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Galert et al. claim that everyone should have the autonomy to decide whether or not to use CE drugs and potentially change his or her personality and whether the expected benefits are worth the risks.11 Restricting the right of selfdetermination paternalistically can conflict with democratic principles.1,8,11 However, the question of whether people are competent in self-determination should also be considered.1 Some users (e.g., addicts) might not be constantly aware of their motives, resulting in less reflection on and evaluation of potentially harmful effects of CE drug use.8,12 Therefore, Wulf and colleagues8 propose case-by-case decisions, and Schleim12 argues that some individuals should be protected against themselves.


A frequently stressed social consequence of CE drug use is their potential violation of fairness norms, as in competitive situations in which not all competitors can access CE drugs.12,19 Therefore, some argue that CE drugs should be freely available/legal because if everyone can easily use them, no one would gain a relative advantage.11-12-19-25 But free availability might increase indirect coercion to also use such drugs and accept their side effects in order to avoid relative disadvantages.18-19-25-44 This might be especially problematic for people who would like to refuse CE drug use. Moreover, CE might create a norm of perfect functioning humans.8 Whereas CE drug use might increase pressure and expectations on individuals—which is seen critically11—the literature also points to potential societal gains (e.g., CE-driven increases in productivity44). Furthermore, for some people, pressure might be so high that they reflect less about the risks of CE drugs.11 Direct coercion has also been discussed with respect to general welfare (e.g., in prescribing their use to surgeons, military, or rescue workers).19 This conflicts with the “free choice” argument. Galert and colleagues state that—as long as CE drugs are not harmless—people unwilling to use them should be protected from falling behind in competition.11 Moreover, the community at large should not pay for the cost of enhancement.11-12

If access to CE drugs were positively associated with social status (e.g., higher financial resources), then social inequality and injustice might increase.11-44 Therefore, CE proponents suggest subsidies for disadvantaged groups (e.g., higher taxes for CE drugs for privileged groups); however, this would again lead to coercion for the disadvantaged.11 Nevertheless, many accepted means such as private schools, tutoring, or special training already serve to protect the status of and provide advantages to the privileged and those using them, and this also causes coercion.

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