What are the ethics of using brain stimulation technologies for ‘enhancement’ in children?

New open access publication: announcement:

In a recently published article, Hannah Maslen, Roi Cohen Kadosh, Julian Savulescu and I present an argument about the permissible (and not-so-permissible) uses of non-invasive brain stimulation technology in children. We consider both children who may be suffering from a specific neurological disorder, for whom the stimulation is intended as a ‘treatment’, and those who are otherwise healthy, for whom the stimulation is intended as ‘enhancement’. For the full article and citation, see here:

Maslen, H., Earp, B. D., Cohen Kadosh, R., & Savulescu, J. (2014). Brain stimulation for treatment and enhancement in children: An ethical analysisFrontiers in Human Neuroscience, Vol. 8, Article 953, 1-5.

Although in previous work we have argued that the treatment/enhancement distinction tends to break down in the case of adults, in the case of children, we argue, it may have some normative force. Specifically: “As the intervention moves away from being a treatment toward being an enhancement—and thus toward a more uncertain weighing of the benefits, risks, and costs—considerations of the child’s best interests (as judged by the parents) diminish, and the need to protect the child’s (future) autonomy looms larger.” Of course, we don’t see either “treatment” or “enhancement” as having either a clear definition (in terms of what they pick out), or distinct ethical implications in and of themselves; rather, we see “treatment” as referring to interventions whose benefit-to-harm ratio is comparatively uncontroversial (with the benefits outweighing the harms), while we see “enhancement” as referring to interventions whose benefit-to-harm ratio is more heavily influenced by subjective factors.

One situation in which subjective factors might play a larger role in shaping one’s judgements about benefit vs. harm, is when a proposed intervention is likely to precipitate certain mental or physical trade-offs – i.e., the loss (or diminishment) of one capacity or feature as a means of gaining (or enhancing) another capacity or feature. In the case of non-invasive brain stimulation technologies, there is evidence that just such a trade-off may occur in some instances. To pick one example, due to the cognitive architecture of the human memory system, certain enhancements to, say, long-term memory may come at a direct cost to processes involved in short-term memory. Thus, how one personally values long vs. short-term memory will play a big role in determining how one evaluates the benefit-vs.-harm profile of an intervention into her memory system. As we argue:

Whilst adults are in a position to decide whether effect X is valuable enough (to them) to justify incurring impairment Y, children do not yet have the capacity or the life experience to make such trade-off decisions. They do not know what they will value when they grow up and nor do their parents. Whilst an intervention that improves X may count as an enhancement for the individual who does not care much about Y, another individual, valuing Y over X, will view the very same outcome as an impairment. In such cases—that is, cases in which the very status of an intervention’s being an (overall) enhancement vs. an impairment is controversial—the weight of considerations should shift toward delaying the intervention until the individual who will actually be affected by it has sufficient capacity to decide. The more permanent and substantial the trade-off, the more this argument has force.

For the full argument, along with relevant references, feel free read the entire paper, which is available open access here: http://journal.frontiersin.org/Journal/10.3389/fnhum.2014.00953/full.

For related arguments about diminishment vs. enhancement, see:

Earp, B. D., Sandberg, A., Kahane, G., and Savulescu, J. (2014). When is diminishment a form of enhancement? Rethinking the enhancement debate in biomedical ethics. Frontiers in Systems Neuroscience, Vol. 8, Article 12, 1-8.

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One Response to What are the ethics of using brain stimulation technologies for ‘enhancement’ in children?

  • cid andrenelli says:

    Published on Frontiers “On this account, in order for an intervention to count as an enhancement, it does not matter if the capacity itself is being modified “up” or being modified “down.” Nor does it matter if the modification is being accomplished by means5 of a drug, a biochip, an electrical brain-stimulator, or something more familiar and lower tech. Nor does it matter if the intervention is called “medicine” or “therapy” or “beyond therapy” or anything else. If it increases the person’s chances of leading a good life in the relevant circumstances, then we propose that it should be considered an enhancement.”
    The exact same reasoning existed for carrying out a lobotomy: to increase a person’s chances of leading a better life.
    Now we have non invasive technology, now it’s far more selective regarding exactly what areas can be eliminated/diminished: painful memories, painful love, or the incrementation of other areas such as verbal recall, cognitive skills etc.
    The result tends towards a new level of “Stepford wives, husbands and children” regulated, enhanced and diminished to become beautifully, perfectly functioning organisms….
    Fine if you’re an adult, this could be equated to choosing breast or penile enhancement: Why not enhance the brain too?
    But with children and young adults/students that live in a competitive, perfection obsessed society; advocating plastic or non invasive brain “surgery” is equally unethical.
    Unless you are actually unhealthy, you do not need to augment/or reduce your breasts, penis or areas of your brain, it is unethical to promote an ideal of ever bigger, ever better, more clever = evermore successful evermore perfect.
    Children should be allowed to be the best they can be and proud of who they are… or do we believe we can also develop perfect characters for them, far better than who they are right now? Better intelligence? Better personalities? Better bodies? Shall we all look like Barbie & Ken? And think, reason and perform in harmony with the expectations of the moral majority? Is this really better for humanity? And last of all will these enhancements include a great sense of humour and irony and who is to be the judge?

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