How to Prescribe Smart Drugs to Children Ethically

Ilina Singh and colleagues argue that the use of drugs such as Ritalin among young people is becoming so common that family doctors should be able to prescribe them as study aids to school pupils aged under 18.(1)

While the Guardian article rather cherry-picks from the range of Singh’s arguments in her original article, I have made broadly similar arguments to those in the Guardian article supporting cognitive enhancement myself (see here for a selection on enhancement).

However, one might ask whether the prescription of enhancement for young children who are incapable of consenting for themselves raises unique issues. 

The limits to should be:

1. Safety – the drug should be safe enough and benefits clearly outweigh the harms

2. Harm to others – the drug should not cause the child to harm others, by for example, increasing violent behavior

3. Distributive justice – the delivery of the drug should not use up limited societal resources unfairly, for example, by consuming resources which would do more good if directed towards educational strategies

4. The parent’s choices are based on a plausible conception of well-being and a better life for the child

5. The effects are consistent with development of autonomy in child and a reasonable range of future life plans

These last two limits are important. It makes for a higher standard of “proof” that an intervention will be an enhancement because the parents are making choices for their child, not themselves. The critical question to ask is: would the change be better for the individual? Is it better for the individual to to be relaxed but failing and lazy or hardworking, successful and tense? We require good data on the effects on normal children and we won’t get this until we do proper double blind controlled trials on normal children. These questions are difficult to answer. While we might let adults choose to be take the risks themselves, and decide whether upsides outweigh the downsides, we should not let parents choose interventions which are harmful to their children, like denying them blood transfusions or cochlear implants. If smart drugs are as safe and effective as they appear to be, paradoxically, it may be harmful not to prescribe. There might be a moral obligation to provide smart drugs just as there is one to provide a cochlear implant to a deaf child.

There will be cases where some intervention is plausibly in a child’s interests: increased empathy with other people, better capacity to understand oneself and the world around, or improved memory. One quality is especially associated with socioeconomic success and staying out of prison: impulse control. If it were possible to correct poor impulse control, we should correct it. Whether we should remove impulsiveness altogether is another question.

Joel Feinberg has described a child’s right to an open future.(2) An open future is one in which a child a reasonable range of possible lives to choose from and an opportunity to choose what kind of person to be. That is, to develop autonomy. Some critics of enhancement have argued that genetic interventions are inconsistent with a child’s right to an open future.(3) Far from restricting a child’s future, however, some biological interventions may increase the possible futures or at least their quality. It is hard to see how improved memory or empathy would restrict a child’s future. Many worthwhile possibilities would be open. But is true that parental choices should not restrict the development of autonomy or reasonable range of possible futures open to a child. In general, fewer enhancements will be permitted in children than in adult. Some interventions, however, may still be clearly enhancements for our children and so just like vaccinations or other preventative health care.

Sometimes, you hear the argument that in the case of kids, decisions should be deferred until the child is old enough to decide for itself. This is right when waiting has not costs. But in the case of education, the horse may have bolted by the time the child is 16 or older, old enough to decide. That cost has to be weighed into the equation. Some choices cannot be reversed.

The key, as I have said, is to make these choices with a wide conception of what is plausibly good for the child and good data on the effects on smart drugs on that well-being. This requires a societal dialogue on what is a good life and the willingness to do scientific research on normal children in large numbers. The cost of not doing this is likely to be large numbers of children getting these drugs on the “grey market” with unknown and potentially serious side-effects. Or short-sighted, nervous policy makers banning them, with the potential huge opportunity costs.

Time to do some proper research.

1) Ilina Singh Neuroenhancement in Young People: Proposal for Research, Policy, and Clinical Management AJOB Neuroscience January 2010

2) Feinberg J. (1980) The child’s right to an open future. In: Aiken, W. and LaFollette, H. (eds) Whose Child? Parental Rights, Parental Authority and State Power Rowman and Littlefield, Totowa, NJ. pp124-53.

3) Davis, D., The right to an open future Hastings Center Report Mar/Apr (1997)

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One Response to How to Prescribe Smart Drugs to Children Ethically

  • John Jones says:

    Children can be persuaded to take drugs that can help them meet performance targets if we present them with tasks that they cannot fulfil. And parents can be persuaded to give drugs to their children if we tell them that their child is ill. This is what is happening today.

    One must then ask who is setting the tasks that require us to do more than we are naturally capable of doing and ought we to accommodate them?

    This is why it is important to undermine a person’s autonomy and happiness of self if we want to promote performance enhancing drugs. Only if people have a terminal sense of social failure and personal misery can they be expected to want to accomplish tasks that are naturally beyond them. Once they are infected with this angst of spirit then the idea of amelioration in the form of drugs is easily sold.

    Yet it is strange that while we subject children to drugs that make them reach performance targets on the grounds that it makes them happy, no such ethical due is given to children who just take drugs to be happy. The only difference is that in the former we claim a cure is being engineered, or, we are offering them mature choices. The choice is Hobson’s – rejection or the submission of autonomy to someone else’s values.

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