Toward a Legitimate Public Policy on Cognition-Enhancement Drugs
2012-07-01

Abstract This article proposes a model for regulating use of cognition enhancement drugs for nontherapeutic purposes. Using the method of reflective equilibrium, the author starts from the considered judgment of many citizens that treatments are obligatory and permissible while enhancements are not, and with the application of general principles of justice explains why this is the case. The author further analyzes and refutes three reasons that some influential authors in the field of neuroethics might have for downplaying the importance of justice: (1) Justice applies only to public funds and state action—not to individual choice or corporate actors. (2) "Performance enhancement" does imply questions of justice, while "performance maintenance" does not. (3) There is no sufficient difference between cognition-enhancement drugs and other technologies to warrant the importance of justice for the debate. The challenges are refuted by taking into account the difference between consumption and tool use, and the influence of socioeconomic pressure for widespread use that existing drugs could have on the basic structure of society and equal autonomy of citizens. The analysis of requirements of justice points to a conclusion that introducing economic disincentives for the use of cognition-enhancement drugs would be the most legitimate public policy. With the imposition of taxes, fees, and requirements of additional insurance, the use and indirect coercion to use would be less profitable and less widespread, while additional funds thus created could be allocated to meet basic medical needs and/or education. Keywords: neuroethicscognitive enhancementjusticepublic policyeconomic disincentives model Notes In the following, I try to offer an analysis of requirements of justice in the general case of CED. Two remarks are in order here: First, a complete assessment of requirements of justice on CED would have to entail a case-by-case basis analysis, which (for reasons of space) I can only promise to deliver in future. Second, although I believe that different approaches to justice when applied to the issue of CED would lead to similar conclusions (compare Daniels Citation2008, 64–78), I cannot pursue this point in this short article. I can only say that I have every intention of addressing this issue elsewhere, and that I hope that application of different reasonable conceptions of justice to cognitive enhancements will have a prominent place in neuroethics in the future. Rawls's principles of justice (in the final formulation) state that (1) each person has an the same indefeasible claim to a fully adequate scheme of equal basic rights and liberties, which scheme is compatible with the same scheme of liberties for all; (the equal liberty principle); and (2) social and economic inequalities are to satisfy two conditions: First, they are to be attached to positions and offices open to all under conditions of fair equality of opportunity (the principle of fair equality of opportunity); and second, they are to be to the greatest benefit of the least advantaged members of society (the difference principle) (Rawls Citation2001, 42–43). The British Medical Association (2007, 34) discusses this drawback for the policy of permissive regulation that is similar to, yet undeveloped and distinct from, the economic disincentives model of regulation.