Written by Benjamin Pojer and Daniel D’Hotman
Faculty of Medicine, Nursing and Health Science, Monash University
Oxford Uehiro Centre for Practical Ethics, University of Oxford
A recent review published in the European Journal of Neuropsychopharmacology (1) on the efficacy and safety of modafinil in a population of healthy people has found that the drug “appears to consistently engender enhancement of attention, executive functions, and learning” without “preponderances for side effects or mood changes”. Modafinil, a medication prescribed in the treatment of narcolepsy and other sleep disorders, has gained popularity in recent years as a means of increasing alertness and focus. Informal surveys suggest that up to one in five undergraduate university students in the UK admit to using the drug as a study aid (2). Previously, the unknown safety profile of modafinil has been an obstacle to its more widespread use as a cognitive enhancer. Admittedly, the long-term consequences of modafinil use remain unclear, however, given its growing popularity, this gap in the literature should not preclude a discussion of the ethics of the drug’s use for cognitive enhancement.
We argue that objections to the recreational use of modafinil do not stand up to ethical analysis. The use of cognitive enhancers, commonly known as ‘smart drugs’, is broadly opposed on two counts: (a) that the use of cognitive enhancers raises issues of fairness and inequity, where some individuals may have access to the drug when others may not, and (b) that the greater uptake of cognitive enhancers will introduce social pressures to medicate oneself to keep up with the increasing pace of an enhanced world. We reject both of these claims.
Fairness and inequity
Opponents claim that the permissibility of cognitive enhancing drugs will perpetuate inequality. They argue that modafinil will provide unfair advantages to those who choose to use it, and in this way is a form of cheating. We challenge this claim for two reasons.
First, there exist a myriad of other factors that influence academic and professional performance, which we do not choose to restrict. For example, it would be unreasonable to ban the use of private tutors in high schools, or prohibit the drinking of coffee in workplaces, simply because these allow some people to have an advantage. Moreover, individual biology and genetics are inherently discriminatory. The fact that some people are naturally more academically gifted, or physically capable, does not mean we should place restrictions on them with the aim of creating an equal playing field. We can alleviate natural inequality by allowing access to cognitive enhancing drugs, thus allowing people who are at a biological disadvantage greater opportunity to succeed. Potentially, fair distribution of enhancing substances could be regulated by selective state subsidization of drugs, such as modafinil, for those who are worse off (3). While the specifics of regulation require further discussion, this could mitigate some concerns over inequality.
Secondly, banning the use of cognitive enhancers may in fact perpetuate inequality leading to the development of a black market of smart drugs. This is the situation that exists currently – a majority of modafinil is procured from unregulated sources online. Such markets, by their very nature, limit access of enhancers to a select few and this only further entrenches the disparity in access. The legal and regulated provision of cognitive enhancers, such as modafinil, would allow all individuals equal access to the drug and diminish concerns of inequality.
A new normal?
Opponents of the use of cognitive enhancement argue that widespread use of smart drugs will lead to dangerous social and political problems. They suggest that there will be increased pressure on individuals to enhance their work performance, in order to keep up with those around them. Further, there is a risk that employers will encourage the use of the drug to increase productivity. In both of these situations there exists some form of implicit coercion, which many would consider morally problematic.
It should be recognized that there is nothing inherently wrong with society evolving to adapt to new technologies. For instance, the advent of computers undoubtedly resulted in a higher standard of performance than before, which led to an increased pressure on individuals to adopt the new technology and perform at a higher level. Few would suggest that such progress was detrimental. While similar concerns of creating a ‘new normal’ were presented at the time, the benefits of the wider implementation of such technologies outweighed these fears in the long run.
The risk of implicit coercion is a reasonable concern. However, it is difficult to accept this as a reason to restrict modafinil use specifically. We are subject to implicit coercion all the time. Students are ‘coerced’ into staying up later to study to keep up with their driven classmates. Athletes are the regular subjects of implicit coercion to push themselves beyond the standard levels of human performance – striving to become faster or stronger. It is not immediately clear that ‘coercion’ in these circumstances is so problematic that we should restrict these practices. Similarly, modafinil use is unlikely to lead to any greater level of coercion than already exists in practices we deem permissible. Indeed, students and athletes will continue to endeavour to better themselves, whether or not cognitive enhancement is allowed. Employees will continue to work long hours in high-pressure environments, regardless of whether they have access to modafinil. Access to cognitive enhancing drugs, if used safely, would simply allow these people to be more productive and innovative in their endeavours.
Conclusion
We argue that the two common objections to modafinil use presented in this article do not stand up to scrutiny. Insofar as modafinil does not having significant side effects, we believe its potential benefits warrant its wider availability.
Further, even if future research suggested side effects of modafinil yet to be considered, this would not necessarily preclude the drug’s use by competent and informed adults. Indeed, society already accepts the use of many substances (eg. alcohol, tobacco) and participation in activities (eg. base jumping, snow skiing) which have known risks. In line with modern understandings of autonomy, the potentially harmful consequences of an action do not necessarily disqualify its use, as long as it does not harm others. It is not immediately clear why modafinil should be held to a different standard.
An intuitive objection to the use of cognitive enhancers is that there is something inherently wrong with unnatural or synthetic enhancement in the form of a pill. Such intuitions are inconsistent when we consider the widespread use of other drugs which society deems acceptable, such as the use of caffeine for wakefulness or paracetamol to alleviate a headache. This is not to say that modafinil should necessarily be available off the shelf. It would not be unreasonable for some level of regulation to be in place, for example restricting availability to minors who are unable to make informed choices. Ultimately, however, we argue that members of society who are able to weigh up the risks and benefits of using modafinil, should have access to the drug as a means of enhancing their performance and improving their lives.
References
- M. Battleday, A-K. Brem. Modafinil for cognitive neuroenhancement in healthy non-sleep-deprived subjects: a systematic review. European Neuropsychopharmacology, Available online 20 August 2015 at: http://www.sciencedirect.com/science/article/pii/S0924977X15002497
- Young-Powell, L. Page. One in five students have taken the study drug modafinil. The Guardian. Available online 8 May 2014 at: http://www.theguardian.com/education/abby-and-libby-blog/2014/may/08/one-in-five-students-have-taken-study-drug-modafinil
- Savulescu. Justice, fairness, and enhancement. Annals of the New York Academy of Sciences (2006): 321-338.
I’d be concerned about the studies reporting “impairments in divergent creative thinking”. Is there much reported use of this drug by artists, writers, composers etc? It might be better suited to people working in non-creative fields.
Hey guys,
Firstly, great post! It’s good to see that the next batch of BMedSci students are doing so well!
I agree that a lot of the ethical concerns regarding cognitive enhancement with modafinil are, as you suggest, overblown, and more of an instinctive aversion to its ‘unnaturalness’. If we ignore this instinctive aversion as an invalid ethical concern, a large part of why the ethical concerns about modafinil specifically are overblown is that it’s not the super-powerful miracle cognitive enhancer that the media seems to suggest it is. I haven’t done a detailed look into the literature, but my impression is that the consensus is that it provides a small, but significant and fairly reliable boost to cognitive performance on certain tasks. As you rightly point out, a lot of things already do this – a good education, a private tutor, coffee, but also childhood enrichment programs, regular exercise, adequate sleep, a good diet etc. And there’s no reason to think that we should ban these, or that these make our society incredibly (or unacceptably) unfair or that they force everyone to unhappily take up these interventions. There is very little reason, at present, to ban modafinil – it is unlikely to dramatically increase unfairness/inequity, or present sufficient ‘implicit’ coercion to infringe more on personal freedoms than is currently acceptable.
The key, of course, is that most of these ‘enhancing interventions’ each have ambigious or small effects, and are somewhat unpredictable. Public vs. private education, for example – there’s not much really strong evidence to back up the idea that private is really better (since these kids tend to come from wealthier families, which correlates with better outcomes anyway). See https://nces.ed.gov/nationsreportcard/pdf/studies/2006461.pdf for example.
The real intuitive test, I think, is what happens if (or when?) we find an intervention that is this super-powerful miracle cognitive enhancer. Imagine a surgically-implanted computer-brain interface that plugs into your cerebral cortex, sharing the cognitive load and increasing working memory and storage. It reasonably reliably increases your cognitive capacity to beyond anything man has known before – let’s put it at an average of +1000 IQ points. Surgical techniques have been polished to the point that there are minimal, if any, complications, and no short-term adverse effects are known.
Such an intervention would almost certainly increase inequality – both because there would be an incredible incentive to monopolise or control it, and because there would now be a wide gulf between the enhanced and non-responders (i.e. because of ‘biological quirks’) or unenhanced persons. Regulation and government oversight might help a bit, but their track record isn’t encouraging – I’m in the US right now, for example, and universal basic healthcare is still incredibly controversial.
The degree of ‘implicit’ coercion would almost certainly be sufficient to give us pause; and the ‘leap’ of significantly altering essential human nature (read: biological makeup) in comparison to previous technological ‘shuffles’ that left it largely the same might cause us to wonder about whether we land on a bed of roses, or over a precipitous cliff.
In summary – I agree that modafinil isn’t likely to shake the status quo, and there’s little reason to ban or excessively control its use. I wonder, though, what happens if a real game-changer does come along? I’d be keen to hear some thoughts from you guys!
Let it be assumed that it is perfectly safe to take a smart drug such as Modafinil. It seems possible that in some cases the taking of such drugs might lead to inadvertent deception. Let us assume someone takes such a drug and due to her usage obtains a good job or other goods. Let us further assume she then ceases to take the smart drug. I would suggest her new employer or examining board have been deceived about her true potential. It might be pointed out the same situation would apply had she drunk large amounts of coffee, had been educated privately or even had a private tutor. In response to this objection I would suggest the effect of coffee is minimal compared to that of Modafinil. Secondly the effects of a private education don’t dissipate once that education ceases, I am assuming the effects of Modafinil do. I am not opposed to the use of smart drugs provided users of such drugs continue taking them in order not to deceive others. Indeed provided such drugs are safe continued use seems to be the rational option. I deal with this topic in more detail in a posting in wooler.scottus on 04/05/10.
I can see a brave new world embracing performance enhancing drugs. Steroids will be widely available so that the athlete with access to these drugs can perform at peak capacity. Methamphetamines likewise will lead to a society in which immediate gratification is the norm. There are other examples which to quote the authors “members of society …. should have access to the drug as a means of enhancing their performance and and improving their lives”
meaning in the end they will start legalizing all drugs? I am not opposed to the use of smart drugs provided users of such drugs continue taking them in order not to deceive those close to them
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