Home Health Cognitive enhancement : ethical and policy implications in international perspectives
Taking the 6 Cs into consideration enables an assessment of the various positional perspectives of enhancement, as well as the values and needs that shape the use of neuroscience and neurotechnology. For example, some have supported a duty to intervene once we are in the position of realizing how an intervention is becoming technologically feasible. Being in a responsible position carries burdens. Yet, justifying interventions on others simply because they have become available fails to account for additional realities spawned from actualizing possibilities. Comprehension of long-term consequences is limited, and encouraging (what may be long-l asting) modifications without ensuring equally durable individual welfare is reckless.37
Shall the position of the responsible individual prevail instead? Letting individuals choose for themselves is no less reckless. Even when individual benefits can be guaranteed, it must be asked: which people should receive them? The answer, “All who can benefit,” is no answer at all because it won’t really be the case that people will have the same or even similar access at the same time. Differential access is inevitable in a world of finite time and resources. That differential access is prima facie unjust because those who already possess certain traits, attributes, and/or resources will likely acquire even more. Hence, realistic concerns for distributive justice arise from the position of society at large. The distribution of improved health and lifestyle status, and even improved moral status, will always be a social concern.38-39
Worries over distribution cannot, nor should not, be easily dispelled. Those with the least assets are those most unlikely, statistically speaking, to get access to state-of-the-art scientific and technological interventions. It is unrealistic to assume that some massive shift in the social architectonics of medical resource allocation will occur (a shift without historical precedent) so as to allow neuroscience and neurotechnology to close the gap between those who “have” and those who “have not.”40 Given this reality, does everyone really want a society where the people getting the most enhancement(s) are precisely those enjoying great wealth? The prospect of cognitive enhancement surely highlights this worry: intelligence does what character directs, and the kinds of characters getting so wealthy in our times may not be the people to be trusted with even more intelligence and the powers concommitant with intelligence. Proponents of unlimited access to enhancement are unwitting enablers of unbalanced distribution. Contests between idealistic distributive methods can be debated in ethics, but they get realistically adjudicated in politics.
Entering the realm of politics is unavoidable. The politics surrounding access to enhancement will be intense. Of equal importance are the ways that the capabilities of brain science tempt its use within agendas of political power to control fundamentally biological aspects of individuals’ and communities’ existence (invoking what Foucault referred to as biopolitics).41-43 Bioethical and neuroethical analyses cannot avoid addressing the relationships among science, ethics, and politics: science as a public good, ethics as a search for the good and the right, and politics as the participation of citizens in decisions about the guidance of public order.
As public debate over the impact(s) of enhancing interventions accelerates, the search for principled guidelines has ensued, and the discipline and key groups of scholars in neuroethics are presently involved in this effort.44-46 Guidelines may be expected to display continuities with older medical tenets for experimental research, advocating due caution with experimental clinical applications and emphasizing priority access for those in worse health. Should wisely conservative guidelines from the medical ethics tradition be further extended for guiding the biopolitics concerning modes of enhancement beyond “normal” health? We doubt that this simplistic extension will prove satisfactory. Irrespective of whether enhancement is regarded as a dangerous minefield or a bountiful cornucopia, the vital contexts of enhancement radically transform its biopolitical status.
For example, recall from a previous section our attention to the choice among physiology, normality, and ethical standards for identifying what counts as enhancement. Experimental medical research focusing on physiological alterations (typically) emphasizes interventions for the most unhealthy. Policy tends to approve funding for basic research if and when it could soon help those with the most severe and/or epidemiologically extensive health conditions. These prioritizations wouldn’t work in the realm of enhancement for two reasons. First, a traditional approach to funding and engaging research would tend to leave most enhancements on the theoretical drawing board. Second, although there may be desires for expensive advanced research into fundamental neurological mechanisms that can be targeted for cognitive performance enhancement, unless these approaches can be ascribed to incur some “therapeutic” benefit against an identified disease, disorder, or (medical) condition, financial and administrative support for broad-scale research and translation of outcomes and products would tend to be lacking.
A related issue is contemporary medical endorsement of interventions that restore or sustain normality. Explicitly and implicitly, this position conforms to sociocultural requirements that all people should seek and exhibit “normal” functioning, rather than (what is regarded to be) abnormal or antisocial conduct that deviates from socially established standards. What posture should be assumed when (1) certain people seek optimal functioning in pursuit of what they personally deem as the apex of the good life, and/or (2) society sets requirements that individuals in special roles (such as physicians, pilots, peace officers, or military personnel) must attain optimal functioning?47-48 Medicine’s laudable work in service of living a good life isn’t automatically extendable to living a great life or to achieving great performance in a socially sanctioned service. Justifications for specialized enhancements for enabling idiosyncratic lifestyles or for extraordinary public service will not arrive from medical principles.
A second set of examples arise from our earlier discussion of the cultural variability inherent to the precise identification of cognitive improvements. Medicine’s due caution with clinical application, watching carefully for deleterious health and lifestyle side effects, typically relies on cultural consensus about what constitutes “normal” performance in daily life.49 Those seeking significant enhancements, by contrast, won’t be interested in conforming to cultural norms about ordinary performance, and medicine may not be able to restrain them. When the recipient of an enhancement is achieving extraordinary performance levels and feeling empowered to transgress cultural expectations in the name of greatness (despite the risks), what social institution or cultural tradition can and will restrain such pursuits?
Evidently, society turns to law for these proscriptions. Here, it becomes necessary to ask how restrictions of and prohibitions against certain types and extents of enhancement will be determined. Targeting neurological modifications for legal action (i.e., imitating the criminalization of psychedelic drugs and un- or inaptly prescribed AAS or bans against performance-enhancing substances for professional athletes) has the merit of objective verification. But this only spurs those seeking improved types of cognitive performance to find alternative physiological methods not yet banned or detectable, and the chase is begun anew.
Legal bans could instead prohibit specific kinds of “cognitive enhancement” as excessively abnormal, no matter the neurological method involved. Here, the objectivity inherent to medical classifications of diseases and disabilities fades away entirely. Could there realistically be a legal ban against, say, excessive speeds of logical inference? This would necessitate some form of baseline assessment against which to measure change in cognitive task performance. Absent this methodological rigor, enhanced performers could simply retort that any improvement they’ve undergone merely represents an ability to keep many things in mind simultaneously, which can be conflated with nearinstantaneous inference speed. Given the legal standard to assume innocence, it would need to be demonstrated beyond reasonable doubt that any such cognitive performance is the result of some (banned form of) intervention. Although this might be possible, it then opens up a proverbial can of worms in its reliance on neuroimaging and other types of neurological assessments to define and/or predict “normality” and “abnormality” in ways that would be admissible under the law.50-51
Blanket bans on every form of cognitive processing relevant to superior intelligence, at least the forms confirmable by neuroimaging, could temporarily work within a culture sharing common (albeit conventional) views on labeling what being “smart” entails. But we question the effectiveness of this approach. After all, how well have operational definitions of “intelligence” worked thus far? Conventional views, and hence any laws relying on them, are limited, biased, and fragile. They do not translate across cultures or even subcultures with any exactitude, and they thereby limit applicability. Moreover, they will not translate well into the future as neuroscientific findings reveal how conventional categories for intellectual subprocesses only perpetuate folk psychology or embody traditional prejudices, thereby proving to be little more than myth. Future neurotechnologically enhanced intellects could regard legal bans against “dangerous” cognitive improvements to be humorously irrelevant or socially biased (if not marginalizing and subjugating). We must ask: what is the final goal or end on this horizon of possibility? We believe that neither neuroethics, neuropolicy, nor neurolaw can—or will—provide any quick and easy answers. But then, we promised that a contextual neuroethics won’t be about applying top-down guidelines from any traditional ethos or ethical system.
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