Strange food for thought

Others see no need for making an ethical distinction between therapy and enhancement. "There's better and worse. More life is good. More smarts is good," says James Hughes, who teaches health policy at Trinity College in Hartford, Conn., and is author of the forthcoming book "Citizen Cyborg: Why Democratic Societies Must Respond to the Redesigned Human of the Future."

"Sometimes I think I'm arguing for the plow" - a simple dramatic upgrade in human technology, Professor Hughes says. In 100 years, he predicts, "we'll have currently unimaginable cognitive abilities on tap" through technology.

Those who caution about a rush toward neural enhancement - such as Professor Fukuyama; Bill McKibben, author of "Enough: Staying Human in an Engineered Age"; and Leon Kass, the head of the President's Council on Bioethics - are, in Hughes's assessment, "bio-Luddites," dragging their heels against inevitable technological progress.

But in a recent National Science Foundation-sponsored report entitled "Neurocognitive enhancement: What can we do and what should we do?," a group of scientists, educators, and ethicists concluded that "continuing our current laissez- faire approach [toward brain boosting] risks running afoul of public opinion, drug laws, and physicians' codes of ethics. The question is therefore not whether we need policies governing neurocognitive enhancement, but rather what kind of policies we need."

The report identifies a number of areas of concern, including safety, fairness and equity, coercion, and "personhood and intangible values" - and concentrates on the questions surrounding enhancement drugs, stressing that they are leading the way in the field of neuroscience.

Safety considerations should include "both the conventional medical effects and the more subtle psychological effects that are likely to accompany neurocognitive enhancement," says Dr. Farah, an author of the study. "For example, will attentional enhancement become routine and will we use it to become an even more workaholic society than we are now?"

While patients might be willing to undertake some risk to use a drug to treat a disease, enhancement drugs should meet a higher threshold for safety, says Judy Illes, a senior research scholar in biomedical ethics at Stanford University and the study's other author.

Might Ritalin use, for example, cause a loss of mental capacity in old age? Our worry about possible hidden costs to brain boosting is part "of our mistrust of unearned rewards," the sense that we may be making a Faustian bargain, the study says.

Even enhancement advocate Hughes agrees that safety remains important. The Food and Drug Administration needs to certify drug safety "and it needs to be independent of the biomedical industry in a way that it hasn't been," he says.

Mapping the brain brings its own set of concerns, Caplan adds. He foresees brain scans someday being used at airports to screen passengers. Do you have to give informed consent to have someone look at your brain? he asks. What if it can be done at a distance without your knowledge? And who's going to be allowed to keep information about your brain?

Some kind of regulation will be needed. "You don't want people just setting up machines on the sidewalk saying 'I'll tell you if your spouse is cheating on you,'" Caplan says.

Perhaps most troubling - and most difficult to deal with from a scientific basis - is the question of personhood. "Some people just think messing with the brain is unnatural because the brain is the seat of who we are," Caplan says. "To change it is to change our identity."

"It's at the heart of what this new field of neuroethics is all about," Dr. Illes says. That doesn't mean we must forestall research "because it's getting too close to our personhood," she says, "but rather to empower research with critical ethical thinking."

The concept of a "self" does not make much sense in the framework of neuroscience, "where you and I are just big networks of neurons that can be changed by a drug or other procedure," Farah adds. On the other hand, she says, "I feel I have a self, I feel that other brains are persons, and even though this may be an illusion, it is part of my understanding of life that I am not ready to dispense with, no matter what neuroscience tells me!

"I think the most challenging ethical issues in neuroscience have to do with reconciling these two views of human life."

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