Responding to requests from adult patients for neuroenhancements

Abstract

In the last decade, persons who have no diagnosed medical or mental health condition are increasingly seeking and utilizing, for the ostensible purpose of enhancing their memory or cognitive skills, prescription drugs that were originally developed to improve executive function or memory in persons diagnosed with disorders such as attention deficit hyperactivity disorder or Alzheimer disease. Evidence suggests that this practice, now known as neuroenhancement, is gathering momentum. As a result, neurologists may be encountering patients without a diagnosed illness asking for medications with the goal of improving their memory, cognitive focus, or attention span. Strong arguments have been made for and against this practice, often reflecting strongly held convictions concerning the appropriate practice of medicine. The purpose of this report is to provide neurologists with an overview of the ethical, legal, and social issues surrounding the use of pharmaceuticals prescribed to enhance or augment normal cognitive or affective functioning, as well as practical guidance for responding to an adult patient's request for neuroenhancement.

Should physicians prescribe cognitive enhancers to healthy individuals?

“…Based on guidance from its Ethics, Law and Humanities Committee, the American Academy of Neurology has stated that prescribing medications for cognitive enhancement is not ethically obligatory or prohibited, and is therefore ethically permissible, 10 but that refusing to prescribe is also ethically and legally permissible. 10 Thus, according to the academy, physicians can, but are not obliged to, grant requests for cognitive enhancers.…”

“…5 Box 1 presents landmarks in the debate surrounding the ethics of cognitive enhancement. 1,[3][4][5][6][7][8][9][10][11] Physicians are important stakeholders in this debate, given the risks and regulations of prescription drugs and the potential for requests from patients for cognitive enhancers. 12,13 The underlying question for physicians is not solely whether cognitive enhancement should be legitimized, but what role physicians should play, and under what circumstances they should prescribe these agents to individuals with no medical need, if at all.…”

“…Box 2 contains additional medical context. 7,10,[14][15][16] Here we argue that uncertain measures of benefits and harms, limited health care resources and professional integrity of physicians are 3 reasons why physicians should not prescribe cognitive enhancers to healthy individuals.…”

“…10 This permissive position grants cognitive enhancement the status of moral acceptability without clear and decisive evidence. In fact, there is no substantive evidence to support the use of medications such as acetylcholinesterase inhibitors, antidepressants and stimulants as cognitive enhancers in healthy individuals.…”

“…26 The American Academy of Neurology expresses related concerns that "neuro enhancement therapies are likely to be seen as 'lifestyle' drugs and therefore are unlikely to be covered by third-party payers." 10 Both physicians and members of the public are reluctant about cognitive enhancers being covered by insurance and public funds. 16,27 The use of these drugs might therefore be limited to a relatively small segment of the population who can afford to pay for them.…”