"Our findings may help steer us toward more fruitful discussions
regarding cognitive enhancement," says Thomas H. Murray, PhD, of The
Hastings Center in Garrison, NY, "and may aid us in answering
questions like: What if we could think better? What would it mean to
have biomedical technologies that could enhance our cognitive
functioning? What would be the pros and cons of having these
technologies widely available to the public? Can we learn anything
about cognitive enhancement from the experience of
performance-enhancing drugs in sport?"

Murray and his colleagues' research includes neuroethics, a
relatively new field born out of bioethics, that examines the benefits
and dangers of modern research on the brain and the social, legal, and
ethical implications of the clinical applications of that research.
They have been exploring the ethical implications of enhancement in
sport and in other realms of life, leading them to a number of insights
about the nature and ethics of cognitive enhancement. Murray delivered
the David Knopf Memorial Lecture on Neuroethics at this meeting.

"As responsible researchers, we must fully consider the ethics of
cognitive enhancement by weighing possible harms as well as likely
benefits," says Murray. "Who is affected by enhancements? And what
values and ends do the enhancements serve?"

The appeal of cognitive enhancers is apparent to anyone who has
wrestled with a difficult intellectual problem or tried to stave off
mental fatigue. Drugs that affect mental alertness, such as caffeine,
already exist. New drugs that may have more precisely targeted effects
on memory or executive cognitive functions are appearing. "They are
likely to be developed in the first place to treat cognitive disorders
such as dementia, but their enhancement applications are likely to be
noticed immediately, just as biosynthetic erythropoietin (EPO)-the
endurance-boosting drug-was rapidly taken up by some competitive
cyclists and other athletes," says Murray.

Recently, Murray and his colleagues at the Hastings Center have
conducted an ethical and philosophical analysis of cognitive
enhancement. A working group of experts-including athletes,
scientists, physicians, and scholars in law, philosophy, and
history-helped to identify key arguments regarding forms of
enhancement, including cognitive enhancement.

Three particular findings from their study stand out. First, any effort
to base the ethics of cognitive enhancement on the distinction between
therapy and enhancement is doomed to fail, according to Murray. "In a
sense, all therapy can be understood as enhancement, as it is building
upon the intrinsic healing processes of the body and mind with the aim
to restore the body to a natural, balanced state," says Murray.
"Cognitive enhancers may be a way to improve the mind's ability to
think and remember, especially in the case of dementias, just as
antibiotics are a means to enhance the body's capacity to fight off
infection."

In addition, a set of biomedical interventions already exist that aim
at improving health, yet are just as clearly a form of enhancement:
vaccines. Classical vaccines work by enhancing the immune system's
capacity to mount a response against infection. The capacity to produce
such antibodies is latent in the immune system to begin with, according
to Murray. The vaccine enhances the body's resistance to infection
and therefore pursues an approved aim of medicine-preserving health
and preventing disease.

Furthermore, the same goal may be reached by a variety of means-and
not all of those means are biomedical, according to Murray. Many
people, for example, take a class of drugs known as selective serotonin
reuptake inhibitors (SSRIs). A lack of serotonin in the brain is
related to a variety of unpleasant psychological states such as
depression, low self-confidence, and anxiety. A drug that relieves the
suffering of people with clinical depression is a valuable therapy. But
for at least some of these desired states, there may be other paths to
the same end. Someone who lacks self-confidence might enhance their
psyche by doing things that build self-confidence. Someone uneasy in
mind might find that meditation, prayer, or some other spiritual
discipline leads to the inner peace they seek. "As we think about
biomedical interventions as enhancements, we must bear in mind that
similar ends may be reached by quite dissimilar means," notes Murray.

A second finding of the working group is that the distinction between
natural and unnatural enhancements is as equally unhelpful as basing
the ethics of cognitive enhancement on the distinction between therapy
and enhancement. Not all that is natural is good, and not all unnatural
enhancements are bad.

"For example, plagues or hurricanes are natural, but not good,"
says Murray. "Eyeglasses and anabolic steroids are certainly
unnatural, yet who objects to eyeglasses as an aid to reading or
driving on the basis that they are unnatural?" The goal of reading or
driving is a valued one, and if eyeglasses make it easier or safer,
then that is beneficial. "Anabolic steroids used by an Olympic
weightlifter are no more unnatural than eyeglasses, yet they are almost
universally abhorred," says Murray.

The difference lies in the meaning of the activity and the place the
idea of the natural plays in it, according to Murray. Excellence in
sport is meant to be the product of natural talents and their
perfection by hard work and other virtuous activities. The idea of the
natural here is essential to the shared social meaning of the practice
itself. This is why performance-enhancing drugs in sport are
disapproved of. Further, because sport is a rule-governed activity and
because fairness is highly prized in competition, athletes who use
banned performance-enhancing technologies are condemned as cheaters and
as people who compete unfairly and therefore behave unjustly toward
their fellow athletes.

It also is a mistake to assume that there can be an ethics of
enhancement, according to Murray's work. "Instead, the ethical
wisdom of cognitive enhancement will depend on many things including
the broad social context, the impact on justice, and the meanings
embedded in the social practice in question," says Murray.

Mankind's possibilities for enhancement do not occur in isolation
within each of us as single, free human beings, but collectively within
all of us as embodied creatures whose lives and flourishing are deeply
intertwined with one another, according to Murray. "A thoughtful
understanding of the ethics of enhancement must take into account the
meaning and purpose of the activities being enhanced, their social
context, and the other persons and institutions affected by them,"
says Murray. "There will be no single ethics of biomedical
enhancement."

Other questions related to cognitive enhancement, especially for more
widespread use, may be prudent to ask, according to Murray. Cognitive
enhancers may first be used to treat disorders like dementia, but they
could also benefit all of mankind by increasing everyone's cognitive
abilities. What would be so bad about that? Is taking cognitive
enhancers just another practice of good educational or mental health,
like providing a positive learning environment and practicing good
study habits? Or, is popping a pill a "quick fix" or way of
avoiding a real issue, instead of working toward improving cognitive
ability through reading or increased practice? Should we take
accessibility of the drugs in to consideration? Will people of lower
incomes be able to afford such cognitive enhancers, and if not, what
consequences will unbalanced availability of the drugs have?

Part of the answers to these neuroethical questions may lie in
contrasting likely scenarios of cognitive enhancement with the use of
performance-enhancing drugs in Olympic sport, according to Murray. This
also will highlight the differences between the ethics of enhancement
in sport and the ethics of cognitive enhancement in a variety of
different settings, for a range of different purposes.