Views on Cognitive Enhancement in the Netherlands

Most of the studies just reported also asked about opinions of people with regard to cognitive enhancement, and there are some additional studies available that inquire into public opinion concerning human enhancement in general.

GENERAL PUBLIC

In 2012, the Rathenau Institute published a report on public perceptions and opinions regarding human enhancement.12 The report contains the results of a focus group study among the Dutch public featuring concentration enhancers, especially methylphenidate, as one of the cases discussed. After a brief explanation, participants were asked whether they would want to use certain enhancements. Of the 38 participants in the five focus groups, 41% indicated they would use Ritalin" as an enhancer, 22% said they would not, and 38% were not sure. Interestingly, after their discussion of the topic, these numbers had shifted: only 5% still said they would use Ritalin, 75% said they would not, and 22% still were not sure.

The researchers give a qualitative account of the focus group discussions on the use of Ritalin as a cognition enhancers for healthy people and state that the participants came up with a number of concerns. First, they were surprised to hear that Ritalin could be used by healthy people and questioned whether this was allowed. Next, they discussed potential side effects and the lack of knowledge about long-term side effects. There were concerns about the lack of knowledge regarding long-term side effects, and some were of the opinion that people take too many medications already and that this is not a good thing: “Medication always burdens the body and therefore caution is needed.”12: 65 Participants also expressed worries regarding risks of dependence and addiction and suggested alternatives like homeopathic drugs.

In response to the question of whether Ritalin should be available for healthy people, a number of other issues were brought up. Participants discussed possible shifting of performance norms, risks of social pressures and of coercion by employers, issues of equal access and fairness, and effects of enhancement use on personality (e.g., the development of stamina or the pride one could take in performances that were not really “one’s own”).

The researchers conclude that a majority of the respondents found it undesirable for Ritalin to be available for healthy people without prescription—in general, they were of the opinion that one should not take medication in the absence of disease, although some believed that limited use for special occasions, like taking an exam, would not be problematic.12 The researchers write:

Most respondents think that the use of Ritalin by healthy people should be limited. A frequently heard argument is “if we pose no limits to the use of Ritalin then it will be taken more and more.” And “this could be the thin end of the wedge.” Exactly which doomsday scenario’s respondents see before them here, does not become clear” (translation MS).12:69

Some respondents stressed the potential benefits of availability of cognition enhancers for healthy people: they could improve work or study or be used in certain professional circumstances, like sustaining concentration in lengthy surgery, they suggest. A minority of the respondents believe that Ritalin should be freely available, just like coffee or energy drinks. Their main arguments are freedom of choice and an aversion to paternalism, and the more pragmatic thought that a prohibition would be counterproductive.

These results are in certain respects similar to results of a study we did on lay people’s perceptions and opinions regarding various examples of wish- fulfilling medicine.13

One of the examples we discussed in our five focus groups (consisting of 37 lay people) was the use of beta-blockers against exam anxiety for a driving test. Such use of medication to enhance performance on a test can be understood as a form of neuroenhancement, although it does not figure in the debate on (cognitive) enhancement so far. This use of beta-blockers is an accepted practice in the Netherlands, in the sense that occasional use of a beta-blocker for exam anxiety or stage fright is advised by general practitioners’ professional guidelines.14 Most participants in our focus groups, however, were not aware of this and were very surprised that it was possible to use medication for such purposes, and they questioned whether it was allowed, just as the participants in the Rathenau study did regarding Ritalin use by healthy people.12- 13 Many participants in our focus groups were of the opinion that medication should not be taken in the absence of disease, and, moreover, they were convinced that medication would somehow be “bad for you.” A participant said: “Yeah, paracetamol, if you take too much, it is not safe either. But I believe that with prescription medication, that there is a reason ... that you cannot go to a pharmacy and just say ‘I want this.’ ”13: 3 They also raised worries about habituation or even addiction.

Even after the harmlessness of a single dose of a beta-blocker was explained, many remained convinced that it would be risky or simply wrong to take it: “it is still medication, isn’t it?”

In our study, as in the Rathenau study, participants suggested alternatives such as psychological consultation, herbal extracts, or homeopathy apparently because, in their view, such “natural” remedies were more harmless or otherwise “better.” This is in line with a Swedish study that found that the general public had more favorable attitudes toward the use of “natural remedies” for enhancement than toward medication.15

Two groups in our study also brought up the question of whether it was better to just accept one’s limitations instead of trying to enhance oneself with medication; according to some participants, acceptance was the morally right thing to do. For instance, in response to an example of a violinist who used beta-blockers for stage fright, one of the participants suggested that this person should choose a different profession rather than use medication.13

 
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