Regulating Minds: A Conceptual Typology
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Bioethicists and neuroethicists distinguish therapy from enhancement to differentiate the clusters of ethical issues that arise based on the way a drug or device is used. Taking a stimulant to treat a diagnosed condition, such as ADHD, raises different and perhaps fewer ethical issues than taking it to perform better on a test. Using a drug or device to enhance performance—whether in the workplace, the classroom, the football field, or the battlefield—grants the user a positional advantage over one’s competitors. Positional enhancement raises issues of fairness, equality, autonomy, safety, and authenticity in ways that do not arise in therapy; accordingly, distinguishing enhancement from therapy makes sense as a heuristic to flag these ethical issues.
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Studies show that the controlled and supervised administration of psychedelics reliably induces a “peak” or “mystical” subjective experience of altered perceptions, mood, and cognition characterized by feelings of oneness, transcendence, and ineffability. Anxiety and fear are not uncommon elements, but careful management of the “set and setting” of the experience successfully protects the psychological safety of study participants. In a 2006 study, most subjects rated their psilocybin experience as “either the single most meaningful experience of his or her life or among the top five most meaningful experiences of his or her life.” Further research recently demonstrated that this may lead to sustained, positive changes in personality, worldview, or behavior that may benefit society, especially if reinforced by personal development practices such as meditation.
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On one hand, recreation enhancement entails the use of a drug or device to enhance one’s experience of a recreational activity. Using a transcranial stimulation device to enhance video game performance, for example, provides some individual benefit without raising substantial ethical issues at the collective level. Studies now show that psychedelics can enhance the emotional appreciation of music, a finding that spans recreation, virtue enhancement, and even therapy—depending on the context and intent of use—and could have both individual and collective benefit.
Michael N. Tennison is a Senior Law & Policy Analyst at the University of Maryland Center for Health and Homeland Security. His research interests focus on the ethical, legal, social, and scientific issues associated with drug policy. The opinions expressed are the author’s own and do not represent the view of the Center for Health and Homeland Security or the University of Maryland. Portions of this post are adapted from the author’s poster presentation at the 2017 Annual Meeting of the International Neuroethics Society.
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