No abstract

Neuroenhancement involves the use of neurotechnologies to improve cognitive, affective or behavioural functioning, where these are not judged to be clinically impaired. Questions about enhancement have become one of the key topics of neuroethics over the past decade. The current study draws on in-depth public engagement activities in ten European countries giving a bottom-up perspective on the ethics and desirability of enhancement. This informed the design of an online contrastive vignette experiment that was administered to representative samples of 1000 respondents in the ten countries and the United States. The experiment investigated how the gender of the protagonist, his or her level of performance, the efficacy of the enhancer and the mode of enhancement affected support for neuroenhancement in both educational and employment contexts. Of these, higher efficacy and lower performance were found to increase willingness to support enhancement. A series of commonly articulated claims about the individual and societal dimensions of neuroenhancement were derived from the public engagement activities. Underlying these claims, multivariate analysis identified two social values. The Societal/Protective highlights counter normative consequences and opposes the use enhancers. The Individual/Proactionary highlights opportunities and supports use. For most respondents these values are not mutually exclusive. This suggests that for many neuroenhancement is viewed simultaneously as a source of both promise and concern.Electronic supplementary materialThe online version of this article (10.1007/s12152-018-9366-7) contains supplementary material, which is available to authorized users.

In 1968, Jürgen Habermas claimed that, in an advanced technological society, the emancipatory force of knowledge can only be regained by actively recovering the ‘forgotten experience of reflection’. In this article, we argue that, in the contemporary situation, critical reflection requires a deliberative ambiance, a process of mutual learning, a consciously organised process of deliberative and distributed reflection. And this especially applies, we argue, to critical reflection concerning a specific subset of technologies which are actually oriented towards optimising human cognition (neuro-enhancement). In order to create a deliberative ambiance, fostering critical upstream reflection on emerging technologies, we developed (in the context of a European 7th Framework Programme project on neuro-enhancement and responsible research and innovation, called NERRI) the concept of a mutual learning exercise (MLE). Building on a number of case studies, we analyse what an MLE involves, both practically and conceptually, focussing on key aspects such as ambiance and expertise, the role of ‘genres of the imagination’ and the profiles of various ‘subcultures of debate’. Ideally, an MLE becomes a contemporary version of the Socratic agora, providing a stage where multiple and sometimes unexpected voices and perspectives mutually challenge each other, in order to strength-en the societal robustness and responsiveness of emerg-ing technologies.

The use of pharmaceuticals to support learning and behaviour in children has been a controversial topic since the 1990s. Concerns have been raised about overmedicating children, thwarting their moral develop with drugs, as well as providing an unfair advantage. Everyday enhancement can be understood as the grey area between unambiguously therapeutic and unambiguously non‐therapeutic uses of medication to improve cognitive performance in children. Attention‐deficit hyperactivity (ADHD) disorder and psychostimulant medication use offer a good case study to reflect on the questions raised by everyday enhancement. Over the past years several frameworks have been developed to guide medical professionals' decision‐making. These are rooted in different ethical commitments and include a pragmatic managerial approach to reducing or preventing the harms of enhancement in children; a framework centered on the physician's fiduciary responsibility; and a framework starting from the notion of children's best interests. Key Concepts Enhancement is a controversial subject that rose to prominence from the late 1990s. Evidence suggests that psychostimulant medication is being used to enhance normal performance in children and adolescents. Current evidence is inconclusive about the prevalence of the practice and the efficacy of stimulants in improving normal cognitive performance. Several ethical, societal and neurodevelopmental concerns have been raised about the use of psychostimulants for nonmedical purposes, although the boundaries between therapeutic and enhancing interventions may sometimes be very difficult to define. Various frameworks for professional decision‐making have been formulated, which allocate different weight to a shared set of ethical and societal considerations, such as harm reduction, children's best interests and the fiduciary responsibility of physicians.