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Eckhard Frick SJ {*}



From: Stimmen der Zeit, 9/2010, P. 577 et sequ.
webmaster's own, not authorized translation


The English verb "to enhance" means: improve, increase, boost. "Enhancement" is generally used to describe the medical treatment of healthy people with the goal of optimization and perfection - mostly of performance, but also of external appearance. Well-known examples are the doping in high-performance sports, the cosmetic surgery, increase of sexual potency by drugs, the administering of life-style and anti-aging medicines, and neuro-enhancement "beyond therapy" (also after the disease treatment). This involves increasingly the performance (alertness, attention, learning and memory ability).

But neuro-enhancement cannot enhance creativity. The Munich psychiatrist Hans Förstl reckons with more than 100 drugs that are still analysed or already supplied available as "smart drugs" for the brain doping. These include substances that are used for the treatment of dementia, but also antidepressants such as fluoxetine. "Brain boosters" are also the stimulants methyl phenidad (used in the treatment of attention deficit, hyperactivity or "fidgety" syndromes), and modafinil, which is administered to the shift workers with marked daytime sleepiness. Substances such as alcohol, nicotine, caffeine, cannabis, chocolate and cocoa produce similar effects.

In the U.S. up to 25 percent of the students and scientists allegedly increase their academic performance with the help of "smart drugs". In 2009 the German Angestelltenkrankenkasse [statutory health insurance for employees] stated that five per cent of employees undergo a brain doping, often by medical prescription outside of a therapeutic indication for certain diagnoses ("off-label"). Although psychotropic drugs are not without controversy in public, it is likely that the tendency to neuro-enhancement is rather increasing.

Why do more and more healthy people consume psychoactive drugs? The reasons may lie in the person concerned, especially if an addiction already exists. Withdrawal symptoms can then occur and are "treated" by re-taking. With neuro-enhancement, however, it is about much more than an individual problem. The ideal of the best "performance" seems to dominate our work, but also leisure and sexuality. This does not only increase the acceptance of the performance principle but also the expectation that performance-enhancing methods are used. This can lead to gentle pressure of workmates or fellow students from the same exams group as well as to anticipatory obedience especially of employees who see that their strengths are on the wane.



Brain doping is the fulfillment of an ancient dream of mankind. Our ancestors, too, knew how to "dope". What is new are the improved possibilities and efficiencies of chemistry, but also possible side effects. The psychiatrist and pharmacologist must soberly weigh the advantages and disadvantages of neuro-enhancement. Findings that were gained with sick people, e.g. with dementia patients, must not without reflection be applied to healthy people. The old medical rule is valid that the indication must be very strict if there is no disease requiring treatment, the side effects cannot be assessed, and when an embryo or a growing child are affected. The malformed limbs of the "thalidomide children" remind us of what can happen when indications - under the influence of pharmaceutical advertising - are made too "generously".

The new research branch of neuroethics deals with the effects of neuro-enhancement on our conception of man. Do we measure the value of a man according his performance alone? Are rest and leisure allowed? Or is also the leisure behaviour dominated by the performance principle? Is the sole goal of leisure the restoration of one's strength for labour?

Similar to pharmacologists and psychiatrists, neuro-ethicists, too, are well advised when they soberly approach the problems of enhancement. Speculative ethics of possible scenarios and (horror) visions are of no help to anybody. However, when one modafinil dose has the same effect on performance and alertness of a shift worker as six cups of coffee, would not it be better to promote natural rhythms of relaxation, rest and food, instead of adapting the workers to rhythms of shift work?

France and Spain deal 'more generously' with neuro-enhancement than e.g. the Netherlands that are influenced by Calvinism. In times of the Internet, information and procurement opportunities for neuro-enhancer have become globalized. It seems that a huge pharmacological "field test" takes place, but it is hardly evaluated, as far as the efficacy profile, the side effects, and the social consequences are concerned. Here, a considerable need to catch up exists, as a precondition for neuro-ethical reflection.

Perhaps the most important aspect of neuro-enhancement is the social signal effect. What can be learned from this discussion about the prevalence of the performance principle in Western industrialized countries? In the perspective of medical ethics, the balance between benefit and harm to patients is at stake - as with any medication, but also the autonomous decision of those who want that their brains are "enhanced". Finally, the discussion reminds indirectly of the bioethical principle of justice. Those who go hungry or are ill with AIDS and malaria in the southern hemisphere live below the subsistence level, where the problem of enhancement "beyond therapy" does not exists.


Link to 'Public Con-Spiration for-with-of the Poor'