Robust resilience and substantial interest: a survey of pharmacological cognitive enhancement among university students in the UK and Ireland

Use of ‘smart drugs’ among UK students is described in frequent media reports as a rapidly increasing phenomenon. This article reports findings from the first large-scale survey of pharmacological cognitive enhancement (PCE) among students in the UK and Ireland. Conducted from February to September 2012, a survey of a convenience sample of 877 students measured PCE prevalence, attitudes, sources, purposes and ethics. Descriptive and logistic regression statistical methods were used to analyse the data. Lifetime prevalence of PCE using modafinil, methylphenidate or Adderall was under 10%, while past regular and current PCE users of these substances made up between 0.3% - 4% of the survey population. A substantial majority of students was unaware of and/or uninterested in PCE; however about one third of students were interested in PCE. PCE users were more likely to be male, British and older students; predictors of PCE use included awareness of other students using PCEs, ADHD symptomatology, ethical concerns, and alcohol and cannabis use. The survey addresses the need for better evidence about PCE prevalence and practices among university students in the UK. We recommend PCE-related strategies for universities based on the survey findings

Living well in the <i>Neuropolis</i>

This paper is about the relationship between cities and brains: it charts the back-and-forth between the hectic, stressful lives of urban citizens, and a psychological and neurobiological literature that claims to make such stress both visible and knowable. But beyond such genealogical labour, the paper also asks: what can a sociology concerned with the effects of ‘biosocial’ agencies take from a scientific literature on the urban brain? What might sociology even contribute to that literature, in its turn? To investigate these possibilities, the paper centres on the emergence and description of what it calls ‘the Neuropolis’ – a term it deploys to hold together both an intellectual and scientific figure and a real, physical enclosure. The Neuropolis is an image of the city embedded in neuropsychological concepts and histories, but it also describes an embodied set of (sometimes pathological) relations and effects that take places between cities and the people who live in them. At the heart of the paper is an argument that finding a way to thread these phenomena together might open up new paths for thinking about ‘good’ life in the contemporary city. Pushing at this claim, the paper argues that mapping the relations, histories, spaces, and people held together by this term is a vital task for the future of urban sociology

Design bioethics:a theoretical framework and argument for innovation in bioethics research

Empirical research in bioethics has developed rapidly over the past decade, but has largely eschewed the use of technology-driven methodologies. We propose "design bioethics" as an area of conjoined theoretical and methodological innovation in the field, working across bioethics, health sciences and human-centred technological design. We demonstrate the potential of digital tools, particularly purpose-built digital games, to align with theoretical frameworks in bioethics for empirical research, integrating context, narrative and embodiment in moral decision-making. Purpose-built digital tools can engender situated engagement with bioethical questions; can achieve such engagement at scale; and can access groups traditionally under-represented in bioethics research and theory. If developed and used with appropriate rigor, tools motivated by "design bioethics" could offer unique insights into new and familiar normative and empirical issues in the field.</p

Chapter Is coercion ever beneficent?

Early intervention in mental health seeks to improve the wellbeing of as many people as possible, by intervening at an early stage in the onset of illness, or by taking preventative action in ‘at risk’ populations. The paradigm is rhetorically powerful, and it is easy to talk in terms of it helping to deliver rights to health and realise social justice. However, in spite – or perhaps because – of the apparently unarguable desirability of such goals, it is harder to discuss rights to dissent. In this respect the risk of coercion is an issue that should be discussed, especially because of the stigmatizing effect that the labelling associated with early intervention may have in mental health contexts. Here we explore this issue, with a particular focus on its practical and ethical implications in relation to UK policy for treating Attention Deficit Hyperactivity Disorder and mild Conduct Disorder in young people

The mystery of mental integrity: clarifying its relevance to neurotechnologies

The concept of mental integrity is currently a significant topic in discussions concerning the regulation of neurotechnologies. Technologies such as deep brain stimulation and brain-computer interfaces are believed to pose a unique threat to mental integrity, and some authors have advocated for a legal right to protect it. Despite this, there remains uncertainty about what mental integrity entails and why it is important. Various interpretations of the concept have been proposed, but the literature on the subject is inconclusive. Here we consider a number of possible interpretations and argue that the most plausible one concerns neurotechnologies that bypass one’s reasoning capacities, and do so specifically in ways that reliably lead to alienation from one’s mental states. This narrows the scope of what constitutes a threat to mental integrity and offers a more precise role for the concept to play in the ethical evaluation of neurotechnologies

Flourishing, mental health professionals and the role of normative dialogue

This paper explores the dilemma faced by mental healthcare professionals in balancing treatment of mental disorders with promoting patient well-being and flourishing. With growing calls for a more explicit focus on patient flourishing in mental healthcare, we address two inter-related challenges: the lack of consensus on defining positive mental health and flourishing, and how professionals should respond to patients with controversial views on what is good for them. We discuss the relationship dynamics between healthcare providers and patients, proposing that ‘liberal’ approaches can provide a pragmatic framework to address disagreements about well-being in the context of flourishing-oriented mental healthcare. We acknowledge the criticisms of these approaches, including the potential for unintended paternalism and distrust. To mitigate these risks, we conclude by suggesting a mechanism to minimize the likelihood of unintended paternalism and foster patient trust

Approaches to consent in public health research in secondary schools

OBJECTIVES: We assess different approaches to seeking consent in research in secondary schools. DESIGN: We review evidence on seeking active versus passive parent/carer consent on participant response rates and profiles. We explore the legal and regulatory requirements governing student and parent/carer consent in the UK. RESULTS: Evidence demonstrates that requiring parent/carer active consent reduces response rates and introduces selection biases, which impact the rigour of research and hence its usefulness for assessing young people's needs. There is no evidence on the impacts of seeking active versus passive student consent but this is likely to be marginal when researchers are directly in communication with students in schools. There is no legal requirement to seek active parent/carer consent for children's involvement in research on non-medicinal intervention or observational studies. Such research is instead covered by common law, which indicates that it is acceptable to seek students' own active consent when they are judged competent. General data protection regulation legislation does not change this. It is generally accepted that most secondary school students age 11+ are competent to provide their own consent for interventions though this should be assessed individually. CONCLUSION: Allowing parent/carer opt-out rights recognises their autonomy while giving primacy to student autonomy. In the case of intervention research, most interventions are delivered at the level of the school so consent can only practically be sought from head teachers. Where interventions are individually targeted, seeking student active consent for these should be considered where feasible

Smarter Than Thou, Holier Than Thou: The Dynamic Interplay Between Cognitive and Moral Enhancement

The debate about the desirability of using drugs to enhance human skills encompasses cognitive abilities such as memory and attention, and moral capacities such as emotional empathy and a sense of fairness. These two strands of literature in bioethics have grown relatively independent from each other, and an implicit framing assumption has emerged suggesting that apparently morally neutral cognitive capacities and paradigmatically moral capacities are distinct and vary independently of each other. Here, we identify key distinctions between competing accounts of cognitive enhancement and moral enhancement and argue that, despite the polarized nature of the bioethical debate, cognitive and moral capacities are intertwined. For example, moral behavior can be improved by enhancing “morally neutral” abilities such as attention span; and cognitive skills can be honed by means of socio-moral interaction. Further, cognitive skill is frequently assigned the abstract status of virtue and treated in the same way as more paradigmatically “moral” traits. We argue that the distinction between moral and cognitive enhancement is more apparent than real, since despite being nominally treated as distinct, cognitive and moral skills are frequently interdependent. As such we present evidence to support the claim that the enhancement of these two kinds of capacities cannot be clearly disaggregated from each other in the way that the theoretical poles of the debate in the literature suggest. We synthesize relevant scientific and bioethical literature and combine it with a line of analysis derived from Peter Hacker to show more clearly the terms of what can be said intelligibly about cognitive and moral skills and their enhancement. As a result of this analysis, we conclude that ethical questions in human bioenhancement are only fully intelligible at the level of persons imbued with feelings, thoughts, intentions, desires, values, and abilities, embedded within a particular social context, rather than at the level of pharmacological modulation of particular cognitive or affective capacities which, though conceptually distinguishable, in the embodied context of moral agency are profoundly intertwined

Decentralising the Self – Ethical Considerations in Utilizing Decentralised Web Technology for Direct Brain Interfaces

The rapidly advancing field of brain-computer (BCI) and brain-to-brain interfaces (BBI) is stimulating interest across various sectors including medicine, entertainment, research, and military. The developers of large-scale brain-computer networks, sometimes dubbed ‘Mindplexes’ or ‘Cloudminds’, aim to enhance cognitive functions by distributing them across expansive networks. A key technical challenge is the efficient transmission and storage of information. One proposed solution is employing blockchain technology over Web 3.0 to create decentralised cognitive entities. This paper explores the potential of a decentralised web for coordinating large brain-computer constellations, and its associated benefits, focusing in particular on the conceptual and ethical challenges this innovation may pose pertaining to (1) Identity, (2) Sovereignty (encompassing Autonomy, Authenticity, and Ownership), (3) Responsibility and Accountability, and (4) Privacy, Safety, and Security. We suggest that while a decentralised web can address some concerns and mitigate certain risks, underlying ethical issues persist. Fundamental questions about entity definition within these networks, the distinctions between individuals and collectives, and responsibility distribution within and between networks, demand further exploration