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Designer Genius: An Ethical Investigation of Cognitive
Enhancement
Kenny Moran
Ms Wu
AP English Literature and Composition
Los Altos High School
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April 29, 2011
"Adderall makes me feel like I'm superman; it makes me feel like I can get
anything done, and I can do it in the best way humanly possible. Like, every
single action I take is so finely tuned to perfection that there's absolutely no
way I could be doing any better at anything, and that's really just an
incredible feeling . . . the things you can do on Adderall are just incredible
just incredible. By taking Adderall, the papers that Im putting out, the things
that Im learning, the things that Im remembering are just so much
better . . . so, I mean, if everybody was taking Adderall . . . wed all be doing
so much better, wed all be so much smarter and the things that humanity
could get done if everybody took Adderall it would be incredible. It would
be incredible. I cant even begin to describe the kind of world that were
missing out on.
The short, dark-haired, alluring young woman that well call Danielle is not a
very good student or at least, she wasnt born that way. Throughout high school,
Danielle often wouldnt do her homework and wouldnt study for tests. Whenever
she did try to succeed in school, she never found herself doing above-average work,
and she barely managed to pull off the C average she needed to keep playing on
her schools varsity softball team. After graduating, Danielle enrolled in community
college and decided that she wanted to get her life back on track. When she
started college, she still found herself struggling to overcome her lackluster study
habits and her problems remembering all the information that her college classes
threw at her but that hasnt stopped her from coming out at the top of all of her
classes and performing well enough during her first two years of college to be
accepted as a transfer student at UCLA.
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Danielles life turned around when she met Jeff, a peer at community college
two years her elder. Jeff is prescribed Adderall, a powerful psychostimulant
composed of a number of amphetamine salts. Adderall is approved for the
treatment of narcolepsy and Attention Deficit Hyperactivity Disorder, more
commonly known as ADHD. Jeff is diagnosed with ADHD, but he soon found that,
without much effort, he could easily convince his doctor to prescribe him twice the
dose he needed to function normally, allowing him to make a sizable profit selling
his extra pills to peers. Danielle is a regular customer of Jeffs, and, with the help of
Adderall, she has transformed herself from a below-average, apathetic student to a
highly motivated, studious scholar who consistently receives excellent marks. What
happened?
Adderall is what neurologists would call a cognitive enhancer in other
words, a smart pill. Many would immediately call Danielles decision to use a
cognitive enhancer immoral and contemptible. Danielle has managed to get
admitted into a prestigious university, despite the fact that her past history in high
school would indicate that she clearly doesnt belong there. How could
manipulating the system in this way be acceptable, let alone dignified?
The question of whether or not Danielles actions are acceptable may seem
like a simple one, but if we evaluate it on a deeper level, we see that it is far from
simple, and it brings up a number of complex questions about the ethics of
cognitive enhancement. We know that Danielle was performing below average
before taking Adderall. Its also true that Jeff struggled in school before he was
diagnosed with ADHD and prescribed Adderall. If its okay for Jeff to use Adderall to
fix his problems in school, why isnt it okay for Danielle to do the same thing? Some
might say that because Jeffs use is therapeutic and has the purpose of correcting a
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disorder, it can be distinguished from Danielles use, which only has the purpose of
making her smarter. As it turns out, though, figuring out where to draw the line
between therapeutic cognitive enhancement and non-therapeutic cognitive
enhancement is a very difficult task.
So how do we distinguish between therapy and enhancement? Should we
even have to? Is therapeutic enhancement morally objectionable, permissible, or a
moral obligation? Most importantly, what implications does cognitive enhancement
have for fairness and equality, and what should we do about it?
What is Cognitive Enhancement?
Before we can define exactly what is meant by cognitive enhancement, we
must first define what it is that cognitive enhancement techniques aim to enhance:
cognition. The term cognition is often used to refer to many different things by
different researchers in different fields, but in general, it is agreed that cognition
refers to a number of different psychological skills that are necessary for humans to
think and live. These include skills like perception (the ability to ascertain
information from ones environment), attention (the ability to control what
information is perceived and what is not), memory (the ability to retain
information), reasoning (the ability to manage, analyze, and synthesize
information), motor skills (the ability to effectively and efficiently control ones
movement in the manner that is most in accordance with the information managed
by the aforementioned skills), and cognitive executive functioning, a term for the
brains ability to effectively and efficiently allocate the brains energy among the
five other cognitive abilities. (Bostrom/Sandberg), (Bostrom/Roache).
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The collection of specific skills that depend on one or more of the six aspects
of cognition is massive; in fact, its extremely difficult to come up with a skill that
humans use that doesntdepend on cognition in one way or another. As such, it is
no surprise that researchers and customers are enthusiastic about the prospect of
enhancing cognition; in theory, cognitive enhancement alone could drastically
improve ones performance in every aspect of life. In practice, however, it is not
that simple. The scientific community has not developed a bona fide smart pill
that substantially improves all six aspects of cognition, and it is unlikely that it ever
will. Cognitive enhancers instead tend to target one or two aspects of cognition in
particular. For example, some of the popular modern cognitive enhancers that are
often used treat Attention Deficit-Hyperactivity Disorder target attention and
cognitive executive functioning, whereas the forms of cognitive enhancement that
are being developed to slow or stop the onset of Alzheimers Disease tend to target
memory exclusively. Different types of cognitive enhancers can affect the brain in
many different ways, and each form of cognitive enhancement has a unique set of
ethical implications. Though it may be tempting to do so, to make a
comprehensive, sweeping judgment about the moral value of cognitive
enhancement would ignore the significant differences in efficacy, permanence,
effects, and ethical implications between the different types of cognitive
enhancement.
With a definition of cognition and the six cognitive abilities in place, we can
now turn to cognitive enhancement itself. Like cognition, the term cognitive
enhancement can entail a number of different types of treatments with varying
degrees of efficacy and feasibility. The safest and least effective form of cognitive
enhancers available today is found in a number of substances that fall into the
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category of nootropic agents. The term nootropic, derived from the Greek words
nous, meaning mind, and trepein, meaning to bend, was coined in 1972 by
Romanian chemist Corneliu Giurgea. Although the definition has changed
substantially since it was coined, Girugeas original definition is a fairly accurate
description of what is characteristic of modern nootropics. Girugea defined a
nootropic drug as one that (1) enhances learning and memory, (2) enhances the
brains ability to resist conditions that tend to disrupt memory and learning such as
oxygen deprivation or intoxication, (3) protects the brain against physical or
chemical injuries, (4) improves the brains control of psychological and somatic
processes (i.e. improves cognitive executive function), and (5) has no substantial
side effects and very low toxicity. (Malik).
Since Girugea coined the term, many have neglected the fifth aspect of this
definition, declaring any pharmacological cognitive enhancer to be a nootropic,
even those that have profound side effects and risk factors associated with them.
Still others use the term only to refer to those substances that only increase the
availability of existing chemicals (e.g. Oxygen, enzymes, hormones, and
neurotransmitters) in the brain, rather than drugs that introduce a new chemical to
the brain in order to have an effect on cognition. For our purposes, we can discount
the second and third requirements of Girugeas definition, because the brains
physical and chemical resistance to damage does not is not an aspect of cognition
as we have defined it. Thus, we can consider nootropics to include all substances
that improve cognition in some way, however marginal, without any substantial or
noticeable side effects or risk factors.
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The idea of a pill that can enhance cognition without any side effects may
seem romantic and appealing to many, but the reality is that all nootropics that are
currently available only very marginally improve cognition. Examples of modern
nootropics include supplements, herbs, and vitamins that already enjoy widespread
use. The most common and popular nootropics are B-vitamin supplements and
Omega-3 fatty acids found in many supplements such as fish oil capsules as well as
herbal remedies such as ginseng and Gingko biloba. Although these nootropics
improve cognitive function, they will not dramatically turn an average human into a
genius, and their effects on cognition are typically not significant enough to be
noticeable.
More significant cognitive enhancement can be found in the (usually illegal)
use of pharmaceuticals initially developed to treat mental disorders as a means of
temporarily improving cognition. Most of these pharmaceuticals were initially
developed to treat dementia, Alzheimers Disease (e.g.donepezil, ampakines),
Attention Deficit Hyperactivity Disorder (e.g. amphetamine, methylphenidate,
atomoxatine, pemoline), narcolepsy (e.g. amphetamine, modafinil), depression (e.g.
fluoxetine), hypertension (e.g. propanolol), or mental retardation. (Whitehouse).
Just as these drugs were found to bring those with cognitive deficits up to a normal
cognitive level in other words, to cognitively enhance such individuals many
have found that taking such drugs can bring an individual with normal cognitive
capacities to enhanced levels. Besides nootropics and caffeine, pharmaceutical
treatments for cognitive limitations are the most prominent and most widely
discussed class of cognitive enhancers today. Most cognitive enhancers that are
being developed today are emerging from efforts intended to effectively treat
severe mental disorders but among the bioethical community, these kinds of
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cognitive enhancers are less interesting than hypothetical future forms of
enhancement that are more powerful and more permanent.
The forms of enhancement we have discussed so far are a far cry from the
dramatic, futuristic, and powerful forms of enhancement depicted in films such as
Flowers for Algernon, in which a revolutionary form of neurosurgery enhances a
mentally retarded adult into a genius whose intelligence comes to exceed that of
even the researchers who enhanced him and the 2011 thriller Limitless," in which
a failing writer begins taking a pill that allows him to access 100% of his brain,
rather than the usual 20%. (It should be noted that it is an urban myth that humans
only use 20% of their brains; brain imaging techniques have in fact demonstrated
that no significant part of our brain goes unused. To only use 20% of a brain as
complex as ours would constitute a very inefficient allocation of ones energy, and
such inefficiency is almost always selected against by evolutionary pressures. The
mechanism of cognitive enhancement depicted in Limitless is not the way that
any of the forms of enhancement we are discussing here enhance cognition. This
mechanism of enhancement has different ethical implications about identity and
fairness, but we need not consider it.) The disappointing reality is that no such
wonder drugs exist today, and it will be a long time before we come close to these
fantasies. Cognitive enhancement technology is rapidly advancing, though, and
although more profound modes of enhancement are not yet available, ethicists are
obligated to consider what cognitive enhancement could mean to us in the coming
decades; current trends in the field indicate that someday, enhancement
technology could enable us to permanently alter our brain chemistry and cognitive
capacities, either through more advanced pharmaceutical agents or by way of
neurosurgery or genetic engineering. In this way, we might be able to someday
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fundamentally alter the way an individual thinks and functions. This is a profoundly
novel concept that raises a number of fascinating ethical issues, and the majority of
the debate surrounding cognitive enhancement in the neuroethical community is
futurological in nature; that is, it is concerned principally with ethical questions as
they apply to possible futures for humanity. We should be grateful that this is the
case, for it is far preferable to the alternative scenario, where new technologies and
scenarios must be confronted without any substantial ethical background with
which moral judgments can be made.
We cannot examine the implications of technologies that aim to permanently
change the way our brains work without also making some mention of the
intellectual and cultural movement known as transhumanism. In the strictest
sense, transhumanists affirm that humanity will someday have the technology
available to fundamentally alter the human condition by eliminating aging and
greatly enhancing physical and cognitive capacities and that when this technology
is available, we ought to embrace it and make it widely available. Transhumanists
seek to facilitate humanitys transition into a posthuman future in which some or
all descendents of todays humans have been so profoundly altered that they no
longer resemble normal humans and can be more accurately be classified as a new
species of posthumans. Transhumanism is concerned with much more than just
the prospect of powerful and lasting cognitive enhancement techniques, but a
significant portion of philosophical debates about the merits of transhumanism are
important to developing an ethics of cognitive enhancement, because as humanity
approaches the transhumanists ideal future, the relevant questions will be less
concerned with the ethics of enhancement in general and more concerned with the
implications of crossing species boundaries and relations between humans and
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posthumans. It would be nave of us to make sweeping judgments about cognitive
enhancement in a general sense, for to do so would be to ignore the massive
differences in efficacy, permanence, and effects of different kinds of cognitive
enhancement. At the same time, we cannot neglect any of the different levels of
cognitive enhancement if we are to conduct a comprehensive ethical analysis of the
topic. Each different form of cognitive enhancement compels us to ask different
ethical questions about what we should be able to do to enhance our own
capacities, and each deserves its own thorough ethical evaluation.
At what point does cognitive enhancement cease to be therapeutic?
A distinction that is of great relevance in defining and ethically evaluating
cognitive enhancement is the distinction between therapy and enhancement. We
generally define therapeutic treatment as treatment that fixes a problem, disorder,
disability or disease in an individual to bring him or her back to normal function.
Enhancement, on the other hand can be defined as treatment that improves the
positive health of individuals who would have otherwise functioned at normal levels.
(McMahan). Very few ethicists have the audacity to question the belief that the
severely disabled are entitled to therapeutic enhancement and that society is
obligated to provide it to them. As our thinking goes, the severely disabled do not
have the same opportunity and potential for success that the rest of the population
has, and therapeutically enhancing such individuals, if not a moral imperative, is at
least morally defensible on the grounds that such therapeutic enhancement is
necessary to preserve the principle of equality of opportunity that is integral to
Western culture. On the other hand, moral critiques of cognitive enhancement
beyond the societal norm are abundant in the neuroethical community. Whereas
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therapeutic enhancement restores fairness and equality, enhancement beyond the
norm, it is said, undermines these principles.
It is tempting to accept this dichotomy at face value, as evidenced by the fact
that the two of the most notable cultural assessments of cognitive enhancement,
Flowers for Algernon and Limitless, come out decidedly against cognitive
enhancement and associate it with greed, arrogance, and the allegedly impersonal
and dehumanizing nature of modern science. Some scholars would even go so far
as to claim that this distinction between therapy and enhancement alone gives us
the only relevant moral constraint on cognitive enhancement. Therapeutic
enhancement, they claim, is inherently noble, and enhancement of the healthy is
inherently wrong, regardless of the circumstances. Such a view is expressed by
bioethicist Karen Bramstedt, who concludes her paper analyzing childrens use of
caffeine as a cognitive enhancer by declaring that she has figured out the answer to
all our questions about cognitive enhancement:
The test for whether or not cognitive enhancement is cheating is the
concurrent presence or absence of a clinically diagnosed cognitive deficit. In
the presence of such a deficit, drug-mediated cognitive enhancement is not
cheating but rather correction of a medical problem. In the absence of such a
deficit, drug-mediated cognitive enhancement is a form of cheating because
it circumvents the honest way of attaining excellencethat is, diligent
study. (Bramstedt).
In other words, Bramstedt claims that therapeutic enhancement is okay because
(by definition) it is a correction of a medical problem, but enhancement beyond the
norm is cheating, because it circumvents the necessity to study and work hard to
achieve excellence. Theres a reason why this reasoning seems so intuitive and
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taking fish oil capsules every morning? We cant avoid the fact that different forms
of cognitive enhancement require different ethical analyses, and we cannot wrap up
all of the hairy ethical issues that the topic brings up in a simple and intuitive
statement.
Most importantly, though, we cannot rely on the therapy-enhancement
distinction, as Bramstedt does, in order to construct a robust set of ethical
standards concerning cognitive enhancement, because the line that separates
therapy from enhancement turns out to be a very blurry one, and its difficult to
decide exactly where this line should be drawn. Consider the following scenario: A
man who in most respects can be considered normal begins to feel depressed.
After undergoing a psychiatric evaluation, he learns that he does not meet the
diagnostic criteria for clinical depression. For simplicity, let us assume that his
depression cannot be attributed to any other psychiatric disorder, and he just
happens to be experiencing low-grade, sub-clinical depression, an everyday reality
for countless people. Unable to obtain a treatment for his depression from a
psychiatrist, he goes about illegally securing prescription antidepressants, which
eliminate all traces of his depression, and enable him to approach everyday
challenges with a newfound enthusiasm and positive attitude. Are we to consider
the mans nonmedical use of antidepressants as treatment or enhancement, and to
what extent are his actions morally justifiable?
Bramstedts ethical standard specifically defined the permissibility of
enhancement to be contingent upon the presence of a clinically diagnosed
cognitive deficit, which would classify the mans actions as enhancement, not
therapy, making them morally objectionable in Bramstedts view. Many would
agree that, since antidepressants are intended to treat those who are clinically
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depressed, one should not take them without being diagnosed as such. There is an
important difference, however, between the competitive academic setting in which
Bramstedt discusses the therapy-enhancement divide and the setting of our
thought experiment. Bramstedt objects to cognitive enhancement of the healthy
because it circumvents the honest way of attaining excellencethat is, diligent
study. Her argument rests on the judgment that there is virtue inherent in the
non-enhanced experiences that enhancement avoids: in this case, diligent study
as a means of attaining academic excellence. Although this is a relatively
unsupported normative statement, such statements cannot be avoided entirely in
any meaningful ethical argument, and, more importantly, the virtue of hard work is
a significant element of Western culture that is espoused by many. Bioethicist D.
Gareth Jones, however, questions whether we can assign virtue to the non-
enhanced experiences that the sub-clinically depressed man avoided by enhancing
himself:
If [sub-clinical depression] is not an illness, are some of the treatments
illustrations of enhancement? If this concerns us, it follows that if some forms
of depression are normal, then we should refrain from treating them.
However, is there any virtue in living with sub-clinical depression if it can be
treated? What we are beginning to encounter here is the very fine line
between the normal and the pathological. (Jones).
There is no apparent reason to believe that living with sub-clinical depression is
virtuous, and it is doubtful that anyone holds such a view. It may seem like this
thought experiment concerning depression doesnt apply to our analysis of
cognitive enhancement as we have defined it; after all, mood is not one of the six
aspects of cognition we are looking at. However, a strong case can be made
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arguing that mood is intimately entwined with cognitive executive functioning, if
they are not the same thing. Regardless of whether or not we accept this
argument, though, this thought experiment has some unexpected implications if we
apply the same reasoning to enhancements of other aspects of cognition. What if
the man suffered not from depression but instead from poor reasoning skills? Let
us assume, as we did before, that the man does not meet diagnostic criteria for any
psychological disorder, and that the man is just dull, as are countless others. Would
he be justified in nonmedically securing a (hypothetical) treatment for mental
retardation that substantially increases intelligence and reasoning skills? Here, it is
even more intuitively appealing than it was in the last scenario to conclude that the
mans actions in enhancing himself were unethical. If we reflect on this though,
such a conclusion turns out to be just as irrational; are we really prepared to claim
that it is virtuous to live life as a fool?
Since treatment and enhancement are both defined in terms of notions of
normalcy and pathology, the very fine line between health and disease is
accompanied by an equally fine line separating therapy from enhancement, and
such a distinction is not a good foundation from which to develop an ethics of
enhancement especially considering the fact that the bioethical community seems
to be wholly unable to come to a consensus on where the line between disease and
health should be drawn:
. . . it is not necessary, and indeed it is probably fruitless, to try to draw a
conceptual line between legitimate treatment and nonmedical
enhancements by trying to limit the former to curing diseases and the latter
to improving positive health. The concept of disease is notoriously elastic . . .
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an appropriate line can be drawn simply by striving to allocate fairly medical
services within a population. (Whitehouse).
This system of bioethics, developed by James Sabin and Norman Daniels, does a
somewhat better job than Bramstedts generalization does in defining the line
between treatment and enhancement, and exploring cognitive enhancement
through this ethical lens sheds light on some of the deeper ethical issues
surrounding cognitive enhancement that Bramstedts model glosses over. Whereas
Bramstedts framework depends on a simplistic and relatively arbitrary assignment
of virtue to hard work and diligent study as a basis for her normative judgments,
Sabin and Daniels model relies on the principle of equality of opportunity as a
normative foundation. Although there is a case to be made that this principle is
arbitrary as well, it is nonetheless a more sophisticated, more agreeable, and more
universally accepted ethical foundation than is the virtue of hard work, which is why
Sabin and Daniels normal functional model of medical necessity is popular and
widespread among bioethicists. It turns out that Sabin and Daniels model does run
into problems, because it is exceedingly difficult to define the concept of species-
typical function on which the model is based, but this is beyond our concern.
Should the cognitively disabled be enhanced?
Until now, we have made the assumption that therapeutic enhancement is
always permissible due to the fact that such a view is held by an overwhelming
majority of bioethicists. However, Jeff McMahans Cognitive Disability and
Cognitive Enhancement introduces a novel way of looking at therapeutic
enhancement by evaluating it in the setting ofprenatal cognitive enhancement of a
cognitively disabled fetus, allowing him to persuasively argue that the virtue of
therapeutic enhancement, at least in this context, is nowhere near as strong as we
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might think it is, and other, stronger moral imperatives might take precedence over
therapeutic enhancement in certain situations. McMahan begins by establishing
what sort of conclusions we would come to about prenatal enhancement if we were
to assume that our intuitions about the difference between therapy and
enhancement were accurate, as Bramstedt does:
Most people . . . seem to believe that there is no moral reason to enhance
the future cognitive capacities of a cognitively normal fetus, and perhaps
even a reason notto, at least by genetic means. Yet even those who claim
that disabilities are not misfortunes tend to concede that there is a moral
reason, if possible, to enhance the cognitive capacities of a fetus that would
otherwise be cognitively limited, and to do so for its own sake. [his italics].
(McMahan).
The relevant difference between the conventional ethical evaluation of
enhancement and McMahans approach is that, whereas until now we have only
been forming judgments about the extent to which an individuals conscious choice
to enhance himself is morally defensible, we are now faced with the challenge of
actually making this choice for a cognitively limited fetus, and we thus have to
evaluate prenatal enhancement in terms of the desirability of the different possible
outcomes that could come about by enhancing such a fetus or refraining from doing
so.
There are three different interests we have to consider in this thought
experiment: the interests of the fetus, the interests of the individual that the fetus
would grow into, and impersonal, societal interests. Based on the fetuss interests
alone, it seems at first glance that we could quite easily develop an ethical
argument for enhancing a cognitively limited fetus: although it is debatable whether
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a life with cognitive disabilities is inherently worse than a cognitively normal life, it
is relatively noncontroversial to contend that the fetus would have more dimensions
of well-being accessible to it if it grew into a cognitively normal adult than it would
have otherwise. Therefore, the outcome of enhancing the fetus is better for the
fetus than the outcome of not enhancing it, and we can therefore conclude that it is
morally good to enhance the fetus to serve its own interests. McMahan does not
object to the conclusion that therapeutic enhancement is morally good but he
does object to conventional beliefs about how morally good it is.
It is difficult, if not impossible, to quantify the normative values that we
assign to different outcomes, but this does not mean that we cannot develop a
means for comparing moral obligations derived from future interests. McMahan
surmises that the difference in value between the two possible lives determines
the strength of the individuals present interest in the better of the two, which
would mean that the magnitude of the moral obligation to enhance a cognitively
limited fetus is proportional to the difference between the better outcome, a
cognitively normal life, and the worse one, a cognitively limited life but this way
of understanding the strength of the fetuss interest . . . is misleading. (McMahan).
McMahan contends that noting the difference in value between two outcomes is not
enough to fully evaluate how strong an individuals interest is in the better of two.
In order to more accurately model an individuals future interests, the difference in
value between outcomes must be measured based on what McMahan calls time-
relative interest.
McMahans model of time-relative interest essentially posits that any value
judgment about the appeal of a certain future to a certain individual should be. . .
discounted for the degree of psychological discontinuity between [the individual]
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now and [the same individual] in the future . . . (McMahan). In other words, the
more psychologically distant an individual is from the outcomes in question, the
weaker that individuals interests in that outcome are. Typical theories of rational
self-interest in economics and some fields of ethics assume that identity is constant.
With this assumption in place, the extent to which a thing will satisfy an individual
once he or she attains it can be measured by the magnitude of the individuals
current desire for that thing. In reality, though, identity is not constant, even if we
act and think under the assumption that it is. While this may not matter in
economics, it is of great importance both in evaluations of cognitive enhancement
and in ethical debates that concern the interests of unborn fetuses.
The notion of a variable identity may seem counterintuitive at first. Ask
yourself, though: can you really say with confidence that you are the exact same
person today as you were as a newborn? Of course, if we are to accept the
conventional view of identity at face value, then we certainly can say this but if we
consider identity to be defined by the sum of psychological characteristics, the
question becomes: can any of us say with confidence that he has the exact same
psychological characteristics today as he had as a newborn? We obviously cannot
say this, for if that were the case, we would have had the same memories, skills,
preferences, and perceptions when we were newborns as we have at the present
moment. If we abandon the conventional notion of identity, it is clear that we do
not have the same identity today that we had as infants. The psychological
discontinuity between a given individual as a baby and the same individual as an
adult is comparatively massive; we could perhaps even conclude that some of our
peers who are the same age as us are closer in identity to us than our present
selves are to ourselves as babies.
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Now that we have established that a stricter definition of identity forces us to
conclude that identity changes as an individual grows, we can come to an intuitive
understanding of McMahans time-relative interest through another thought
experiment. Assume you are offered some large amount of money to spend
however you want with the condition that, if you accept this money, it is guaranteed
that you will die painlessly and instantly in ten years, no earlier and no later. This
offer will only be available for the next five minutes and will never present itself
again. How much money would have to be offered for you to accept it? Many
would say that no amount of money is enough to counteract such a shortening of
ones lifespan. What if, though, you were guaranteed to die not after ten years, but
instead after eighty years? Those who would have accepted a large amount of
money in the first scenario would probably accept the offer in the second scenario
for much less money, and those who refused the first offer would probably be much
more inclined to accept the second offer for some large sum of money. Indeed, it is
very likely that countless individuals would pay large sums of money to guarantee
an additional eighty years of life, even if in doing so they had to literally guarantee
their death at a certain point. The reason why we are much more inclined to accept
the second offer for a given amount of money than we are to accept the first offer
for the same amount is because, although our interests in not dying will be roughly
the same in ten years as they will be in eighty years, our present time-relative
interests in not dying are much stronger for the first offer than they are for the
second offer. Even on an emotional level, this phenomenon tends to hold true; our
fear of imminent death is one of the most powerful and profound emotions we can
ever experience, but our fear of eventual death is much more abstract and
detached, and is lesser in magnitude as a result.
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Despite the strength and philosophical utility of McMahans model, time-
relative interest is something of a misnomer. Factors other than time can cause
psychological discontinuity, such as cognitive enhancement. With this in mind, we
can return to McMahans thought experiment and apply the notion of time-relative
interest to evaluate the strength of the moral obligation to enhance a cognitively
limited fetus, if we can still say that one exists. We already determined that,
without taking into account psychological discontinuities, a cognitively normal life is
better than a cognitively limited one. The psychological discontinuity between any
fetus and any adult into which it will develop is great; it is for this reason that the
question of the permissibility of aborting a fetus is so much more complex and
controversial than the question of the permissibility of murdering an adult. This
psychological discontinuity diminishes a limited fetuss interests in a cognitively
limited life as well as its interests in a cognitively normal life, and the fetuss
interest in living a cognitively normal life is furtherdiminished by the psychological
discontinuity caused by cognitively enhancing the fetus. Because the psychological
discontinuity between the cognitively limited fetus and itself in the future with or
without enhancement is so large, McMahan is able to conclude that a cognitively
limited fetuss comparatively weak interest in having normal cognitive capacities as
an adult grounds only a weak moral reason to provide it with cognitive
enhancement.
McMahans model is a powerful one, but it does have one fatal flaw that could
invalidate our entire analysis. All of McMahans judgments about an individuals
interests in some action being taken have been evaluated in terms of that
individuals interests in the outcome of that action. What McMahan fails to answer
is this: when exactly is the outcome? McMahan makes the arbitrary decision to
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evaluate the fetuss interests in terms of the quality of the fetuss life after it has
developed into an adult, but what would happen to his conclusions if we instead
defined the outcome to be the moment right after childbirth? This would greatly
diminish the psychological discontinuity between the fetus and itself at the time of
the outcome that weakened the moral imperative to enhance the fetus, making the
resulting moral imperative to enhance the fetus much stronger. On the other hand,
if we extend the outcome far enough into the future, the outcome will be the
same no matter what: death. If this is where we define the outcome, this method
of analysis would find no discrepancies whatsoever between any two given future
timelines!
Fortunately, we can easily fix the model to avoid this problem. To do so, we
will not evaluate an individuals interest in a particular action being taken in terms
of the desirability of the outcome, but instead in terms of the sum of the
individuals interests in all moments in that individuals life in the timeline that is
brought about by taking a particular action, after diminishing each of the terms of
this sum by the appropriate amount due to psychological discontinuity. This way,
we avoid the ambiguity brought up by McMahans negligence to clearly define how
to determine when the outcome is, and our analysis takes into account the results
of defining the outcome at any moment in the rest of the individuals life.
Although McMahans model has allowed us to make a strong case against the
intuitive belief that there is a strong moral imperative to enhance a limited fetus,
our entire analysis thus far has been conducted in the context of McMahans original
thought experiment that aimed to determine the moral value ofprenatal
therapeutic enhancement. One might think that this would mean that we cannot
generalize the conclusions of our analysis to questions of therapeutically enhancing
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individuals who have already been born. Recall, though, that we have only been
evaluating the strength of the first of the three different interests that might ground
a moral imperative for prenatal therapeutic enhancement: the interest of the fetus,
as it exists at the present moment, in living a cognitively normal life. To figure out
how our judgments about prenatal therapeutic enhancement would apply to
cognitively disabled individuals after they have been born, we need only turn to the
second of the three interests that need to be considered: the interest of the
individual into whom the fetus will develop.
The two outcomes under consideration remain the same; the individual will
either live a cognitively normal life or a cognitively limited one. The magnitude of
the future adult individuals interest in the fetus receiving enhancement, then, is
measured in almost exactly the same way. As was the case when measuring the
fetuss interest, the magnitude of the adult individuals interest in prenatal
enhancement is proportional to the difference in value between the two outcomes.
Since the outcomes under consideration here are the same as before, this step in
the analysis does not reveal any distinctions between the interest of fetus and the
interest of the adult in prenatal therapeutic cognitive enhancement. Unlike the
fetus under consideration, the adult under consideration is not separated from the
outcomes we are considering by time or by biological development, and the adults
interests in prenatal enhancement are therefore not weakened by psychological
discontinuity in this respect. However, the psychological discontinuity caused by
cognitive enhancement still applies, and this discontinuity will also weaken the
adults interests in being enhanced. Thus, the adult into whom the fetus will
develop does have a weak interest in prenatal enhancement of the limited fetus,
but it is not as weak as the interests of the fetus itself in being enhanced.
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We will now concern ourselves with the question of how the interest in
therapeutic enhancement will change if the cognitively limited individuals under
consideration have already been born and now have the option of being
permanently enhanced. In order to approach this question with the same method
of analysis we have used to evaluate prenatal enhancement, let us make the
assumption that the individual under consideration is so severely cognitively limited
that we must make decisions for it, as we did for the fetus. As it turns out, there is
no difference whatsoever between the interest that the individual into whom a
cognitively limited fetus will develop has in prenatal cognitive enhancement and the
interest that a cognitively limited individual has in post-birth therapeutic cognitive
enhancement, because in the eyes of the ethical test we are using, the two
scenarios are exactly the same; the outcomes that we are deciding between are still
a cognitively limited life and a cognitively normal life; no significant psychological
discontinuity arises from differences in time or biological development between the
individual whose interests are under consideration and the individual who will
experience the outcomes under consideration, but the ultimate moral imperative to
enhance is weakened in both cases by the psychological discontinuity between a
cognitively limited and a cognitively normal mind. We can therefore conclude that
any moral obligation to enhance a cognitively limited individual will be a weak one
but how weak will it be?
The moral imperative to enhance was weakened due to the significance of
the difference between the individuals psychological state before enhancement
and after enhancement. It follows, then, that the moral imperative will be
weakened more when this difference is greater. We must not forget, though, how
McMahan initially assigned normative value to a given action: . . . the difference in
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value between the two possible lives determines the strength of the individuals
present interest in the better of the two. Although more powerful forms of
enhancement yield greater psychological discontinuity between pre-enhancement
and post-enhancement states, weakening the moral imperative to enhance, they
also yield a greater difference in value between the two possible outcomes,
strengthening the moral imperative. I will not take on the task of determining which
of these effects is stronger, but it suffices to say that all forms of therapeutic
enhancement, regardless of efficacy, are especially limited in virtue and
relative importance, owing either to the insubstantial amount by which they
improve the lives of cognitively disabled individuals or to the psychological
discontinuity between the cognitively limited individual before and after
enhancement. It may seem that, in making this judgment, weve lost sight of the
precautions and standards for analysis that we deemed so important earlier: It
would be nave of us to make sweeping judgments about cognitive enhancement
in a general sense, for to do so would be to ignore the massive differences in
efficacy, permanence, and effects of different kinds of cognitive enhancement, but
notice that, unlike Bramstedt, we have considered the varying degrees of
enhancement in our analysis, and we have put forth an argument for why the same
judgment will hold true for all of them, so we are justified in making a generalized
conclusion about enhancement in the abstract.
Some might point out that although we have developed a very robust
argument against conventional beliefs about therapeutic enhancement, we have
only proved that the moral imperative to therapeutically enhance is weak, not that
it does not exist at all. Proving this may seem like a pointless exercise, but even
relative claims about the moral value of medical procedures can be very useful and
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can have important applications. As of now, our society makes a number of implicit
judgments about the extent to which we are morally obligated to help people with
disabilities, including the cognitively disabled. These judgments are manifested in
the amount of taxpayer money that we have decided to allocate to government
programs like Medicaid and Medicare, which have to treat many cognitively
disabled individuals, relative to other taxpayer-funded services. It is worth the
effort to work through this ethical analysis of therapeutic enhancement, because,
with a new understanding of the relative importance and virtue of therapeutic
enhancement, we might decide that we ought to re-evaluate the way we currently
allocate government resources to therapeutic enhancement relative to projects that
fulfill other societal goals. Our conclusion, like most bioethical conclusions, might
have comparably important applications for private insurance companies and
hospitals as well.
Should we want to enhance ourselves?
The power of McMahans model is apparent in the way that it allowed us to
generalize our conclusions about therapeutic enhancement to both fetuses and
grown humans and to all different forms of enhancement. If this analysis can cross
firm and substantial boundaries like the boundary between the interests of a fetus
and the interests of a person and the boundary between nootropics and
transhumanist, species-altering, cognitive enhancement technology, then perhaps it
can also traverse a boundary that we have shown at length to be blurry, thin,
ambiguous and elusive: the line between therapy and enhancement. If we are to
consider the same amount of cognitive enhancer being used both to bring a
cognitively limited person to a normal cognitive level and to bring an average
person to an enhanced level, then theres actually nothing whatsoever that
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distinguishes therapy from enhancement; although the outcomes being considered
are different, the difference in value between enhancing and not enhancing from
which the magnitude of interest in enhancement is being measured is the same for
therapeutic enhancement as it is for enhancement beyond the norm. Similarly, the
degree of psychological discontinuity between the unenhanced individual and the
enhanced individual, and thus the extent to which these interests are weakened is
the same for therapy as it is for enhancement. A cognitively normal individuals
interest in being cognitively enhanced is thus the same as a cognitively
disadvantaged individuals interest in being therapeutically enhanced. The average
persons interest in cognitive enhancement beyond the norm is not associated with
a proportionally strong moral obligation, as was the case with therapeutic
enhancement, because in this case we are not exploring what is best for others but
instead what is in our own best interest. Nonetheless, the conclusions we were able
to draw about what is in the best interests of a cognitively limited individual apply in
the same way to the best interests of cognitively normal individuals. This means
that although normal individuals do have an interest in being cognitively enhanced,
this interest is a weak one that is inferior to a number of other interests that the
cognitively normal may have to weigh as well in making decisions.
Those who find the idea of cognitive enhancement emotionally appealing
may dislike being told that their seemingly strong interests in enhancement are
actually relatively weak; for if this is the case, then why doesnt cognitive
enhancement only come off as weakly appealing? Before moving on, it would serve
us well to revisit why McMahans measure of time-relative interest is discounted by
psychological discontinuities. We have established that ones net psychological
state and, by extension, ones identity is not constant and will change as an
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individual grows. As a result, your identity a year from now may resemble your
identity today in most respects, but it will not be the same. Your identity in ten
years will be even less similar to your identity today, and this is why things that are
going to happen in a year tend to have more immediate emotional significance to
you right now than things that will happen in ten years. The more that the identity
of a future version of you differs from your current identity, the less you can
accurately call that person yourself. Any desire essentially comes down to an
interest in a future version of oneself experiencing some particular experience, for it
is impossible for us to satisfy our present desires in the past or in the present
(unless we are to act so fast that we instantly satisfy our desires the moment we
come up with them). This means that we pursue desires by trying to make
something happen for some future version of ourselves. Were not doing this out of
sympathy for our future selves, whom we have never met and might not know
anything about; if that was the case, wed be just as inclined to purchase a meal for
a person sitting on the opposite side of a restaurant at which we were eating as we
would be to purchase a meal for our (future) selves. We are still acting out of self-
interest, but our actions only fulfill our self-interest to the extent that the future self
psychologically resembles the present self. If one goes about trying to achieve
some goal at age 15, but by the time this goal is achieved, three years have passed
and 50% of the individuals brain has changed, then we might say the 15-year old
only experiences 50% of the satisfaction that would have been experienced if the
goal had been achieved instantly. The amount that an individual psychologically
changes before attaining a goal is inversely related to the extent to which that
individual enjoys the full benefits of attaining that goal.
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Putting this in terms of cognitive enhancement, we can conclude the efficacy
of the cognitive enhancer being used is inversely related with the extent to which
our present selves will enjoy the benefits of being enhanced. If Harold takes a weak
nootropic cognitive enhancer at 3:00 that only marginally enhances his cognition,
Harold at 3:01 will only be a slightlydifferent person than Harold at 2:59, and the
2:59 Harold enjoys almost all of the benefits from the nootropic that the 3:01 Harold
experiences. In contrast, if Sara undergoes a reconstructive neurosurgical
procedure from 3:00 to 4:00 that dramatically improves her memory, then Sara at
4:01 will be a substantially different person than Sara at 2:59. As a result, although
the 4:01 Sara will experience all of the benefits of the surgery, the 2:59 Sara
experiences significantly less of these benefits, and the fraction of the total benefit
(i.e. the benefit that the 4:01 Sara will experience) that the 2:59 Sara enjoys is less
than the fraction of the total benefit that the 2:59 Harold enjoys, because the
psychological discontinuity between 4:01 Sara and 2:59 Sara is greater than the
psychological discontinuity between 3:01 Harold and 2:59 Harold. It may seem
strange that we must be so insistent on evaluating what portion of the benefits 2:59
Harold and 2:59 Sara experience despite the fact that the treatments do not
begin until 3:00. Of course, the corporeal individuals that can be called Harold
and Sara at all times (We must make sure that we maintain a tone that
implements our stricter definition of identity, even though the conventional notion
of identity is so intimately tied with the use of names in our culture that doing so
seems a bit absurd and awkward at first.) will not literally experience the benefits of
their treatments at 2:59. To understand this, we need to think of 2:59 Harold, 2:59
Sara, 3:01 Harold, and 4:01 Sara to be four distinct individuals while simultaneously
assuming that 2:59 Harold and 2:59 Sara arepartially preservedbeyond their
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instantaneous moments of existence as distinct identities and incorporated into the
identities of 3:01 Harold and 4:01 Sara, respectively. We cannot simply evaluate
the treatments in terms the benefits that 3:01 Harold and 4:01 Sara experienced,
because we are not trying to figure out how cognitive enhancement will benefit
anyone at all we are trying to intuitively understand how cognitive enhancement
will affect the individuals that exist before enhancement. Since the ethical analysis
is conducted before any enhancement occurs, the 2:59 versions of Harold and Sara
are the only relevant individuals who actually exist, and the only individuals whose
interests in enhancement matter in our analysis. As we can see, our conclusion that
there are only weak reasons for a healthy individual to cognitively enhance himself
or herself does not disregard the emotional appeal of being cognitively enhanced.
This appeal is represented by 2:59 Harolds interest in experiencing what 3:01
Harold will experience and 2:59 Saras interest in experiencing what 4:01 Sara will
experience. The reason why the 2:59 individuals interests in deciding to enhance
themselves are not the same as their interests in experiencing what the post-
enhancement individuals will experience is because making this decision will not
bring about those experiences for the 2:59 individuals at least, not entirely. This
is the crucial point to understanding why McMahans model works on an intuitive
level, and it requires us to distance ourselves from the conventional notion of
identity as much as possible. Thus, the forms of enhancement that are effective
enough to be strongly emotionally appealing to you should actually be no more
rationally appealing to you than the weaker forms of enhancement, because the
extent to which you would get to see the benefit of this enhancement is much
less for more effective cognitive enhancers.
Is cognitive enhancement fair?
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We may have established that cognitive enhancement is desirable to us,
even if it is to a very weak extent. The strongest ethical problem cognitive
enhancement faces, though, is that of fairness. Our society is dedicated to
protecting the principle of equal opportunity for all, which was the moral principle
behind the imperative to provide therapeutic enhancement to the cognitively
limited. Does permitting cognitive enhancement undermine equality of
opportunity? After all, cognitive enhancement gives some individuals an
improvement in cognitive abilities that we could be expect to be accompanied by an
increase in opportunity. If some individuals are able to increase their opportunity
through enhancement, do we have a responsibility to ensure that everyone can
increase their opportunity by the same amount? To determine how the bioethical
community would approach this question, it benefits us to turn to a similar ethical
debate that has already been well-developed and well-publicized: that of the
permissibility of the use of anabolic steroids as athletic enhancement in professional
sports.
Those arguing that athletic enhancers should be allowed usually argued not
that athletic enhancement itself was morally permissible, but instead that individual
liberty should allow athletes to use anabolic steroids if they wish, or that a ban on
steroids is unenforceable or would have negative consequences. There is a case to
be made, though, that using athletic enhancers, even within competition, is in and
of itself morally justifiable. How could this be the case? Because, some argue,
athletic enhancement is already an important part of competitive sports. Most
runners would run a faster mile wearing running flats than they would barefoot.
Most baseball players would play a better game after weeks of training than they
would after a year of vacation. Hockey players who want to win often seek out the
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best brands of skates and sticks they can find. Anabolic steroids allow athletes to
transcend their biological limitations and perform better but isnt this exactly the
purpose of using better running shoes, better training techniques, and better
hockey sticks? In effect, tools, training, and dieting techniques all can be said to fall
under the label of athletic enhancement. Why should steroids be treated
differently?
To determine if there is any morally relevant distinction between standard
use of tools and training as enhancement and the use of anabolic steroids and other
pharmaceuticals as enhancement, we first have to decide whether we aim to
measure participants objective abilities or participants abilities relative to their
competitors. In competitions like the shot put and the long jump, players receive
objective scores which measure participants innate abilities. In competitions like
the SAT, however, a test which assigns participants a normalized score that
measures a participants location in the distribution of all participants scores on
that particular test, or in two-team competitions like baseball, basketball, and
football, we are not concerned with measuring innate ability, only relative ability.
Next we must determine whether the form of enhancement in question
fundamentally changes an individuals demonstration of competency in the respect
we which to measure it in. The introduction of fiberglass poles to pole-vaulting
dramatically increased the heights that vaulters could reach and forced them to
alter their technique, but they were permitted perhaps because they didn't
change the fundamentals of the sport. If somebody wanted to wear roller skates to
the Boston Marathon, however, it'd be hard to argue that the benefits provided are
analogous to those provided by air-cushioned running shoes or running flats,
because roller skates would dramatically change the fundamental meaning of the
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sport. Whether or not anabolic steroids change athletes demonstrations of
competency is still debatable, and is different for each sport, but the majority of
sporting institutions continue to prohibit them.
To evaluate whether cognitive enhancement would be unethical in cognitive
competitions, like chess matches, spelling bees, and the SAT, we have to look at
what it is we value in the contest itself, and whether the use of enhancers changes
the participant's attempt at demonstrating competency in that respect. The use of
calculators as a means of effective cognitive enhancement on the SAT is not
prohibited, because the SAT aims to measure relative ability, and The College Board
has determined that, provided that all students taking the test have access to them,
calculators do not change students demonstration of relative ability.
In light of our analysis of the time-relative merits of cognitive enhancement,
we ought to point out a peculiar implication of enhancement in the competitive
context that must be considered when the contest measures cognitive abilities
rather than athletic abilities. Because athletic enhancement usually affects the
body rather than the mind, the psychological discontinuity between a cognitively
enhanced individual and the same individual without enhancement does not apply
to athletic enhancement. As a result, there is no difference in identity between an
unenhanced and an enhanced athlete (unless one considers the body to be an
element of identity, which we have not done). As a result, if the enhancement
fundamentally changes the athletes demonstration of competency, the legitimacy
of the competition is threatened. Athletic enhancement changes ability but not
identity; the competition therefore would therefore assess the same individual more
favorably than intended. As we determined earlier, though, the psychological
discontinuity associated with cognitive enhancement changes an individuals
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identity to an extent that is proportional to the strength of the enhancer. The
competition therefore does not judge the same individual more favorably than
intended it instead judges a differentindividual with the same name and body as
the unenhanced individual more favorably than it intended to judge the unenhanced
individual. So although at first glance it may look like cognitive enhancement
qualifies as cheating, the way that cognitive enhancement changes identity means
that, in the strictest sense, it does not diminish the legitimacy of the competition
like athletic enhancement does. Of course, cognitive enhancement only partially
changes an individuals identity, so we cannot give cognitive enhancement a free
pass. The extent to which the legitimacy of the competition is threatened is,
somewhat counter-intuitively, greater for the least effective forms of enhancement.
At the same time, though, the least effective forms of cognitive enhancement will
have the least significant effect on the results. For each sport, the significance of
the effect on the results, the significance of the psychological discontinuity between
an unenhanced individual and the same individual after enhancement, and the
extent to which the enhancement fundamentally changes participants
demonstration of the factor we wish to measure must all be taken into
consideration in determining whether using a particular cognitive enhancer is
unfair.
Examining the issue in this manner calls our attention to an interesting
question which we can evaluate through another thought experiment. Assume a
chemical is developed that drastically improved reasoning skills, but there are only
enough resources to synthesize enough of this chemical for one person. The
government decides that this chemical should be given to a person randomly
selected from all babies born in the next year. Tom, who has an identical twin
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brother named Tim, is selected and receives the enhancer in infancy, developing
into a hyper-intelligent individual with extremely powerful reasoning skills. Tim, on
the other hand, is average in all respects. While in high school, the two twins take
the SAT on the same day. Tom scores a 2400, the maximum possible score, and
Tom scores a 1500, the average score. If we make the assumption that the
psychological differences between Tom and Tim significantly outweigh their
differences in score, then, according to our analysis, Tom deserves to outscore Tim.
Now assume that fraternal twins Tod and Rod take the same SAT test on the same
day. Tod is naturally smarter than Rod, so much so that Tod scores a 2400 and Rod
scores a 1500. Societal morals would imply that Tod deserves to outscore Rod, and
it was because of these societal morals that we were able to conclude that Tom
deserved to outscore Tim but why exactly does either Tod or Tom deserve to
outscore his twin? Both of them did not receive their advantage through hard work;
there is nothing in particular that would indicate that Tod and Tom are entitled to a
cognitive advantage more than Tim and Rod are. Before coming into existence, Tod
and Rod had the same chance of having such an advantage over the other, and
before the smart pill was randomly assigned, Tom and Tim had equal chances as
well. Does the fact that the distribution of cognitive advantage is random really
make it fair that some individuals are naturally smarter than others? To answer this
question, or to develop an ethical model that did not assume that it is fair that
natural advantages are distributed by a genetic lottery would be a daunting
philosophical task that I will not take on here, but this question deserves to be
asked, and further research ought to be conducted in this area. If we can reject the
fairness of the genetic lottery, then we can conclude that cognitive enhancement is
without a doubt unfair in cognitive competitions, but as long as our society does not
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take issue with the genetic lotterys distribution of cognitive advantages, some
forms of cognitive enhancement will have to be permissible.
Conclusion
Answering ethical questions about cognitive enhancement is an exceedingly
difficult endeavor, and it seems that the only way to responsibly develop an ethics
of cognitive enhancement is on a case-by-case basis. Intuition would tell us that the
only relevant distinction determining whether cognitive enhancement is permissible
is the distinction between therapy and enhancement but as it turns out, finding a
satisfactory definition of where this distinction lies is almost impossible. Ethicists
ought to abandon their fruitless pursuit of a line that cleanly divides permissible
therapy from contemptible enhancement, for there are much more sophisticated
ways to ethically evaluate cognitive enhancement that hold true for both therapy
and enhancement. Factors that need to be taken into consideration include the
efficacy and permanence of the form of cognitive enhancement under
consideration, the nature of the competition whose legitimacy is allegedly
threatened by cognitive enhancers, and the magnitude of psychological
discontinuity that enhancement causes.
All of this analysis has been conducted within a moral framework that has
questionable implicit assumptions. Our society currently has no issue with
rewarding some people more than others simply because some are more
genetically lucky. Although religion may see this issue differently, the extent to
which this assumption holds in a secular society is extremely questionable. To
maintain a consistent moral frame, ethicists have two options. We must decide
between accepting the fact that cognitive enhancement will sometimes be
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permissible or confronting the fact that our societal morals might be largely
founded on a fallacious assumption. The latter task is a formidable one, but we
have a responsibility as human beings with moral integrity to undertake it, even if it
means we might have to drastically restructure the way our society works. The
intuition of the layman may fiercely oppose such a transition, but, as we have seen,
intuition often comes to deeply erroneous conclusions about what is best for the
individual and for society. Attempts to question societal moral norms will
undoubtedly be labeled as sinful, reprehensible, wicked, and vile but let us not
forget why we undertake these tough ethical endeavors in the first place: to make
the world a better place for all who inhabit it.