: results from a randomized
controlled trial 87
Ahmed Dahir Mohamed
7 Does modafinil improve cognitive functioning in healthy
individuals? 107
Ahmed Dahir Mohamed
8 Cognitive enhancement using noninvasive brain stimulation: weighing
opportunity, feasibility, and risk 125
Priyanka P. Shah-B asak and Roy H. Hamilton
9 The use of brain stimulation technology for cognitive enhancement
and the potential for addiction 150
Mark Attiah
10 Debunking the ethical neuroenhancement debate 164
Stephan Schleim and Boris B. Quednow
