Walcher-Andris Elfriede
IZEW Universitat Tubingen, Wilhelmstrabe 19, 72074 Tubingen, Germany.
Ethik Med. 2006 Mar;18(1):27-36. doi: 10.1007/s00481-006-0411-4.
Pharmacological cognition enhancement aims at an improvement of cognitive activity and performance in healthy people by means of appropriate drugs. Ethical implications of this kind of cognition enhancement stand in need of reflection.
For a number of reasons, the distinction between treatment and enhancement is fuzzy with regard to Attention Deficit Hyperactivity Disorder (ADHD). In consideration of the growing number methylphenidate prescriptions, one question addressed in this article is whether or not psychostimulants are used not only for therapy but also for cognitive enhancement by children and young people. The possibility of a "grey zone" between treatment and enhancement seems to open the field for medicalization of social and pedagogical problems as well as for "hidden enhancement." In clinical practice, the use of stimulants is associated with certain ethical problems concerning diagnosis, treatment and prevention of ADHD. Some of these problems are associated with the possibility of cognition enhancement. In order to evaluate ethical problems of pharmacological cognition enhancement, short-term and long-term consequences of stimulant use need to be taken into account. This refers to the level of transmitter balance in the learning process, to the level of individual learning strategies as well as to the level of interaction. This raises the question (1) of how well adapted the means of enhancement are with regard to the end of a comprehensive education and socialization, and (2) whether there are justifiable limits to the standardization of behavior and knowledge. (3) Moreover, stipulating an autonomous decision as a minimum prerequisite for legitimate cognition enhancement seems inadequate in the case of children and young persons.
Considering the evidence and the many open questions associated with pharmacological cognition enhancement for children and young persons, it is concluded that it is indeed a morally problematic technique.
药理学认知增强旨在通过适当药物提高健康人的认知活动和表现。这种认知增强的伦理意义值得反思。
由于多种原因，在注意力缺陷多动障碍（ADHD）方面，治疗与增强之间的区别并不明确。鉴于哌醋甲酯处方数量不断增加，本文探讨的一个问题是儿童和年轻人是否不仅将精神兴奋剂用于治疗，还用于认知增强。治疗与增强之间可能存在的“灰色地带”似乎为社会和教育问题的医学化以及“隐性增强”开辟了空间。在临床实践中，兴奋剂的使用在ADHD的诊断、治疗和预防方面存在某些伦理问题。其中一些问题与认知增强的可能性有关。为了评估药理学认知增强的伦理问题，需要考虑兴奋剂使用的短期和长期后果。这涉及学习过程中神经递质平衡的水平、个体学习策略的水平以及互动的水平。这就提出了以下问题：（1）增强手段在多大程度上适合全面教育和社会化的目标；（2）行为和知识标准化是否存在合理的限制；（3）此外，对于儿童和年轻人而言，将自主决定规定为合法认知增强的最低前提条件似乎并不充分。
考虑到相关证据以及与儿童和年轻人药理学认知增强相关的诸多未决问题，得出的结论是，这确实是一种存在道德问题的技术。
