This article was downloaded by: [informa internal users]On: 9 April 2010Access details: Access Details: [subscription number 755239602]Publisher Taylor & FrancisInforma Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK Publication details, including instructions for authors and subscription information: Should Children Have Equal Access to Neuroenhancements? Ori Lev aa Social and Behavioral Research Branch, NHGRI, National Institutes of Health, Online publication date: 17 February 2010 To cite this Article Lev, Ori(2010) 'Should Children Have Equal Access to Neuroenhancements?', AJOB Neuroscience, 1: 1, 21 — 23To link to this Article: DOI: 10.1080/21507740903504442URL: This article may be used for research, teaching and private study purposes. Any substantial orsystematic reproduction, re-distribution, re-selling, loan or sub-licensing, systematic supply ordistribution in any form to anyone is expressly forbidden.
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Ori Lev, Social and Behavioral Research Branch, NHGRI, National Institutes of Health Persuasive arguments have been put forward for the per- to these enhancements. Universal access would ensure that missible use of neuroenhancements (Bostrom and Sanberg disparities are not made worse. This conclusion, however, 2009; Dees 2008). It is argued that in the same way that adults are (and should be) free to use nonmedical means In this commentary I advance two claims: first, that pro- of enhancements such as caffeine, they ought to be al- viding equal access to neuroenhancements might not be the lowed to use neuroenhancements. As long as adults’ use best way to serve justice—indeed, such approach is likely of neuroenhancements does not harm others, they should to exacerbate inequalities. Second, it is important to draw have the freedom to decide whether or not to enhance a distinction between “justice-affecting” and “non-justice- affecting” neuroenhancements. The latter category can be Ilina Singh and Kelly J. Kelleher extend this argument to left for the market to cater for, while the former category suggest that it would be permissible for parents to adminis- ought to be carefully regulated. Thus, as a society we should ter such enhancements to their children. They suggest that, not address neuroenhancements as a category; rather, we just like in the adult case, children are enhanced by their should look at individual enhancements and assess their parents in a variety of permissible ways, such as education, implications for values such as equality and fairness.
training, and nutrition; therefore, parents ought to be free toenhance their children in medical ways as well (Singh andKelleher 2010, 3). There is no essential difference that should EQUALITY OF OPPORTUNITY AND ACCESS
render the former permissible and the latter impermissible.
They proceed by noting important concerns with regard It is commonly argued by liberal egalitarians that justice to the effects neuroenhancements could have for distribu- requires that at the age of majority children should have equality of opportunity to pursue their life plans. On this If neuroenhancement in young people is to become a common view, if two 18-year-olds wish to open a business, but one social practice—which is likely—the uneven demographic dis- has more resources than the other due to family wealth, tribution of stimulant drug use raises distributive justice and then she has an unfair advantage in starting that business.
access concerns. If they meet the rigorous parameters that will Similarly when the two compete over admission to a de- ensure minimum risk and maximum benefit, all young peo- sired college, if one has received private tuition throughout ple ought to have equal access to existing resources to improve her life and the other has not, the former has an unfair ad- themselves and their performance, just as there should be equal vantage. Justice requires that we create a level playing field access to existing resources to address neural and behavioral from which children at the age of majority can compete over impairments. (Singh and Kelleher 2010, 3) Their argument suggests that if left solely to the market, only To move closer to equality of opportunity, liberal democ- those who are able to afford neuroenhancements would racies such as the United States have put in place programs Downloaded By: [informa internal users] At: 17:01 9 April 2010 have access to them and thus a market approach would ex- designed to narrow social inequalities, such as affirmative acerbate inequalities. Already advantaged children would action legislation, estate taxes, and early education initia- gain a further advantage, thereby extending the gap be- tives. They also established public education systems, pub- tween the well-off and the worse-off. Concerns with justice lic libraries, and programs that expand children’s access to are thus appropriate. It is the role of the state to maintain a health care. These institutions are clearly not enough: Well- just society; accordingly, it should provide universal access off parents bestow advantages on their children through This article is not subject to US Copyright Law.
Acknowledgements: I thank Joseph Millum and Alan Wertheimer for their suggestions and criticisms of this paper. This research wassupported by the Intramural Research Program of the National Human Genome Research Institute, National Institutes of Health. Theopinions expressed are those of the author and do not reflect any position or policy of the National Institutes of Health, U.S. Public HealthService, or Department of Health and Human Services.
Address correspondence to Ori Lev, Social and Behavioral Research Branch, NHGRI, National Institutes of Health, Bethesda, MD 20892-2073, USA. E-mail: levo@mail.nih.gov1. There are various versions of the ideal of equality of opportunity; I endorse a version closer to the one luck egalitarians propose, namely,that in the case of children, social and natural inequalities ought to be, as much as possible, mitigated. This is in contrast to Rawls’sversion, in which natural inequalities are not considered an object of justice. See Rawls (1971, 63–64).
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other legally permissible means, for instance, through pro- the best way to serve justice is to allocate resources to non- viding SAT classes and private tutors and through sending medical enhancements and to leave neuroenhancements in them to private schools. The ideal of equality of opportunity Natural differences are another reason why equality of opportunity is difficult to achieve. Children with higher NOT ALL NEUROENHANCMENTS AFFECT JUSTICE
intelligence, better concentration, and superior analytical Let us turn to the second claim, namely, that a distinction skills are advantaged over those whose capacities are not between “justice-affecting” and “non-justice-affecting” en- as great. The former are likely to have more opportu- hancements ought to be made. Since each enhancement nities and better chances of achieving desired positions.
would have particular effects on a specific capacity, each en- Natural and social inequalities are thus intimately related hancement would probably impact justice differently. Some to equality of opportunity (Bostrom and Sanberg 2009, might have a substantial effect, and some might have no effect. Grouping all neuroenhancements together as candi- This analysis has implications for the issue of equal ac- dates for state support is problematic.
cess to neuroenhancements that the authors recommend.
Enhancing traits and capacities such as intelligence, Given the ideal of equality of opportunity, it can be argued memory, alertness, wakefulness, concentration, and analyt- that equal access is not the best way to serve justice. To ical and mathematical skills can affect equality of opportu- begin with, equal access is likely to be more beneficial to nity. However, enhancing certain emotional responses such those who are already well off; they would probably take as sexual pleasure or enjoyment of food is less clearly re- advantage of the access to a larger extent than those who are lated to equality of opportunity (or justice more generally).
worse off. Well-off parents are more likely to know of these To be sure, enhancing these responses can affect one’s well- enhancements and they are more likely to have the time being and perhaps indirectly influence how well a person and resources to attain them. Justice would therefore be does more generally. But to the extent that equality of op- portunity to achieve jobs and positions is concerned, we Even if we assume similar utilization of the neuroen- should be more attentive to the advantages that higher in- hancements by all socioeconomic groups, equal access telligence bestows than the advantages that better ability to would at best prevent existing disparities from getting derive pleasure from food confers. Only the former seems to worse; it would not mitigate them. To promote equality be relevant to justice. Thus, for policy purposes we should of opportunity there ought to be a policy of providing distinguish neuroenhancements along the lines of justice- access to those that are disadvantaged due to social or affecting and non-affecting. The former ought to be care- natural circumstances and to restrict access to those who fully regulated while the latter could be left to individual are better off. Such an approach would narrow the gap that exists between the advantaged and the disadvantaged, This approach could be taken a step further; it is likely thereby mitigating the injustice caused by social and natural that each enhancement would affect equality of opportunity differently. Higher intelligence might have a larger effect on This proposal, however, might face a challenge: One equality of opportunity than enhanced memory, and better might argue that if the neuroenhancements are very expen- memory might influence opportunities more than enhanced sive and their benefits are marginal, then subsidizing them alertness would. Given scarcity of resources, the state would would be wasteful. If there are cheaper and more effective have to decide which enhancements to subsidize, if any.
ways of enhancing the disadvantaged, say, by providing One approach the state ought to consider is to selectively Downloaded By: [informa internal users] At: 17:01 9 April 2010 access to tutors, then pursuing such alternatives would be promote those enhancements that would have the greatest preferable. Under such conditions, leaving neuroenhance- ments to individual choice might be a better option. If theenhancements are very cheap and effective, then subsidiz- CONCLUSION
ing might be the appropriate policy.
Thus, at least from the point of justice it seems that pro- Neuroenhancements are in our future; some are already viding equal access to neuroenhancements would be prob- here. We should prepare appropriate policies that would lematic; it is likely to exacerbate inequalities. Furthermore, ensure that such enhancements do not harm values and it is not certain that access to neuroenhancements is the best ideals like equality and justice. In this commentary I pro- use of resources for promoting justice. It might turn out that posed that in the case of children the state should striveto grant equality of opportunity. This implies that accessto neuroenhancements ought to be granted to those who 2. I leave aside the question of whether such practices can be are disadvantaged, thereby creating a more level playing morally justified. If we endorse an interpretation of equality ofopportunity like the one proposed by egalitarian proponents such field. Moreover, I have suggested that neuroenhancements as Harry Brighouse and Adam Swift, such practices would be re- should not be treated as a uniform category; rather, each stricted. See Swift (2003) and Brighouse (2000). For an alternative enhancement should be evaluated as to its specific im- pact on important values. Such assessment would enable 22 ajob Neuroscience
January–March, Volume 1, Number 1, 2010 us to articulate guidelines and policies that protect such Mason, A. 2006. Leveling the playing field: the idea of equality of oppor- tunity and its place in egalitarian thought. Oxford: Oxford UniversityPress.
Singh, I., and K. J. Kelleher. 2010. Neuroenhancement in young peo- REFERENCES
ple: Proposal for research, policy, and clinical management. AJOB Bostrom, N., and A. Sandberg. 2009. Cognitive enhancement: Meth- ods, ethics, regulatory challenges. Science and Engineering Ethics 15: Rawls, J. 1999. A Theory of Justice, rev. ed. Cambridge, MA: Harvard Brighouse, H. 2000. School choice and social justice. New York: Swift, A. 2003. How not to be a hypocrite: school choice for the morally perplexed parent. New York: Routledge.
Dees, R. 2008. Better brains, better selves? The ethics of neuroen- Wolpe, P. R. 2002. Treatment, enhancement, and the ethics of neu- hancements. Kennedy Institute of Ethics Journal 17(4): 371–395.
rotherapeutics. Brain and Cognition 50: 387–395.
Singh and Kelleher (2010) take the position that “psychotropic “overly cautious,” particularly given the population Singh [i.e., via pharmaceuticals] neuroenhancers are not substan- and Kelleher are striving to protect, necessitates even more tively different from non-drug strategies widely used . . . to caution than Singh and Kelleher have put forth.
enhance cognition and performance” (3, emphasis added) The relevant mechanism distinguishing psychotropic and, drawing out the implications of this, conclude that an neuroenhancers from other varieties of enhancers is the fact agenda for psychotropic neuroenhancers, erring on the side that psychotropic enhancers affect their users only with a of being “overly cautious,” should focus on maintaining buildup in the users’ systems, and, for this reason, the ter- their safety and their noncoercive use, as we would with mination of use is possible in a way that enhancements any sort of enhancement practice. My concern with their from tutoring, private schools, etc. are not. Other forms of Downloaded By: [informa internal users] At: 17:01 9 April 2010 assessment is their first move—that psychotropic neuroen- enhancement, say, physical, also frequently are such that hancers are not, in morally relevant ways, different from termination of enhancement is possible but does not have the direct impact on brain chemistry, and thus not the sub- My reservation focuses on the fact that abrupt with- jective experience that accompanies a rapid alteration in the drawal from some psychotropic drugs can significantly, al- brain chemistry. In what follows, I briefly describe what I beit temporarily, alter not only people’s physical experi- take to be the gap in Singh and Kelleher’s analysis, a con- ence but also their experience of sense of self and place in sequent of viewing psychotropic neuroenhancement as, in the world. This subjective felt experience, while troubling all important respects, similar to other forms of enhance- enough for adult users, may pose significant enough emo- ment, neuro and otherwise. I then detail the significance tional distress for young people already working through of this gap with regard to psychotropic drugs and then its the challenging emotional experiences of adolescence and significance to the population of young people.
young adulthood to warrant further concern about the use When considering the moral permissibility of any form of psychotropic drugs for purposes other than making life of alteration to self, the responsible approach in a culture manageable. If this is a morally relevant difference of psy- concerned with well-being and autonomy is to compare chotropic neuroenhancers, then erring on the side of being potential harms to potential benefits and then to view as Address correspondence to Jennifer McCrickerd, Drake University, Philosophy Department, Medbury Hall, Des Moines, IA 50311, USA.
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