Fortschr Neurol Psychiatr 2012; 80(1): 36-43
DOI: 10.1055/s-0031-1282051
Neuroethik
© Georg Thieme Verlag KG Stuttgart · New York

Zehn Jahre Neuroethik des pharmazeutischen kognitiven Enhancements – Aktuelle Probleme und Handlungsrichtlinien für die Praxis

Neuroethics of Pharmaceutical Cognitive Enhancement: The First Ten Years – Current Problems and Practical Guiding Principles
T. K. Metzinger
Further Information

Publication History

Publication Date:
10 January 2012 (online)

Zusammenfassung

Ein auswertender Überblick über die Entwicklung der Neuroethik des pharmazeutischen kognitiven Enhancements (PCE) innerhalb der letzten zehn Jahre, mit einem Schwerpunkt auf der Situation in der Bundesrepublik Deutschland. Der Artikel benennt die wichtigsten begrifflichen Probleme, aktuelle Substanzen und zentrale ethisch-juristische Fragestellungen; am Ende werden allererste Handlungsrichtlinien und Empfehlungen für die Politikgestaltung formuliert.

Abstract

An evaluating survey of the development of the neuroethics of pharmaceutical cognitive enhancement (PCE) during the last decade, focussing on the situation in Germany, has been undertaken. This article presents the most important conceptual problems, current substances and central ethical and legal issues. Very first guidelines and recommendations for policy-makers are formulated at the end of the text.

 
  • Literatur

  • 1 Illes J, Sahakian BJ. The Oxford Handbook of Neuroethics. New York: Oxford University Press; 2011
  • 2 Marcus SJ (ed.) Neuroethics: Mapping the Field. New York: The Dana Press; 2002
  • 3 Farah M. Neuroscience and neuroethics in the 21st centruy. In: Illes J, Sahakian BJ. The Oxford Handbook of Neuroethics. New York: Oxford University Press; 2011: 761-781
  • 4 Metzinger T, Hildt E. Cognitive enhancement. In: Illes J, Sahakian BJ. The Oxford Handbook of Neuroethics. New York: Oxford University Press; 2011: 245-264
  • 5 Morein-Zamir S, Sahakian B. Pharmaceutical cognitive enhancement. In: Illes J, Sahakian BJ. The Oxford Handbook of Neuroethics. New York: Oxford University Press; 2011: 229-244
  • 6 Sahakian B, Morein-Zamir S. Neuorethical issues in cognitive enhancement. J Psychopharm 2011; 25 (02) 197-204
  • 7 Glannon W. Psychopharmacological enhancement. Neuroethics 2008; 1: 45-54
  • 8 De Jongh R, Bolt I, Schermer M et al. Botox for the brain: enhancement of cognition, mood and pro-social behavior and blunting of unwanted memories. Neurosci Biobehav Rev 2008; 32: 760-776
  • 9 Mehlman MJ. Cognition-enhancing drugs. Milbank Quart 2004; 82 (03) 483-506
  • 10 Larriviere D, Williams MA, Rizzo M et al. Responding to requests from adult patients for neuroenhancements: guidance of the Ethics, Law and Humanities Committee. Neurol 2009; 73 (17) 1406-1412
  • 11 Lieb K. Hirndoping. Mannheim: Tamtmos, Artemis & Winkler; 2010
  • 12 Schöne-Seifert B, Talbot D (Hrsg) Enhancement. Die ethische Debatte. Paderborn: mentis; 2009
  • 13 Förstl H. Neuro-Enhancement – Gehirndoping. Der Nervenarzt 2009; 7: 840-845
  • 14 Hoy KE, Fitzgerald PB. Brain stimulation in psychiatry and its effects on cognition. Nat Rev Neurol 2010; 6: 267-275
  • 15 Kramer PD. Listening to Prozac. A Psychiatrist Explores Antidepressant Drugs and the Remaking of the Self. Viking Press; 1993
  • 16 Cerullo MA. Cosmetic psychopharmacology and the President’s Council on Bioethics. Persp Biol Med 2006; 49 (04) 515-523
  • 17 Clark A, Chalmers DJ. Der erweiterte Geist. In: Metzinger T, (Hrsg) Grundkurs Philosophie des Geistes. Band III: Intentionalität und mentale Repräsentation.
  • 18 Menary R (Hrsg) The Extended Mind. Cambridge: MA: MIT Press; 2010
  • 19 Buller T. Neurotechnology, invasiveness and the extended mind. Neuroethics 2011; DOI: 10.1007/s12152-011-9133-9135.
  • 20 Schermer M, Bolt I, de Jongh R et al. The future of psychopharmacological enhancements: expectations and policies. Neuroethics 2009; 2: 75-87
  • 21 Outram SM. Ethical considerations in the framing of the cognitive enhancement debate. Neuroethics 2011; DOI: 10.1007/s12152-011-9131-7.
  • 22 Jüngst ET. What does enhancement mean?. In: Parens E, (ed.) Enhancing human traits: ethical and social implications. Washington D.C: Georgetown University Press; 1998: 29-47
  • 23 Harris J. Enhancing Evolution. Princeton: Princeton University Press; 2007
  • 24 Greely H, Sahakian B, Harris J et al. Towards responsible use of cognitive-enhancing drugs by the healthy. Nature 2008; 456: 702-705
  • 25 Daniels N. Normal functioning and the treatment-enhancement distinction. Camb Quart Health Eth 2000; 9: 309-322
  • 26 Synofzik M. Ethically justified, clinically applicable criteria for physician decision-making in psychopharmacological enhancement. Neuroethics 2009; 2: 89-102
  • 27 Murphy D. Concepts of disease and health. In: Zalta EN, (ed.) The Stanford Encyclopedia of Philosophy.(Fall 2009 edition). http://plato.stanford.edu/archives/sum2009/entries/health-disease/ [Epub only]
  • 28 Kutschenko L. In quest of “good” medical classification systems. Med Stud 2011; 3 (1): 53-70
  • 29 Birnbacher D. Bioethik zwischen Natur und Interesse. Frankfurt: Suhrkamp; 2006
  • 30 Birnbacher D. Analytische Einführung in die Ethik. 2. . Aufl. Berlin: de Gruyter; 2007
  • 31 Gather J. The evaluation of psychopharmacological enhancers beyond a normative “natural”-“artificial” dichtomoy. Med Stud 2011; 3 (1): 19-27
  • 32 Krämer F. Authenticity anyone? The enhancement of emotions via neuro-psychopharmacology. Neuroethics 2011; 4: 51-64
  • 33 Singh I. Beyond polemics: science and ethics of ADHD. Nat Rev Neur 2008; 9: 957-964
  • 34 Wilens TE, Adler LA, Adams J et al. Misuse and diversion of stimulants prescribed for ADHD: a systematic review of the literature. J Am Acad Child Adolesc Psychiatry 2008; 47 (01) 21-31
  • 35 Low KG, Gendaszek AE. Illicit use of stimulants among college students: A preliminary study. Psych Hea & Med 2002; 7: 283-287
  • 36 Forlini C, Racine E. Autonomy and coercion in academic “Cognitive Enhancement” using methylphenidate: perspectives of key stakeholders. Neuroethics 2009; 2: 163-177
  • 37 Repantis D, Schlattmann P, Laisney O et al. Modafinil and methylphenidate for neuroenhancement in healthy individuals: A systematic review. Pharmacol Res 2010; 62 (03) 187-210
  • 38 Repantis D. Die Wirkung von Psychopharmaka bei Gesunden. In: Wienke A, Eberbach WH, Kramer HJ, Janke K, (Hrsg) Die Verbesserung des Menschen: Tatsächliche und rechtliche Aspekte der wunscherfüllenden Medizin. Heidelberg: Springer; 2009: 63-68
  • 39 Franke AG, Bonertz C, Christmann M et al. Non-medical use of prescription stimulants and illicit use of stimulants for cognitive enhancement in pupils and students in Germany. Pharmacopsychiatry 2011; 43: 1-7
  • 40 Franke AG, Konrad A, Lieb K et al. Psychostimulantien und Nicht-Stimulantien in der heutigen und zukünftigen ADHS-Therapie. Fortschr Neurol Psychiat 2011; 79: 1-11
  • 41 Singh I, Kelleher KJ. Neuroenhancement in Young People: Proposal for Research, Policy, and Clinical Management.  AJOB Neuroscience 2010; 1 (01) 3-16
  • 42 Singh I, Kendall T, Taylor C et al. Young people’s experience of ADHD and stimulant medication: A qualitative study for the NIC guideline. Child Adol Ment Health 2010; 15 (04) 186-192
  • 43 Singh I. A disorder of anger and aggression: Children’s perspectives on attention deficit/hyperactivity disorder in the UK. Soc Scie & Med 2011; 73 (06) 889-896
  • 44 Minzenberg MJ, Carter CS. Modafinil: a review of neurochemical actions and effects on cognition. Neuropsychopharmacology 2008; 33 (07) 1477-1502
  • 45 Repantis D, Laisney O, Heuser I et al. Acetylcholinesterase inhibitors and memantine for neuroenhancement in healthy individuals: A systematic review. Pharmacol Res 2010; 61 (06) 473-481
  • 46 Repantis D, Schlattmann P, Laisney O et al. Antidepressants for neuroenhancement in healthy individuals: A systematic review. Poiesis & Praxis 2009; 6 (03) 139-174
  • 47 Slingsby B. The Prozac boom and its placebogenic counterpart – a culturally fashioned phenomenon. Med Sci Monit 2002; 8 (05) CR389-CR393
  • 48 DAK (Deutsche Angestellten-Krankenkasse). Gesundheitsreport 2009. Analyse der Arbeitsunfähigkeitsdaten. Schwerpunktthema Doping am Arbeitsplatz. Berlin: 2009 http://www.dak.de/content/filesopen/Gesundheitsreport_2009.pdf
  • 49 McCabe SE, Knight JR, Teter CJ et al. Non-medical use of prescriptions stimulants among US college students: prevalence and correlates from a national survey. Addiction 2005; 100 (01) 96-106
  • 50 Franke A, Lieb K. Pharmakologisches Neuroenhancement und „Hirndoping”: Chancen und Risiken. Bundesgesundheitsbl 2010; 53: 853-858
  • 51 Maher B. Poll results: look who's doping. Nature 2008; 452: 674-675
  • 52 Sahakian BJ, Morein-Zamir S. Professor’s little helper. Nature 2007; 450: 1157-1159
  • 53 Schleim S, Walter H. Cognitive Enhancement – Fakten und Mythen. Nervenheilkunde 2007; 26: 83-87
  • 54 Galert T, Bublitz C, Heuser I et al. Das optimierte Gehirn. Ein Memorandum zu Chancen und Risiken des Neuroenhancements. Gehirn & Geist 2009; 11:  40-48
  • 55 Douglas T. Moral enhancement. J Appl Philos 2008; 25: 228-245
  • 56 Harris J. Moral enhancement and freedom. Bioethics 2011; 25 (02) 102-111
  • 57 Persson I, Savulescu J. The perils of cognitive enhancement and the urgent imperative to enhance the moral character of humanity. J Appl Philos 2008; 25: 162-177
  • 58 Fröding BEE. Cognitive enhancement, virtue ethics and the good life. Neuroethics 2011; 4: 223-234
  • 59 Moynihan R, Doran E, Henry D. Disease mongering is now part of the global health debate. PLoS Med 2008; 5 (05) e106 DOI: 10.1371/journal.pmed.0050106.
  • 60 Public Library of Science. A collection of articles on disease mongering. PLoS Med 2008; 3 (04) e191 DOI: 10.1371/journal.pmed.0030191. http://collections.plos.org/plosmedicine/diseasemongering-2006.php
  • 61 Davis K. Rethinking „normal”. Hast Cen Rep 2007; 37 (03) 44-47
  • 62 Metzinger T. The no-self-alternative (Chapter 11). In: Gallagher S, (ed.) The Oxford Handbook of the Self. Oxford: Oxford University Press; 2011: 279-296
  • 63 Metzinger T. Der Ego-Tunnel. Berlin: Bloomsbury; 2011
  • 64 Metzinger T. Why are identity-disorders interesting for philosophers?. In: Schramme T, Thome J, (eds.) Philosophy and Psychiatry. Berlin: de Gruyter; 2004: 311-325
  • 65 Metzinger T. Being No One. The Self-Model Theory of Subjectivity. Cambridge: MIT Press; 2003
  • 66 Bolt I, Schermer M. Psychopharmaceutical enhancers: enhancing identity?. Neuroethics 2008; 2: 103-111
  • 67 Olson ET. Personal identity. In: Zalta EN, (ed.) The Stanford Encyclopedia of Philosophy.(Winter 2010 Edition). http://plato.stanford.edu/archives/win2010/entries/identity-personal/ [Epub only]
  • 68 Shoemaker D. Personal identity and ethics. In: Zalta EN, (ed.) The Stanford Encyclopedia of Philosophy.(Winter 2010 Edition). http://plato.stanford.edu/archives/fall2008/entries/identity-ethics/ [Epub only]
  • 69 DeGrazia D. Human Identity and Bioethics. Cambridge: Cambridge University Press; 2005
  • 70 Galert T. Wie mag Neuro-Enhancement Personen verändern?. In: Schöne-Seifert B, Talbot D, Opolka U, Ach JS, (Hrsg) Neuro-Enhancement. Ethik vor neuen Herausforderungen. Paderborn: mentis; 2008: 159-187
  • 71 Gillett G. Subjectivity and Being Somebody: Human Identity and Neuroethics. Exeter: Imprint; 2008
  • 72 Merkel R, Boer R, Fegert J et al. Intervening in the brain – Changing Psyche and Society. Berlin: Springer; 2007
  • 73 Bublitz JC, Merkel R. Autonomy and authenticity of enhanced personality traits. Bioethics 2009; 23 (06) 360-374
  • 74 Califano J. “You’ve got drugs!” Prescription drug pushers on the internet. New York: Columbia University: The National Center on Addiction and Substance Abuse; 2008: 1-15
  • 75 Sententia W. Neuroethical considerations: Cognitive liberty and converging technologies for improving human cognition. Ann N Y Acad Sci 2004; 1013: 221-228
  • 76 Capps B. Libertarianism, legitimation, and the problems of regulating cognition-enhancing drugs. Neuroethics 2011; 4: 119-128
  • 77 Nagel SK. Too much of a good thing? Enhancement and the burden of self-determination. Neuroethics 2010; 3: 109-119
  • 78 Nagel SK. Ethics and the Neurosciences: Ethical and Social Consequences of Neuroscientific Progress. Paderborn: mentis; 2010