National Core for Neuroethics Journal Club: The Elephant and the Cyborg

Yesterday, the journal club met to discuss the article Cosmetic Neurology’ and the Moral Complicity Argument (Ravelingien, Braeckman, Crevits, De Ridder and Mortier, 2009).

“Abstract: Over the past decades, mood enhancement effects of various drugs and neuromodulation technologies have been proclaimed. If one day highly effective methods for significantly altering and elevating one’s mood are available, it is conceivable that the demand for them will be considerable. One urgent concern will then be what role physicians should play in providing such services. The concern can be extended from literature on controversial demands for aesthetic surgery. According to Margaret Little, physicians should be aware that certain aesthetic enhancement requests reflect immoral social norms and ideals. By granting such requests, she argues, doctors render themselves complicit to a collective ‘evil’. In this paper, we wish to question the extent to which physicians, psychiatrists and/or neurosurgeons should play a role as ‘moral gatekeepers’ in dealing with suspect demands and norms underlying potential desires to alter one’s mood or character. We investigate and discuss the nature and limits of physician responsibilities in reference to various hypothetical and intuitively problematic mood enhancement requests.”

Imagine a world in which “neuromodulation technologies” are refined to the extent that a drug is available to achieve virtually any mood (or more generally, cognitive state).  What kinds of moral questions might arise in such a context?

The article focuses on the following question: if doctors are the ones responsible for prescribing mood-enhancing drugs, then what role should they have in determining whether the request ought to be granted?  This question parallels the more familiar question regarding the doctor’s decision to perform cosmetic surgery. How is a doctor to decide whether to perform, for example, breast enhancement surgery for a 14-year-old girl with obvious body-image insecurities?

Is the doctor like a business owner, performing a service for the patient-as-customer?  In other words is the doctor obliged to do what the patient wants as long as it is within the bounds of regulations, laws, etc., regardless of their own moral leanings? This may be an extreme form of what the article calls “the common liberal position that the ultimate duty of a physician is to respect the patients’ own assessment of what constitutes proper care.”

Against this view, the article cites work by Margaret Little who argues that the relevant issue is the doctor’s responsibility to avoid social harm. Some requests for enhancements may stem from what Little calls “evil” social norms, and the doctor has the ethical duty to conscientiously refuse such requests. Otherwise they are complicit in immoral acts.

The fact is that many people already use drugs for the sake of enhancement, and it’s not likely that they will stop.  It’s then important to consider the specifics.  But the elephant behind these questions is this nagging discomfort that many of us have with enhancements, period.  What is behind this discomfort?

There are many things to consider: will enhancements be equally accessible to everyone, or will they increase the gap between those who have and those who do not; do enhancements neglect the evolutionary function of uncomfortable cognitive states; what are the costs of enhancements (it is not likely that there will be drugs with no side-effects, withdrawal, etc.)?

These are important questions, but I wonder whether one of the factors behind our intuition against enhancements is just an instinctual fear of the unknown, of the encroaching technological age. Enhancement is technologizing the mind.  What comes after enhancing the mind with drugs?  There are already neural implants for medical use. How long until these are used for enhancement as well? If we are not cyborgs already, then we likely will be soon.  No wonder there is anxiety surrounding the increased use of enhancements.  It could foreshadow the end of humanity as we understand it…