In the past six months, I’ve participated in several public events on neurotechnology and human enhancement, from pub talks to presentations to larger audiences. Some of these talks have been part of our work in NERRI; others have been part of different agendas; e.g publicizing the work of researchers in my university; disseminating the report of the Nuffield Council on Bioethics Report on Novel Neurotechnologies, and so forth. I thought it might be worth reflecting for a moment on how those of us involved in these sorts of engagements are ourselves contributing to an “idea” of neuro-enhancement, and particularly, what “idea” I might be putting out there for consumption. This is important because, in fact, public knowledge about and understanding of, neuro-enhancement is still at a rather low level, no matter how much the media advertises an (apparent) explosion in the use of smart drugs or tracking devices. When the explosion happens (if it happens), researchers like those of us in the NERRI consortium will have had a part to play. We should consider our particular roles now rather than later.
My reflections begin with “the idea” of neuro-enhancement. What do I mean by this? I take the notion of “the idea” from (a probably implausibly distant source) Amartya Sen’s arguments in his seminal book An Idea of Justice. One of the key discussions in that book is about whether justice can be said to be an all or nothing concept – it exists, or it doesn’t – or, whether we should think of justice as existing on a continuum. Sen endorsed the latter way of thinking about justice. This view also allowed him to propose that it wasn’t necessary to have a transcendent notion of justice in order to evaluate whether institutions or policies were just; it was possible to do an adequate evaluation using a comparative method. Among his famous examples is that of two people arguing over whether a Van Gogh painting is superior to a Picasso. The resolution of this argument, says Sen, doesn’t depend on the existence of an external truth that X painting is the most perfect painting in the world. Moreover, to spend time on the question of what is the most perfect painting in the world is an unnecessary distraction from the real issue at hand (the Van Gogh and Picasso paintings). When these relatively trivial concerns about paintings are translated to the resolution of major global issues such as the distribution of medicines to the needy, or the availability of clean water, one begins to see how harmful the pursuit of transcendent truths can be.
Why is this political philosophy relevant to neuro-enhancement? Well, it seems to me that two of the recurrent questions I have faced from publics interested in neuro-enhancement reveal similar concerns about the categorical nature (or not) of neuro-enhancement, and about the evaluation of neuro-enhancement. These questions can take the following form: First, what is neuro-enhancement? Second: Is neuro-enhancement good? I think both of these questions are illuminated by Sen’s arguments about the idea of justice. Let me explain.
Following an informal presentation on smart drugs, a student in the audience put up his hand and asked:
“What’s the difference between someone with mild ADHD taking stimulant drugs to help him study, and someone who doesn’t have a diagnosis but has the same sort of problems focusing and studying boring stuff? If they both took Ritalin to help them study, wouldn’t they both be enhancing themselves?”
When I first started working on neuro-enhancement, I was quite likely to give this sort of question a response that accepted diagnosis as a threshold, or a cut off, that separated people who were using Ritalin for enhancement from people who were using Ritalin for treatment. This is also known as the “treatment/enhancement distinction”. This kind of response puts a lot of normative weight on the fact of an objective difference between treatment for a disorder and enhancement of “normal” functioning. Some people would go further to say that not only is there an important difference between using Ritalin as a prescribed treatment to support school work and using Ritalin for school work without a prescription, but prescribed use for this purpose is fine, while use of Ritalin as a “smart drug” is wrong.
Is there really such an objective difference? Over the years I’ve become less convinced that it’s possible to easily distinguish between practices that are “neuro-enhancement” and practices that are not – at least in competent adults (I should add that I think in some cases, diagnosis is a reasonable threshold; for example, I believe that “ADHD” is a real diagnosis, but it’s not a threshold for neuro-enhancement in every case). This is both because of the varying outcomes that count as “neuro-enhancement” and because of the wide range of practices that are associated with neuro-enhancement – from consumption of fish oil tablets to video games to neural implants. Moreover, what counts as, and is experienced as “neuro-enhancement” will vary according to the individual’s baseline performance, environmental inputs, relational factors, psychological factors, and so forth. Like Sen’s idea of justice, neuro-enhancement is a difficult and complex idea; it’s not binary in any straightforward way.
I was pleased to see that this issue of complexity has been raised at a recent meeting of the US Presidential Commission on Bioethical Issues. The Commission has been considering the ethical issues related to neuroscience and neurotechnologies, including cognitive enhancement. In August 2014, the neuroscientist Peter Reiner advised the Commission as follows:
Underlying Reiner’s comment is the familiar problem of relative ends – if we are already “enhancing” ourselves in all sorts of ways, then how can we establish any stable threshold of normality against which to distinguish “enhancement”? The needle is constantly moving; there’s an ever-evolving “new normal”. For the bioethicist Carl Elliott, this situation brings about harmful competition, in which no one is satisfied very long with their “enhancement” because they will eventually be outpaced or outperformed by those with new and better enhancements. But Reiner also implies that neuro-enhancement is itself not an exceptional practice – we’ve been doing it for some time, using various means. So, perhaps we shouldn’t worry too much about it, particularly if our ongoing self-enhancing activities make neuro-enhancement itself difficult to isolate and evaluate.
Yet, just as we still need to be able to evaluate the relative merits of Van Gogh and Picasso, even without a transcendent idea of the perfect painting, we also will need to be able to evaluate neuro-enhancement. What should our basis for judgement be, if we agree that neuro-enhancement is not a categorical concept, and there is no transcendent notion of neuro-enhancement to which we can appeal in order to judge practices and technologies? Should we just evaluate neuro-enhancement on a case by case basis, and say: “it depends”?
“It depends” is rarely a satisfactory response to difficult questions, and it is only minimally helpful when attempting to come up with general claims about what sorts of activities we want to endorse (or not) around neuro-enhancement. The proposal of a comparative methodology does help here though. It is helpful to weigh, for example, the relevant distinctions between taking modafinil for memory enhancement and taking omega fish oils for the same purpose. Or, how does the use of an external GPS device on your phone to get you safely and efficiently from point A to point B differ from implanting a microchip under your skin to track your movements from point A to point B? Or, what’s the difference between providing your children with a private tutor to help their maths skills and providing them with transcranial magnetic stimulation for the same purpose?
In discussing these comparisons we get clearer on what we care about relative to “neuro-enhancement” even if we are nowhere nearer to being able to say what neuro-enhancement is. We get more grip on the underlying values that inhere in our reactions. For example: What do we value about student learning in the university? What do we value about the university? How does taking smart drugs before an exam fit, or not, with those values? Does drinking 5 cups of coffee threaten those values in the same way, and if not, why not? From here we are more likely to generate ideas about appropriate regulation and governance of neuroscience technologies based on a transparent account of what we value and why, rather than on two mistaken assumptions: that we are likely to know neuro-enhancement when we see it; and that all cases of (what we believe to be) neuro-enhancement can be addressed using one approach.
The NERRI project proposes that the public should be involved in discussions about neuro-enhancement. This is a view also endorsed in Peter Reiner’s evidence to the Obama Bioethics Commission. He says:
“I’d submit as we move forward we need to give a fair hearing to the public’s enthusiasms and fears, their utilitarian dreams and their visions for societal harmony for these are the norms to which our policies should hew.”
In NERRI, we have a unique opportunity to welcome a diverse range of publics to the table. Together, we discuss and debate the idea of neuro-enhancement, and we try to notice when we fall into ill-considered and shifting opinions, in order to achieve discussions that tap a place of deep and enduring values.