Abstract
There is mounting evidence that methylphenidate (MPH; Ritalin) is being used by healthy college students to improve concentration, alertness, and academic performance. One of the key concerns associated with such use of pharmaceuticals is the degree of freedom individuals have to engage in or abstain from cognitive enhancement (CE). From a pragmatic perspective, careful examination of the ethics of acts and contexts in which they arise includes considering coercion and social pressures to enhance cognition. We were interested in understanding how university students, parents of university students, and healthcare providers viewed autonomy and coercion in CE using MPH. We found that perspectives converged on the belief that CE is a matter of personal and individual choice. Perspectives also converged on the existence of tremendous social pressures to perform and succeed. Parents emphasized personal responsibility and accountability for CE choices, and expressed feelings of worry, sadness and fear about CE. Students emphasized the importance of personal integrity in CE, expressed tolerance for personal choices of others, and highlighted the challenge that CE poses to maintaining one’s personal integrity. Healthcare providers emphasized the health consequences of CE. These results illustrate: (1) the importance of understanding how context is viewed in relation to perspectives on autonomous choice; (2) the limitations of individualistic libertarian approaches that do not consider social context; and (3) the ethical implications of public health interventions in a value-laden debate where perspectives diverge.
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References
Wilens, T.E., L.A. Adler, J. Adams, et al. 2008. Misuse and diversion of stimulants prescribes for ADHD: a systematic review of the literature. Journal of the American Academy of Child and Adolescent Psychiatry 47:21-31.
Maher, B. 2008. Poll results: look who’s doping. Nature 452: 674–675.
McCarthy, M. 2007. Prescription drug abuse up sharply in the USA. Lancet 369: 1505–1506.
British Medical Association. 2007. Boosting your brainpower: Ethical aspects of cognitive enhancement, 42. London, UK: British Medical Association.
Farah, M.J., J. Illes, R. Cook-Deegan, et al. 2004. Neurocognitive enhancement: what can we do and what should we do? Nature Reviews Neuroscience 5: 421–425.
Appel, J.M. 2008. When the boss turns pusher: a proposal for employee protections in the age of cosmetic neurology. Journal of Medical Ethics 34: 616–618.
Chatterjee, A. 2006. The promise and predicament of cosmetic neurology. Journal of Medical Ethics 32: 110–113.
Warren, O.J., D.R. Leff, T. Athanasiou, et al. 2008. The neurocognitive enhancement of surgeons: an ethical perspective. Journal of Surgical Research 152: 167–172.
Chatterjee, A. 2004. Cosmetic neurology: the controversy over enhancing movement, mentation, and mood. Neurology 63: 968–974.
Baylis, F. and J.S. Robert. 2004. The inevitability of genetic enhancement technologies. Bioethics 18: 1–26.
Farah, M.J. 2005. Neuroethics: the practical and the philosophical. Trends in Cognitive Sciences 9: 34–40.
Hall, W. 2004. Feeling ‘better than well’. EMBO Reports 5: 1105–1109.
Mehlman, M.J. 2004. Cognition-enhancing drugs. Milbank Quarterly 82: 483–506.
Racine, E. and J. Illes. 2006. Neuroethical responsibilities. Canadian Journal of Neurological Sciences 33: 269–277.
Caplan, A.L. 2003. Is better best? A noted ethicist argues in favor of brain enhancement. Scientific American 289: 104–105.
Racine, E. 2008. Which naturalism for bioethics? A defense of moderate (pragmatic) naturalism. Bioethics 22: 92–100.
Arria, A.M. and E.D. Wish. 2006. Nonmedical use of prescription stimulants among students. Pediatric Annals 35: 565–571.
Barrett, S.P., C. Darredeau, L.E. Bordy, et al. 2005. Characteristics of methylphenidate misuse in a university student sample. Canadian Journal of Psychiatry 50: 457–461.
Teter, C.J., S.E. McCabe, C.J. Boyd, et al. 2003. Illicit methylphenidate use in an undergraduate student sample: prevalence and risk factors. Pharmacotherapy 23: 609–617.
Teter, C.J., S.E. McCabe, K. LaGrange, et al. 2006. Illicit use of specific prescription stimulants among college students: prevalence, motives, and routes of administration. Pharmacotherapy 26: 1501–1510.
Babcock, Q. and T. Byrne. 2000. Student perceptions of methylphenidate abuse at a public liberal arts college. Journal of American College Health 49: 143–145.
White, B.P., K.A. Becker-Blease, and K. Grace-Bishop. 2006. Stimulant medication use, misuse, and abuse in an undergraduate and graduate student sample. Journal of American College Health 54: 261–268.
Racine, E., and C. Forlini. 2009. Cognitive enhancement, lifestyle choice or misuse of prescription drugs? Ethical blindspots in current debates. Neuroethics. doi:10.1007/s12152-008-9023-7.
Twenge, J.M., L. Zhang, and C. Im. 2004. It’s beyond my control: a cross-temporal meta-analysis of increasing externality in locus of control, 1960–2002. Personality and Social Psychology Review 8: 308–319.
Vohs, K.D. and J.W. Schooler. 2008. The value of believing in free will: encouraging a belief in determinism increases cheating. Psychological Science 19: 49–54.
Racine, E., O. Bar-Ilan, and J. Illes. 2005. fMRI in the public eye. Nature Reviews Neuroscience 6: 159–164.
McCabe, S.E. 2008. Misperceptions of non-medical prescription drug use: a web survey of college students. Addictive Behaviours 33: 713–724.
Cohen, E. 2006. Conservative bioethics and the search for wisdom. Hastings Center Report 36: 44–56.
Habermas, J. 1973. La technique et la science comme “idéologie”. Paris: Gallimard.
Habermas, J. 1992. De l’éthique de la discussion. Paris: Flammarion.
Sartre, J.-P. 1963. L’existentialisme est un humanisme. Paris: Nagel.
Bergstrom, L.S. and N. Lynoe. 2008. Enhancing concentration, mood and memory in healthy individuals: an empirical study of attitudes among general practitioners and the general population. Scandinavian Journal of Public Health 36: 532–537.
Graff Low, K. and A.E. Gendaszek. 2002. Illicit use of psychostimulants among college students: a preliminary study. Psychology, Health & Medicine 7: 283–287.
McCabe, S.E., J.R. Knight, C.J. Teter, et al. 2005. Non-medical use of prescription stimulants among US college students: prevalence and correlates from a national survey. Addiction 100: 96–106.
Acknowledgments
The authors would like to acknowledge the support of the International Institute for Research and Ethics in Biomedicine, the Canadian Institutes of Health Research, the Social Sciences and Humanities Research Council of Canada and the Institut de recherches cliniques de Montréal. Thanks to Nicole Palmour, Dr. Emily Bell and William Affleck. We also thank the anonymous reviewer who helped us make significant changes to this paper including focusing on the group-level differences between stakeholders.The authors report no conflicts of interest.
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Forlini, C., Racine, E. Autonomy and Coercion in Academic “Cognitive Enhancement” Using Methylphenidate: Perspectives of Key Stakeholders. Neuroethics 2, 163–177 (2009). https://doi.org/10.1007/s12152-009-9043-y
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DOI: https://doi.org/10.1007/s12152-009-9043-y