Wednesday, October 28, 2009

Neuroenhancement American Academy of Neurology 2

Yesterday I talked about the guidance document for physicians that came from the American Academy of Neurology dealing with the issue of neuroenhancement, which is the prescription of psychotropic medication to healthy individuals who want to enhance their cognitive performance. They concluded that it is ethical for physicians to prescribe medication for these purposes. It is interesting to see their argument and justification for their conclusion.

The argument that they make is that they divide the practice of medicine into three domains, a core domain, a middle domain, and an outer domain. The core domain are those actions consistent with the traditional goals of medicine: to prevent, diagnose, and treat disease or injury, reduce suffering and to help patients die in peace. The outer domain are those actions that are ethically prohibited such as participating in the torture of prisoners and the like. They describe the middle domain as those actions that are not prohibited but fall outside the traditional role of physicians. They use cosmetic surgery as an example of a middle domain action and liken this to cognitive enhancement.

Right now we have three types of medications used for cognitive enhancement; stimulants, the wakefulness agent modafanil, and the anticholinesterase inhibitors used to slow down memory loss in dementia. There will be more to come in the near future so this is an issue that will stay with us.

I do not think that I will participate in the use of medications for cognitive enhancement in healthy individuals. Medications can result in great benefits but have side effects and risks as well. The physician must always balance potential benefit vs. potential risk. For example I would find it hard to justify myself prescribing Adderall to healthy individuals and putting them at risk of addiction or cardiac difficulties.

I would love to get comments or questions on this issue.

Thought for the day

This is the day that the Lord has made. Let us rejoice and be glad in it.

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