Ethical Aspects of Enhancement

Sarah -   We're talking about drugs that can enhance brain function this week and in particular, the so-called smart drugs that could give us an intellectual edge.  The fact that we might be able to give ourselves a boost like this raises some interesting ethical questions, ones that we're likely to need to address more and more as our understanding of the human body increases.  Professor Julian Savulescu is the Director of the Oxford Uehiro Centre for Practical Ethics and he joins us now.  Hi, Julian.

Julian -   Hello.

Sarah -   So, if we're talking about the ethical issues of using drugs like this, first of all, how do we define what is the normal state, the normal cognitive state, the normal intellect?

(c) Jirah @ wikipedia' alt='Raven's Progressive Matrices Example' >Julian -   Yes.  Abnormality has been defined statistically for these purposes as anyone who is more than two standard deviations below the mean.  So, for IQ, we have a normal distribution curve and two standard deviations means that roughly 2% of people have what's defined as an intellectual disability.  So, if your IQ is below 70, you're said to have an intellectual disability.  Above 70 are normal.  But this is a purely an arbitrary line that we've drawn in order to find resources for medical research, decide who gets medical treatment.  So as in the previous segment, whether you're entitled to get modafinil as a medical treatment, it will just depend on how sleepy you happen to be and whether this is defined arbitrarily as a disease.

Sarah -   And so, how does this issue inform neuroethics?  What is the field of neuroethics?

Julian -   Well neuroethics is the study of the ethical implications of advances in neuroscience and also, the neuroscience of ethical judgment and moral judgment, looking at what happens in the brain when people make moral judgments.  But with respect to this issue, there are several, I think, important insights that ethics can offer.  The first one is that the distinctions that we have can have very profound significance for ordinary life.  I think the most striking that I've come across in the last few months was in September, a woman in the US called - I think her name was Theresa Louis- was executed in Virginia for committing murder.  Now Virginia has a law that says if you're intellectually disabled, you can't be executed.  You can only be given life imprisonment.  Her IQ was 72.  If it had been 69, she would've lived.  Now 3 points of IQ difference of that level will have no functional significance.  In fact, if she'd been on modafinil, when she took the IQ test, she might've just crept up from 69 to 72 on the test.  So, where we draw these lines has profound legal significance.  It also has profound ethical significance because it means that people who have an IQ above 70 won't be eligible for the use of cognitive enhancers for treatment of intellectual disability.  Nonetheless, people in the band between 70 and 90 or 70 and 100, face enormous obstacles in everyday life.  You need an IQ of 90 to complete a tax return in the US.  That means that over 20% of normal people in the US lack the IQ necessary to complete their tax returns.  So, when you look at the ethical consequences of the sorts of scientific distinctions that we make and the science that we're generating, they have profound impacts on people's lives.

Sarah -   What are the ethical issues if we're talking about enhancing cognition and using drugs like modafinil and things?  If we're talking about people who are using this illicitly, what are the kind of ethical issues there?

Julian -   Well the argument I often hear when it comes up with students taking modafinil or other cognitive enhancers is "isn't this cheating?"  I think in one sense, it is cheating if some people have access to the drugs and other people don't.  But the far more important issue is how safe are those and what are the risks and benefits?  That's not the issue that we tend to look at.  We tend to say, this is enhancing normal function, human beings shouldn't be enhancing.  It's unnatural to enhance normal function.  And so, what we try to do is get people to scratch a little bit deeper and see what the actual risks and benefits are.

When it comes to people at the low end the benefits are enormous as I've said, and even at the top end, if you look at people in the top 1% of the band of IQ, that is the very top percentile, and divide those into the lowest quarter of that 1% and the top 1 quarter, people in the top 1 quarter of the top 1% produce about 7 times as many patents as the average person, and people in the bottom quartile of that top 1% produce about 3 times as many patents.  So even if you increase the performance of people in the very top 1%, you'll still have significant social advances in terms of inventions and patentable inventions. 

If you shift the whole IQ curve 3 points to the right, that is 3%, people have estimated that you'd add 1.5% to the GDP of the US, so $150 billion for the economy and reduce welfare recipiency by 20%.  So on a social level, this isn't just an issue of boffins performing better on their exams.  It's an issue of vital social and economic justice.

Sarah -   So, do you think that universities should be dope testing for this sort of thing or do you think that it could be a benefit to the GDP of society, I suppose, like you said?

Julian -   Well, I think it's premature to say that and I think the really unethical issue in the whole of the discussion so far is that it's virtually impossible to do proper, long term, large scale studies of normal people using cognitive enhancers because we have this treatment/enhancement distinction.  So in the research, I think it was mentioned as far as I know, they could only give just one or two pills to normal people.  They can't even study people who are taking this illicitly every day of the week because that would involve giving people drugs that are enhancements and this very anti-enhancement culture that we have is hindering proper scientific research, so we just don't know what the long term adverse effects of large numbers of normal people taking cognitive enhancers are.  We need that information and if they are as safe as caffeine, it may well be a time when we view taking modafinil in the same way as we take drinking coffee.  In fact, there's no reason in principle why it couldn't be a better cognitive enhancer than caffeine.

Sarah -   Well there you go.  It's quite an uncertain future there.  That was Professor Julian Savulescu.  He's the Director of the Oxford Uehiro Centre for Practical Ethics.