Two Types of Pharmacological Cognitive Enhancement

It is suggested by Anders Sandberg that the use of cognitive enhancing drugs under medical supervision might achieve more overall learning and academic achievement and this is preferable to being driven into illicit use by bans, see practical ethics . In a previous posting I argued that the use of cognition enhancing drugs in examinations should be permissible subject to two conditions, see cognition enhancing drugs . In this posting I will firstly argue that there are two types of pharmacological enhancement. I will then consider such enhancement should be permissible, I will suggest that they should in some circumstances. Some of my conclusions might also apply to brain zapping, trans-crainial direct current stimulation, which might increase memory and as a result enhance cognition. I will not consider brain zapping directly.

Let us assume some drugs effectively enhances cognition. Any such drugs need to satisfy two further conditions for its use to be permissible.

1. Any cognition enhancing drugs must be safe to use without any major side effects. In certain circumstances some of these drug must be safe for long term use.
2. In certain circumstances the users of a cognition enhancing drugs must be prepared to continue using these drugs.

Commenting on Sandberg’s posting Dennis Tuchler worries about how long the effect of cognition enhancing drugs will last. He worries if cognition enhancers only work for a short time that their use will mislead employers and graduate schools about someone’s cognitive abilities. For instance let us assume someone gains a job in the diplomatic service due to her superb powers of concentration. Let us further assume that these powers are due to her taking cognitive enhancers. Lastly let us assume that once she gains this position she stops taking the enhancers and her powers of concentration fall away. In these circumstances someone else who failed to obtain the post due to the drug takers previous powers of concentration might feel he has been treated unjustly. Moreover the diplomatic service might be disappointed with the appointment. Whether Tuchler’s worries are justified depends on exactly what is involved with cognitive enhancement. Cognitive enhancement might occur in two ways. Firstly cognitive enhancement might be an ongoing process and secondly cognitive enhancement might be the end result of a process. It follows there are two types of cognitive enhancer. The first type of enhancers would result in an ongoing change in the user even after she has ceased to take the drug. Let us call such an enhancer type 1. An example of type 1 enhancer might be some drug which increases our ability to remember and what we remembered is retained even after we cease taking the enhancer. Type 1 enhancers might be likened to a scaffold round a building, the scaffolding supports the building during construction but once the building is finished there is no further need for the scaffolding and it can be removed. The second type of enhancers would require their ongoing use to be effective, let us call this type of enhancer type 2. An example of a type 2 enhancer might be some drug which helps our brains to concentrate. In the case of type 2 enhancer if use of the enhancer ceases the enhancement disappears, if the scaffolding is removed the building falls down.

Let us first consider the use of type 1 cognitive enhancers briefly. Let us assume that type 1 enhancers increase our power of memory. Sandberg believes memories enhanced by drugs will presumably endure regardless irrespective of whether the enhancer continues to be taken. Whether Sandberg’s belief is correct is open to experiment and cannot be answered by doing philosophy. However provided Sandberg’s belief is confirmed experimentally and a type 1 enhancer has no untoward side effects then philosophically there appears to be no reason why someone shouldn’t take such an enhancer. Indeed Nick Bostrom and Toby Ord’s reversal test seem to support this conclusion (1). According to this test if we accept that giving someone a drug to diminish her cognitive ability is wrong and we argue giving someone a drug to enhance her cognitive abilities is also wrong then we must be able to explain why enhancement is wrong or be accused of having a status quo bias. It appears to follow that provided a type 1 cognitive enhancer is safe that we have no reasons to prohibit the use of such an enhancer. Such a conclusion is premature and reasons might be found to support the status quo. If such an enhancer is prohibitively expensive and available only to a few due to cost then it might lead to social injustice. For instance if the use of cognition enhancing drugs was useful in the diplomatic service and these drugs were prohibitively expensive then people from disadvantaged backgrounds might be discriminated against in their attempts to join the service. The above conclusion might be amended as follows. If a type 1 cognitive enhancer is safe and not prohibitively expensive then we have no reasons to prohibit the use of such an enhancer.

Let us now examine the use of type 2 cognitive enhancers. If this type of enhancer is to be effective it must continue to be taken. Such an enhancer would affect one or more of our physiological processes and this affect would result in increased cognitive ability. Drugs that affect our physiological processes seem to require continuous use. For instance someone taking a drug to reduce his blood pressure must continue to do so. A drug which enhances someone’s ability to concentrate would be an example of a drug that has a temporary physiological affect which temporarily enhances her cognitive capabilities. It might be argued Bostrom and Ord’s reversal test gives us no reason to ban type 2 cognitive enhancers. However once again reasons might be found to support the status quo.

Perhaps the use of type 2 cognitive enhancers might mislead employers or universities about someone’s cognitive capabilities. For instance the examination grade obtained by a student taking a type 2 cognitive enhancer might not accurately reflect his cognitive abilities if he ceases taking the enhancer. However if he continues taking the enhancer then the examination should reflect his cognitive abilities in a similar way to how examinations reflect students abilities without the use of cognitive enhancers of any sort. It appears possible that the use of type 2 cognitive enhancers might be permissible subject to certain conditions. The first of these conditions is that the user of type 2 enhancers must continue taking the enhancer or else any supposed benefit will be illusory. The second condition is that the use of type 2 enhancers will not lead to social injustice.

I will deal with each of these conditions in turn. If we are to permit the use of type 2 cognitive enhancers we must be able to assure ourselves that users of these enhancers continue taking them. How might this be achieved? Let us consider this question in conjunction with safety. I will consider the question first in cases where the issue of safety is clear cut. If such an enhancer has major safety issues then its use should simply be prohibited. If such an enhancer is completely safe and the cost is reasonable then I would question if we need any such assurance. Someone with hypertension will take a safe drug to control his condition without a second thought because it benefits him and carries minimal risk. He has a reason to take the drug and no reason not to. It might be argued by analogy that much the same applies to someone taking completely safe cognitive enhancers. It seems safe to assume if someone has a reason to continue taking a cognitive enhancer and none not to that he will continue to do so. Unfortunately not all cases are so clear cut and most drugs have some side effects. In these circumstances Anders Sandberg suggestion that the use of cognitive enhancing drugs should only occur under medical supervision seems sensible. If the use of type 2 cognitive enhancers takes place under medical supervision then once again we have no reason to question their continued use. It appears to follow that provided type 2 cognitive enhancers are completely safe or only used under medical supervision that we have no reason to question their continued use.

I now want to consider whether the use of type 2 cognitive enhancers might lead to injustice? Someone opposed to cognitive enhancement might argue that the prohibitive cost of such enhancers might make them unavailable to some people leading to social injustice. I will consider this objection in two specific contexts, first jobs depending on good cognitive skill such as the diplomatic service and secondly in higher education. First let us consider type 2 cognitive enhancers in the context of jobs requiring high cognitive skills. It is in employers’ interests to provide employees with the tools to work efficiently. It seems probable that if type 2 enhancers increase efficiency in some contexts that in these contexts it is in the interests of employers to provide them for free. Of course some might not do so. If a significant number of employers do not provide type 2 cognitive enhancers for free when these enhancers have been proved to be safe and increase efficiency then some legislation might be necessary. A similar argument might be advanced with regard to higher education. Universities provide students with the tools to help them learn, libraries, lectures halls and lecturers. If type 2 cognitive enhancers are safe but too expensive for most students then provided they are a useful learning tool perhaps universities should supply them.

The above leads to some tentative conclusions which might need modifying in the light of experience. Firstly provided a type 1 cognitive enhancer is safe and not prohibitively expensive then we have no reasons to prohibit the use of such an enhancer. Secondly even if the cost of type 2 cognitive enhancers is high the use of such enhancers should be permissible in higher education and jobs requiring high cognitive skills. The permissibility of more widespread type 2 cognitive enhancers is dependent on the availability and price of these enhancers.

1. https://nickbostrom.com/ethics/statusquo.pdf 

Autonomy and Toleration

 

In this posting I want to examine the relationship between autonomy and toleration. This examination will highlight the tension between respecting autonomous decisions and autonomous persons. I will argue that the concept of autonomy we adopt affects how tolerant we should be. Toleration will be defined as accepting choices we believe to be wrong and have the power to change, provided that these choices don’t harm others. John Stuart Mill famously argued that “the only purpose for which power can be rightfully exercised over any member of a civilized community, against his will, is to prevent harm to others. His own good, either physical or moral, is not a sufficient warrant.” (1) Mill was discussing liberty but the liberty to choose can be described as a primitive form of autonomy. Mill believed if we accept the above then we must also accept that “if all mankind minus one, were of one opinion, and only one person were of the contrary opinion, mankind would be no more justified in silencing that one person, than he, if he had the power, would be justified in silencing mankind. (2) It follows that if we equate autonomy with the liberty of Mill that toleration and autonomy are automatically linked and that we should tolerate any behaviour, which we disapprove of and have the power to change, provided that this behaviour doesn’t harm others.

It might be objected that it is overly simplistic to equate autonomy with liberty and that a more nuanced account of autonomy is needed. How then might we better define autonomy? Let us first consider autonomous decision making. Of course the freedom to choose is a necessary condition for autonomous decision making but it might not be a sufficient one. My objector might suggest that the simple freedom to choose is an insufficient condition for two reasons. Firstly she might suggest that for someone’s decision to be an autonomous one that it must accord with certain accepted norms in addition to the norm of not harming others. For instance if someone made decisions about what she should to do today based solely on her horoscope we might question if she was truly self-governing. My objector might then argue that our concept of autonomy must contain a substantive element and that that there is no meaningful content neutral account of autonomy. Secondly she might suggest that for someone’s decision to be autonomous he must accept Kant’s hypothetical imperative and always choose means that are likely to deliver the ends he seeks. For instance we might question whether someone was really self-governing if one of the ends he desired was increased learning and he sought to acquire this increase by prayer. In the light of my objector’s suggestions two arguments might now be advanced as to why autonomy and toleration need not be linked. Firstly if we accept a substantive account of autonomy which includes some accepted norms then we have no reason, based on respecting autonomous decisions, to accept those decisions which don’t concur with those norms and hence be tolerant.  Secondly it might be argued we have no reason based on respect for autonomy to respect, tolerate, those who choose means that are unlikely to achieve the ends they seek.

I have outlined a possible more nuanced definition of autonomous decision making. However we can respect autonomous decisions or autonomous people. Let us now turn our examination to respecting autonomous people. I will suggest that that respecting an autonomous person means accepting all of her decisions including ones that appear to have been made in a non-autonomous manner. My objector might argue that it is possible to respect someone as an autonomous person without respecting all of her decisions. In order to consider this objection I will first consider what sort of person is an autonomous person and how is she connected to autonomous decision making. It might be suggested that an autonomous person is simply one who always make autonomous decisions. If we accept this definition then we should have no problem in accepting all the decisions made by an autonomous person. However if we accept this suggestion it might be argued that it would be much simpler if we only respected autonomous decisions and ignored the concept of an autonomous person altogether. Moreover most people don’t always make decisions which conform to conditions outlined above for autonomous decision making, indeed it might be suggested that they rarely do so. It follows that if we accept the above that we are only going to respect an extremely small set of human beings as autonomous persons. In the light of the above should we simply respect human beings and forget about respecting autonomous people? I would suggest we shouldn’t. A three year old and an adult in the prime of her faculties differ in their capacities and intuitively the idea of self-control, self-government or autonomy seems central to this difference. Perhaps a better way to define an autonomous person would be to define her as a human being who has the capacity to make autonomous decisions. Such a definition would satisfy most adults because they want to be defined as the kind of creatures who can make their own decisions rather than simply being defined as human beings. Such a definition would also be useful because it defines a meaningful subset of human beings in contrast our previous definition which only defined a narrow subset. Lastly such a definition roughly concurs with Mill’s idea that liberty is “meant to apply to human beings in the maturity of their faculties”. If we accept this definition of an autonomous person then what does it mean to respect such a person? I have suggested above that this means accepting all her decisions which don’t harm others. Let us assume that we don’t respect all the decisions of someone who has the capacity to make autonomous decisions. Which of her decisions should we respect, only the one that are autonomous ones? However doing so means respecting an autonomous person is equivalent to respecting autonomous decisions and the concept of an autonomous person seems to do no work. Let us accept that if the concept of an autonomous person is to be a meaningful one that respecting someone as an autonomous person necessarily means accepting all of her decisions. This position seems to concur with that of Mill. It follows that respecting someone as an autonomous person means respecting, or at the very least accepting, her autonomous decisions. Acceptance of the above and the previously outlined definition of toleration means that we will be tolerant automatically. It means accepting choices we believe to be wrong and have the power to change, provided these choices don’t harm others.

It might be objected that it is difficult to ascertain whether someone has the capacity to make autonomous decisions. She might point out that if we respect autonomous persons and this means that we must respect non-autonomous decisions that this respect causes difficulties for the doctrine of informed consent. My objector might proceed to argue that because of this difficulty it would be much better to assess whether some specific decision was an autonomous one rather than whether the person making it had the capacity to make autonomous decisions. For this reason she might suggest that when we respect autonomy we should only respect autonomous decisions. She might point out that adopting her suggestion would mean that it would be easier to act beneficently towards someone who seems to be making a decision which runs counter to his best interests. If we accept that respecting autonomy means respecting autonomous decisions and accept a substantive account of autonomy then respect for autonomy and toleration aren’t automatically linked. There are no reason based on respect for autonomy as to why we should accept the decisions of others which conflict with our accepted norms. In a western democracy if the wearing of the hijab goes against our accepted norms then there is no reason to accept it based on respect for autonomy not to ban it; similarly in an Islamic state if not wearing the hijab goes against the accepted norms then again then there is no reason to accept not wearing it based on respect for autonomy. It follows that there is no reason based on respect for autonomy, as conceived above, as to why we should be tolerant, unless of course one of our accepted norms is to be tolerant.

It would seem if we believe respecting autonomy means respecting autonomous persons then we should be tolerant, if we accept a substantive account of autonomy and believe respecting autonomy means respecting autonomous decisions then we have no reason based on autonomy to be tolerant. I will now present two arguments as to why we shouldn’t accept that respecting autonomy means respecting substantive autonomous decisions. Firstly I would argue if we do so then we might be accused of epistemic arrogance. Let us accept that any autonomous decision must accord with the hypothetical imperative. Let us assume someone makes a decision using this imperative but that we don’t accept her decision as an autonomous one. It follows that our rejection is based on rejecting the beliefs or norms her decision is based upon. Let us also accept that our beliefs and desires help define us as persons. It follows if we don’t respect someone’s decisions that whilst we might be respecting her as a human being in a caring way but that we aren’t respecting her as a person. Autonomy and the concept of a person are of necessity connected. Most people don’t want to be only respected as a human being but as a person. It follows that if we only respect autonomous decisions we erode the concept of a person. Secondly I will argue that if we only accept a substantive account autonomous decisions that the concept of an autonomous decisions also loses its usefulness. If we only respect substantive autonomous decisions we only respect what we regard as good decisions. It follows if we only respect what we regard as good decisions the idea of autonomous making is doing no useful work and becomes redundant. It follows that that if he concept of autonomy is to remain a useful concept that we should reject a substantive account of autonomous decision making.

I have argued that we should reject a substantive account of autonomy. Most applied philosophers seem wedded to a substantive account of autonomy perhaps, this is because of an unconscious desire to justify their discipline for after all if something is a primitive concept then there is less of a need for applied philosophy. If we reject a substantive of autonomous decision making and still believe autonomy remains important then we must accept that respecting autonomy means respecting those people who have the capacity to make autonomous decisions. Respecting those people who perhaps aren’t as we educated as some are and rely on their emotions more than most people do. If we do so we must still be able to define an autonomous decision. Clearly not all decisions are autonomous. For instance random decisions, coerced decisions or decision made under some internal compulsion, such as a patient refusing consent because of fear, aren’t autonomous decisions. I have argued above that we should reject a substantive account of autonomous decision making because it erodes the idea of a particular person and reduces the need for autonomous decisions by equating them with good decisions. It follows that we should adopt a content neutral or primitive account of autonomous decision making. An autonomous decision is one which is freely made by someone which is based on her own beliefs and is instrumentally rational enough to serve those beliefs. Respecting this primitive concept of autonomy entails that we will be naturally tolerant. Respecting autonomy means accepting choices we believe to be wrong and have the power to change provided that these choices don’t harm others. Lastly if we accept that informed consent is based on respect for patient autonomy then adopting a primitive account of autonomy means a larger number of people should be competent to give consent compared to the number if we adopt a substantive account.

1. Mill J S. (1974) On Liberty and Other Essays. Oxford University Press (Oxfords Worlds Classics), introduction.
2. Mill J S, chapter 2