Cognitive Enhancement Should Take Priority over Cognitive Therapy

Cognitive Enhancement Should Take Priority over Cognitive Therapy

The purpose of this essay is to call into question the claim that cognitive therapy (CT) is morally preferable to cognitive enhancement (CE).  “Cognition” is here understood to include wakefulness, focus, memory, creativity and executive function.  I will begin by presenting evidence of the widespread, rather entrenched position, that CT is morally preferable to CE.  Then I will present a thought experiment that forces one to choose between performing only CT or CE, arguing that we ought to choose CE.  To support this conclusion, I will present arguments from several ethical principles (beneficence, nonmaleficence, justice) of Beauchamp and Childress to show that prioritizing CE over CT in this scenario follows from the values of modern bioethical thought (Beauchamp and Childress 2009).  I am not arguing that, in the real world, only CE should be pursued and CT research defunded.  The mutually exclusive choice between CE and CT is only a feature of my thought experiment, not the real world.  I present and argue for CE in my thought experiment only to show that CE ought to take priority over CT.  This reordering of our priorities would have implications for how we make funding decisions in projects like the BRAIN initiative.  Exactly how much of the BRAIN initiative’s budget should be split between CE and CT I leave an open question, but I do expect a reordering of priorities would have significant funding consequences.   

The view that CT is morally preferable to CE is held by scholars in neuroethics as well as the general public.  Martha Farah writes, “We assume that treatments have greater benefits than enhancements; the value of returning someone to health is greater than the value of making a healthy person even better off” (Farah 2012, 579).  Jayne Lucke and Brad Partridge have argued that it is simply unethical to invest research dollars to develop technologies that improve the cognition of already high-functioning individuals when those dollars could be used developing CT technologies (Lucke and Partridge 2012, 425).  Additionally, these scholarly views seem to be in line with the attitude of the general public.  A survey was conducted on over 4,000 individuals who viewed CT as more “worth the risk” because the “rewards” of CT are greater than CE (Fitz et al. 2013, 177).  

The prioritization of CT over CE has also held sway as a guide to funding decisions in President Obama’s BRAIN initiative.  The project has seen an increase of a hundred million dollars in federal funding each year since 2013, an increase matched by the private sector.  In 2015, the Presidential Commission for the Study of Bioethical Issues produced the second volume of a report called Gray Matters, which made recommendations to ensure the technological innovations of the BRAIN initiative were conducted in an ethically responsible manner.  In this report, the recommendation that CT should take priority over CE is made explicit.  Recommendation two of the Gray Matters report states, “Funders should prioritize research to treat neurological disorders to improve health and alleviate suffering.”  Concerning the use of funds on CE, recommendation three states that funds should be used to “support research on the prevalence, benefits and risks of novel neural modifiers  […] to augment or enhance neural function” (Presidential Commission for the Study of Bioethical Issues. 2015).  Notice that the report recommends investment in further research to develop CT, while recommending that, with respect to CE, funds be used merely to understand existing technologies and communicating that information to the public.  Investing funds to develop CE directly is not recommended by the report.  

A thought experiment can help us determine whether we should prioritize CE or CT.  Suppose we can quantify cognitive abilities on a sliding scale, where 100 is species-typical functioning.  Furthermore, suppose we have two groups of 1,000 children each where one group is made entirely of cognitively advanced (150) children, and the other made entirely of cognitively disabled (50) children.  Now, if we have a brain booster that will raise the cognition of every child in a group by 50 points and can only be used one time on one of these two groups, on which group ought we to use it?  Do we give 1,000 disabled children the opportunity to live cognitively normal lives (a maximin strategy) or do we raise the cognition of 1,000 highly intelligent children to an even higher, super level of intelligence (a maximax strategy)?  I believe we have stronger reasons to prefer the maximax strategy.  Some reasons for this decision are as follows.  

The principle of nonmaleficence gives us reason to choose CE over CT because the CT group is more likely to do harmful things.  They will not do bad things on account of maleficence, but on account of their cognitive limitations.  This follows from the evidence we have that humans of average intelligence come with a lot of liability; we do not live up to the high expectations the name homo sapiens suggests (Ariely 2010, Marcus 2008, Kahneman, Slovic, and Tversky 1982).  Average humans will continue to do what they have always done, act with short sighted, highly localized, heavily biased thinking.  The danger is we can now act with global impact reaching far into the future.  This is what has made our species a considerable threat to not only ourselves but all life on our planet.  Humans, as they are now, are likely to cause what Julian Savulescu and Ingmar Persson call “ultimate harm,” an event that precludes the possibility of meaningful life on our planet (Persson and Savulescu 2012).  

The principle of beneficence gives us reason to choose CE over CT because the CE group is more likely to do good things.  With the CE group we are likely to get more individuals whose actions will have greater positive benefits for society as a whole because long-term thinking is one of many benefits that accompanies increases in cognition (Shaw 2014, 399).  Interestingly, public opinion on CE is more favorable as one’s ability to positively influence others also increases (Fitz et al. 2013, 177).  People are more likely to favor CE for brain surgeons and pilots.  The super intelligent children are more likely to lead lives with much higher contributions being made to the fields that suit their natural talents.  These contributions will raise the quality of life for many others including future cognitively disabled individuals.  Ironically, if one feels compelled to prioritize CT over CE because they believe we have a moral duty to maximize the number of dysfunctional individuals we can raise to a species-typical level, then such a justification gives one good reason to use the brain booster for CE.  Choosing CE gives us a population with a greater chance of developing better cures for cognitive dysfunction and other ills, which will almost certainly lead to more cognitively disabled individuals being helped in the long run.  

The principle of justice could be used to favor the prioritization of CT, as one can object to the maximax strategy on the grounds that it creates a society that increases rather than decreases disparities between the cognition of individuals.  However, we may have good reasons to consider weighing the concerns of justice less than the other moral factors outlined above.  Creating a society that maximizes equality of abilities among its members is not an absolute good.  Nietzsche has challenged equality by insisting that man is not something to be preserved, but overcome.  This is the point he has in mind when he writes, “Man is a rope stretched between the animal and the Superman—a rope over an abyss”  (Nietzsche 2009, 5).  Are we to judge the value of our species by how well we preserved ourselves, or by how far we pushed beyond our limits?  Perhaps this option of preservation is an illusion in our modern context.  If we choose CT because we wish to preserve a status quo cognition, then, as I have argued above, this could plausibly lead to extinction.  If we choose CE, then we also face extinction as we are because CE will likely lead to creatures no longer recognizably human.  The question then, is not whether we will perish, but what kind of world and what kind of creatures we will leave in our wake.  Will we perish because we have destroyed ourselves and rendered life on this planet inconsequential, or will we perish because we have evolved into something far greater than we currently are?  

It is worth noting that some objections to CE based on a desire to preserve the cognitive status quo run right into the challenge posed by Toby Ord and Nick Bostrom called the reversal test.  For example, if it is denied that increases in cognition will result in greater social benefits, the reversal test leaves the objector with two improbable options.  If cognition would not lead to greater benefits then either (1)- it must be the case that less cognitive abilities would lead to greater benefits, or (2)- it must be the case that we are exactly at the optimal cognitive level to generate optimal benefits. The first option leads to the absurd conclusion—that we should actually decrease our cognitive abilities. The second option is simply an extraordinary claim that lacks extraordinary evidence.  What are the chances that at this exact stage in evolution we have reached an optimal cognitive level (not too much, not too little)?  

In the end, it may be the case that this distinction between therapy and enhancement presents us with a false dichotomy.  Many of our current CE technologies have arisen out of attempts at CT.  Deep brain stimulation, which began as a treatment for multiple neurological disorders including Parkinson’s, depression and obsessive compulsive disorder is now showing promise as a memory enhancer in healthy brains (Suthana and Fried 2014).  Ritalin, which was originally developed to treat ADHD has also come to be used by healthy individuals to reduce fatigue and increase concentration (Whetstine 2015).  As with many things, when we learn how to fix, we learn how to improve.  

False dichotomy or not, the Gray Matters report has drawn the distinction between CT and CE, and produced a forceful endorsement of developing CT technologies over CE.  It is precisely this endorsement that my essay has sought to question.  I think a lot of resistance to CE option comes from simply being afraid to lose control to humans much smarter than us, so much smarter that perhaps they no longer qualify as human.  A vote for the priority of CT is a vote for the preservation of status quo human cognition.  We ought to seriously question the prioritization of CT on the grounds that it is not likely to result in the survival of our species as a whole.  We will either destroy ourselves or evolve into something no longer recognizably human; is man perfect as he is, or a rope?  


 

References:

Ariely, Dan. 2010. Predictably Irrational: The hidden forces that shape our decisions. New York: Harper Perennial.

Beauchamp, Tom L., and James F. Childress. 2009. Principles of biomedical ethics: New York : Oxford University Press, 2009. 6th ed.

Bostrom, Nick. 2003. The Transhumanist FAQ, v 2.1.

Farah, Martha J. 2012. "Neuroethics: The Ethical, Legal, and Societal Impact of Neuroscience."  Annual Review of Psychology 63 (1):571-591 21p. doi: 10.1146/annurev.psych.093008.100438.

Fitz, Nicholas S., Roland Nadler, Praveena Manogaran, Eugene W. J. Chong, and Peter B. Reiner. 2013. "Public Attitudes Toward Cognitive Enhancement."  Neuroethics 7 (2):173-188. doi: 10.1007/s12152-013-9190-z.

Kahneman, Daniel, Paul Slovic, and Amos Tversky. 1982. Judgment under uncertainty : heuristics and biases: Cambridge ; New York : Cambridge University Press, c1982.

Lucke, Jayne, and Brad Partridge. 2012. "Towards a Smart Population: A Public Health Framework for Cognitive Enhancement."  Neuroethics 6 (2):419-427. doi: 10.1007/s12152-012-9167-3.

Marcus, Gary F. 2008. Kluge : the haphazard construction of the human mind: Boston : Houghton Mifflin, 2008.

Nietzsche, Friedrich Wilhelm. 2009. Thus Spake Zarathustra : A Book for All and None. [Waiheke Island]: The Floating Press. Book.

Outram, Simon M., and Eric Racine. 2011. "Developing Public Health Approaches to Cognitive Enhancement: An Analysis of Current Reports."  Public Health Ethics 4 (1):93-105. doi: 10.1093/phe/phr006.

Persson, Ingmar, and Julian Savulescu. 2012. Unfit for the future : the need for moral enhancement, Uehiro series in practical ethics: Oxford : Oxford University Press, 2012.

Presidential Commission for the Study of Bioethical Issues. 2015. Gray Matters. Vol. 2. Washington, D.C.: Presidential Commission for the Study of Bioethical Issues.

Shaw, David. 2014. "Neuroenhancing public health."  Journal Of Medical Ethics 40 (6):389-391. doi: 10.1136/medethics-2012-101300.

Suthana, Nanthia, and Itzhak Fried. 2014. "Review: Deep brain stimulation for enhancement of learning and memory."  NeuroImage 85 (Part 3):996-1002. doi: 10.1016/j.neuroimage.2013.07.066.

Whetstine, L. M. 2015. "Cognitive Enhancement: Treating or Cheating?"  Semin Pediatr Neurol 22 (3):172-6. doi: 10.1016/j.spen.2015.05.003.

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