Cognitive Enhancement in the Netherlands. Practices, Public Opinion, and Ethics

MAARTJ E SCH ERM ER

Introduction

The use of cognitive enhancement drugs for the healthy has received quite a lot of attention in the international bioethics literature. It has rightly been pointed out that it is not always clear what exactly is supposed to be captured under the heading of “cognitive enhancement.”1 Does it refer to hypothetical future smart drugs? Or does it refer to actual use of drugs that allegedly improve cognitive functioning by students, scientists, and others—even though the actual effects of such drugs are doubtful? At this moment, it is questionable whether medication like methylphenidate or modafinil really has significant cognitionenhancing effects in healthy subjects.2-3 Nevertheless, there have been reports, mainly from the United States, of people using these substances with the intention of enhancing their cognition or cognitive performance.4 Although much of the bioethics literature has dealt with the ethical questions that would be raised by the availability of safe and effective cognitive enhancers—questions about freedom of choice, social pressures and coercion, equal access, fairness, human nature—relatively little is known about the actual use of alleged cognition enhancers or of the opinions and moral concerns about cognitive enhancement entertained by the general public. Moreover, views on cognitive enhancement may differ between various cultural and social contexts. A comprehensive debate about both the current use of alleged cognition enhancers, as well as about possible future safe and effective enhancers, should take such knowledge into account.

In this contribution, I will therefore discuss what is known about the use of and opinions on cognitive enhancement in the Dutch context. I will first present the available evidence regarding the use of cognitive enhancement in the Netherlands. Next, I will discuss how cognitive enhancement is looked upon in the Netherlands by reviewing the available research data on opinions of lay people, students, and psychiatrists. Furthermore, a brief analysis of the public debate and media coverage of (cognitive) enhancement is given. It appears that the debate on the increasing number attention deficit hyperactivity disorder (ADHD) diagnoses and the concomitant rise of prescription use of methylphenidate is more significant than that on cognitive enhancement use by the healthy. Finally, these findings are considered in light of Dutch cultural norms and values. I conclude that, in general, the Dutch appear to have a rather conservative attitude toward enhancement and the use of drugs for enhancement purposes. This may partly be due to moralistic considerations—one should earn one’s credits, work hard for achievement—but concerns regarding safety and the proper use of medication seem paramount. However, these culturally and socially determined moral norms may shift in the future, especially if effective and safe cognition enhancers become available.

 
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