Nada Gligorov

The purpose of this essay is to examine some of the ethical concerns raised regarding the use of neuroenhancers. Authors such as Fukuyama and Sandel argue that medical intervention should be limited to treatment of disease, and that enhancement should be outside of the scope of medicine. This commentary will examine the distinction between treatment and enhancement. I shall conclude that it is not a well-drawn distinction and should not be used to provide guidance with regards to the use of psychopharmacological agents for the purpose of cognitive enhancement. I shall further examine whether concepts such as disability and normality could provide a criterion for determining whether enhancement is a permissible use of medical intervention. I conclude that as those concepts are contextually defined, they cannot be used to make principled arguments against enhancement. Finally, I shall review the charge that medicalization of cognitive performance enhancers is not morally permissible. I shall argue that medicalization might have both negative and positive consequences, and decisions about the moral permissibility of medicalization should be made on a case-by-case basis.

Upon entering the examination room, Caitlyn encounters a woman sitting alone and in distress. Caitlyn introduces herself as the hospital ethicist and tells the woman, Mrs. Dennis, that her aim is to help her reach a decision about whether to perform an autopsy on her recently deceased husband. Mrs. Dennis begins the encounter by telling the ethicist that she has to decide quickly, but that she is very torn about what to do. Mrs. Dennis adds, “My sons disagree about the autopsy.” As a standardized patient, a specialized actor, the woman playing Mrs. Dennis has already delivered the same opening lines several times to different learners practicing their clinical ethics consultation skills. An SP encounter is a simulated patient encounter used for educational purposes that requires the standardization of verbal and behavioral responses. In the encounter, the simulator, or “patient,” uses a scripted medical history to enable the learner to employ a certain skill, say, the ability to perform a neurological exam. The use of standardized patients in the evaluation of clinical skills has become a staple in medical education. To tackle the challenge of teaching clinical ethics consultation skills, we have incorporated SP encounters into the curriculum of the Bioethics Program of The Union Graduate College and the Icahn School of Medicine at Mount Sinai. SP encounters are incorporated into one of our onsite classes, the Onsite Clinical Ethics Practicum, and they are part of the capstone examination, which all of our graduates must complete successfully. The inclusion of simulated encounters into the curriculum is one way in which we equip our students with the core competencies specified by the American Society for Bioethics and Humanities Task Force for clinical ethicists