Rethinking the thinking cap: ethics of neural enhancement using noninvasive brain stimulation.

Although a growing body of evidence suggests that noninvasive brain stimulation techniques such as transcranial magnetic stimulation and transcranial direct current stimulation have the capacity to enhance neural function in both brain-injured and neurally intact individuals, the implications of their potential use for cosmetic self-enhancement have not been fully explored. We review 3 areas in which noninvasive brain stimulation has the potential to enhance neurologic function: cognitive skills, mood, and social cognition. We then characterize the ethical problems that affect the practice of cosmetic neurology, including safety, character, justice, and autonomy, and discuss how these problems may apply to the use of noninvasive brain stimulation for self-enhancement.

[Doping in sport and enhancement medicine]. / Dopage sportif et médecine d'amélioration.

The reason that gives doping in sport a deeper philosophical and ethical dimension is the emergence of a new medical paradigm: enhancement medicine. The question of enhancing performance in sport has become part of a broader societal debate on human enhancement. The gradual blurriness of the boarders between therapeutic medicine and enhancement medicine constitutes the most spectacular and the most troublesome form of these modifications. In the contemporary biomedicine, the new medicines and technologies can be used not only to cure the patients but also to enhance human capacities. This evolution represents a paradigmatic change in the medical practice: it is not the mere restoration of health which is expected anymore, nor the promotion of health. What is required is the improvement of performance and the perfectibility of the human being, including in the field of sport. Competitive sport could become the main laboratory of enhancement medicine. The intersection of science and sport raises fundamental philosophical, ethical and policy issues that cannot be answered easily. The prohibition and the war on doping is not the only solution.

["Medicine of desire" between commercialization and patient-centeredness]. / "Wunscherfullende Medizin" zwischen Kommerz und Patientendienlichkeit.

DEFINITION OF THE PROBLEM: Ample evidence points to an emerging new self-understanding within medical practice, away from the established goals of medicine towards greater responsiveness to individual preferences. ARGUMENTS: The altered self-understanding of medical practice unfettered by indications grounded in concepts of disease can be conceptually characterized as desire-driven medicine, or "medicine of desire." This raises the question of morally justifiable limits for the normative governance of a medicine of desire. CONCLUSION: In liberal societies, only two forms of argumentation seem promising for setting limits to the provision and consumption of what a medicine of desire has to offer: Arguments that place expected benefit into the perspective of risks, and arguments that probe the coherence of desires and their fulfillment against the background of a person's conception of a good life for that person.

Systems theory and the ethics of human enhancement: a framework for NBIC convergence.

Representatives from government and the private sector recommend a major, cooperative initiative directed toward using NBIC (nano-, bio-, info-, and cogno-) technologies for human enhancement. By appropriately seeding the convergence of NBIC domains, they believe that the rate of development can be both accelerated and simultaneously channeled to avoid adverse risk and advance human good. However, to accomplish these goals, leaders of the convergence efforts identified as a major intellectual barrier the "development of a hierarchical architecture for integrating science across many scales, disciplines, and data modalities." Such a holistic framework requires a radical rethinking of the nature of science and engineering, and, beyond this, is also necessary for addressing their normative ethical and societal implications. In the first part of this essay, I consider the claim that a new view of science and engineering is needed. After reviewing the central features of a classical view of science, I consider aspects of the nano-revolution, showing why the classical conception is inappropriate and how a systems-oriented perspective is responsive to the character of this new science. I then consider how both science and engineering are transformed, calling into question older dichotomies between pure and applied domains. With the reworking of this distinction comes opportunities for rethinking the relation between science and the humanities more generally, which is necessary if we are to more appropriately address normative ethical aspects of the convergence initiative. After providing this groundwork for the needed hierarchical architecture, I consider a useful example of how a systems perspective might guide NBIC convergence. In the 1960s-1990s George Engel advocated a systems-theoretic model as an alternative to a more reductionistic "biomedical model" in medicine, and he did it for the exact same reasons as those advocated by the leaders of the NBIC convergence; namely, it embodies a more appropriate notion of science and enables one to address ethical aspects of medicine that were insufficiently addressed in the older model. By reviewing Engel's "biopsychosocial model" we can learn important lessons for developing the needed NBIC framework. I close by extending Engel's model so that it addresses all areas of enhancement envisioned as a part of NBIC convergence, and then identify areas where future research is still needed.