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A Comprehensive Review_ The Ethical Implications of Neurological Enhancements and Corresponding Policy Proposals – PDF version

Jessica Guo1, Ivan Yuan2, Joanna Li3*, Raaghav Malik4*, Lydia Wang5*, Elizabeth Zhang6*, Daniel Xie7*, Brooke Ellison8 

1Ward Melville High School, East Setauket, NY, 11733; 2Shanghai High School International Division, Shanghai, China, 200237; 2Townsend Harris High School, Flushing, NY, 11367; 4Columbus Academy, Gahanna, Ohio, 43021; 5Great Neck South High School, Great Neck, NY 11020; 6Phillips Academy, Andover, MA, 011810; 7Panther Creek High School, Cary, NC 27519; 8Center for Compassionate Care, Medical Humanities, and Bioethics, Health Science Center, Stony Brook University, Stony Brook, NY 11794

*Authors contributed equally to this work 

 

Abstract 

 

Neuroenhancements provide the potential to expand one’s cognitive and emotional abilities [1]. With technology rapidly expanding and advanced neuroenhancements coming to fruition, the ethicality and regulations of these enhancements are crucial to discuss.

A variety of safety hazards arise regarding neuroenhancements: particularly, when using techniques such as brain stimulation. Such techniques can have unexpected and unknown side effects, and the usage of them is similar to prescription medications, as there are oftentimes tradeoffs. Unfortunately, confusing labels can lead users to believe these safety issues are not present. 

Despite conventional arguments centering around the level of access people should be given to the devices, there are also responsibility concerns. This interesting new perspective questions whether ethicists should instead ask if the handler of the device or the device itself should be regulated. 

When dealing with fair use of neuroenhancements, analogous situations can be analyzed, such as the practice of doping in sports. Doping is generally looked down upon and restricted in athletic competitions [25], so following this, it may be reasonable to similarly restrict neuroenhancements in intellectual competitions. Investigating the possible effects of neuroenhancements on inequality with a real world case [31] offers guidance on creating fair neuroenhancement regulation standards in such competitions while also limiting unfair use. 

Another issue is in regards to autonomy, or the right to self-govern. When a user is under the effect of a neuroenhancement, side effects of treatments, such as changes in cognitive, psychiatric, and behavioral issues, [34, 35] coupled with increasing speculation of hacking from an external third party [33] can force consumers to act in abnormal ways. These possibilities raise questions about whether recreational neuroenhancements violate a user’s autonomy, and concerns about the degree of control an enhancement should have over the user are key in developing proper regulation. 

This paper sought to review each of the aforementioned ethical implications through the creation of four policy proposals. These include developing a nuanced approach to regulation with neither complete prohibition nor complete free usage, setting firm laws that are similar to gun control reform and curtail usage, creating uniform training procedures for those administering the enhancements, ensuring enhancements purely assist with human action while the user maintains full autonomy, and assuming this full autonomy, mandating that users take full responsibility for any potential harm they cause under the enhancement.

 

• Introduction 

 

The brain is the most complex organ in the body. It gives everyone the ability to think, love, and act. Neuroscience is rapidly advancing, and with each day scientists inch closer to understanding how the brain functions. Now, there are even ways to increase our brain’s strength. But is this ethical?

Neurological enhancements are methods a healthy individual takes to extend their cognitive and emotional abilities beyond underlying neurobiology [1]. As shown in Figure 1, there are multiple types of neuroenhancements. The number of neuroenhancement publications and the amount of neuroenhancements used have been rapidly increasing. 

Currently, methods are used to treat neurological deficits for medical purposes (ADHD, Alzheimer’s, Parkinson’s, etc.) [2,3], but ethical concerns arise over the idea of using these drugs as recreational enhancements. They include concerns about safety, character and individuality, distributive justice, the treatment of  special populations such as children, and more. 

The prominent method for cognitive improvement is through pharmacological actions. This includes using Modafinil —a wakefulness-promoting drug traditionally used to treat patients with narcolepsy, sleep apnea, depression, and bipolar disorder [2]— to improve executive functions such as attention span, learning, and memory [4]. 

There are also non-pharmacological methods, including Transcranial direct current stimulation [5] (tDCS) over the motor cortex and Deep Brain Stimulation (DBS) [6]. tDCS has traditionally been used to help patients with brain injuries such as stroke, but recent studies have shown improved neuroplasticity in young patients treated with tDCS [5]. tDCS enhances the connectivity in the stimulated network, which improves neural efficiency and results in greater motor learning, memory, and higher critical thinking [7]. DBS is currently used to treat severe progressive disorders such as Parkinson’s disease and Dystonia [6]. Because it involves the implantation of a medical device into the brain [6], controversy arises over the possibility of using this method as a neurological enhancement in the healthy population.

Additionally, in recent years there has been an influx of devices engineered to communicate directly with the brain. Since they allow the individual’s brain to directly link up with a computer, which empowers the brain and the user, we also consider this under our broad definition of a neurological enhancement. Two subcategories of these devices are Brain-Computer Interfaces (BCIs) and Brain-Brain Interfaces (BBIs) [8]. While BCIs read neural activity and input it into a software platform, BBIs allow two human beings to directly communicate and collaborate with each other through thoughts [8]. A variety of implementations of these interfaces are being researched with a focus on making people with disabilities, such as paralysis, able to perform actions that they cannot, with some devices such as Synchron, already receiving/achieving FDA approval [9]. As the industry seeks to extend these technologies to the healthy user- the goal Elon Musk sets for his Neuralink technology [8, 10]- it is imperative that the ethical implications for such technologies are well-researched. The three main categories of neurological enhancements are summarized in Figure 1.

Figure 1: Overview of different neurological enhancements

 

Views on the ethics of neurological enhancements are polarized between liberal and conservative ideas due to the opposing opinions on whether individuals have the right to use neurological enhancements, and the societal implications of allowing neuroenhancements to be  used [11]. Liberal perspectives encourage continual enhancement in the pursuit to improve the standards of daily living, while more conservative views want to preserve nature for the fear of unwarranted changes in humans and society [12]. 

As a result of these two opposing viewpoints, more nuanced ethical arguments and areas of concern have arisen and become topics of conversation. Some of these topics include disparities in distribution of neurological enhancements [13], concerns of regulation and safety [14], and questions of autonomy [11] when receiving neurological enhancements. This paper will be describing the conversation surrounding each of these ethical concerns, and proposing potential policies that mediate between the two extreme perspectives.

 

• Regulation

• Unforeseen Adverse Effects

• Safety

One form of neurological enhancement that is widely studied and more ready for clinical use is noninvasive brain stimulation. Noninvasive brain stimulation is a technique that alters brain function through magnetic or electric stimulations. Current studies already show noninvasive brain stimulation to be effective in treating disorders such as depression as well as improving learning abilities. These studies also suggest that such treatments yield minimal adverse effects, including headaches [15]. However, review of existing literature on transcranial direct current stimulation (a form of noninvasive brain stimulation) demonstrates the possibility of adverse effects being underreported due to selective reporting bias and unsystematic evaluation of such effects in studies [16].

In many cases, noninvasive brain stimulation is most effective when used on children, who have developing brains [17]. The use of these enhancements on children proposes additional risks and ethical concerns. Brain stimulation can have impacts on the patient on various time scales, from milliseconds to weeks and even longer. The use of multiple sessions of stimulation can also lead to a buildup of complications, making it harder to evaluate the safety of the treatments [14]. The lack of long term studies and studies focusing on the impacts of brain stimulation on developing brains pose a danger to children receiving such treatment. A similar problem is the possibility of tradeoffs. Many forms of neurological enhancements improve one function at the expense of another. When they are used on children, parents are often the ones faced with the dilemma of whether to choose the enhancement and face the tradeoff. This leads to ethical concerns, as the parents’ decision would have a profound impact on the child’s future development and limit the future pursuits of the child [18].

The potential of misleading terminology that inaccurately describes personal risk assessment is another issue that results from the use of neurological enhancements. Traditionally, the term “noninvasive” refers to medical procedures without incisions or insertions into the body. Many forms of neurological enhancements, including electric stimulation, would qualify as “noninvasive” under such definition but actually interfere significantly with human organ systems [14]. Labeling these treatments as “noninvasive” can lead to the illusion that such procedures do little harm on the body, resulting in many individuals consenting to these treatments without knowing the actual risks of doing so.

Finally, the widening of access to neurological enhancements may also create unexpected safety issues. As enhancements become much more available, the person administering the enhancements may be less trained. In fact, manufacturers are already promoting “DIY-tDCS” products for users to perform electric brain stimulations on themselves. The lack of training and management over the administration of these techniques may result in the wrong part of the brain being stimulated, which can have hard-to-foresee effects [14]. Thus, a system of training and responsibility may be needed to ensure safe use of neurological enhancements. 

 

• Device vs. Handler

Although much debate arises over whether neurological enhancements should be permitted, a question that further complicates the matter is whether it is the device or the handler that should be regulated [19]. 

The Second Amendment of the United States Constitution gives American citizens the right to bear arms, yet the same questions emerge. Long standing laws for protection against gun violence include the Gun Control Act of 1968, which prohibits minors, convicted criminals, the mentally disabled, and dishonorably discharged military personnel from purchasing firearms [20]. Additionally, the 1993 Brady Handgun Violence Prevention Act mandates background checks for all unlicensed individuals purchasing a firearm from a federally authorized dealer [20]. However, recent years have seen some of the worst gun violence in United States history, and nearly 40,000 were killed from guns in 2018. Mass public shootings are occurring more frequently with more severity, and there has been a rise in the number of public protests with heavily armed citizens [21]. 

 In these situations of one person murdering another using the gun, is the manufacturer of the gun, the gun itself, or the person who was handling the gun guilty?

Several actions have been taken recently in an effort to reduce gun violence [22], and the Biden administration has promised more [23]. The United States and the rest of the world are working tirelessly for gun control reform in an effort to reduce destruction. However, when unforeseen adverse effects, such as murders, happen, it is the shooter that is put on trial — not the gun. 

Nevertheless, consider a gun that fires automatically when a user has just a trace of a violent thought towards someone, but does not intend to hurt them. This scenario is analogous to that described by Yuste et al:

 

A paralysed man participates in a clinical trial of a brain–computer interface (BCI). A computer connected to a chip in his brain is trained to interpret the neural activity resulting from his mental rehearsals of an action. The computer generates commands that move a robotic arm. One day, the man feels frustrated with the experimental team. Later, his robotic hand crushes a cup after taking it from one of the research assistants, and hurts the assistant. Apologizing for what he says must have been a malfunction of the device, he wonders whether his frustration with the team played a part. [24]

 

In such a case, it is the fault of the device for being too sensitive to user inputs. The user never intended for the robotic arm, or in the former case, a gun, to harm someone, yet the device still did. This is clearly a malfunction. Therefore, we must ensure that devices are heavily tested before release, and, like a physical computer, require explicit confirmation from the user before an action is performed. Although this may be an inconvenience for the user, and perhaps even make some actions unavailable, it is essential to ensure the creation of a safe device that always acts as the user intends.

If all neurological enhancements act to serve the user’s intentions in such a way, ultimately it is the user who must bear the consequences of his/her actions. However, laws should be enacted to mitigate abuse resulting from the existence of neurological enhancements. Should the neurologically enhanced user choose to employ his/her new capabilities for harm, she/he must be held accountable, even though it is the device that afforded the user the ability/opportunity. 

The user must agree to take responsibility for his/her actions after using the device, and then the four basic principles of bioethics (autonomy, justice, beneficence, non-maleficence) can be applied for assessment. As long as the purchaser is well informed of the possible consequences and benefits as well as the likelihood of success, and consents to the enhancement, it would be a violation of his/her autonomy to ban the enhancements. The product should also be equally available to everyone (justice), and the consumer must purchase the product with the intent to only use it for good (beneficence) and not harm (non-maleficence). If these conditions are met, the user must be responsible, and it is not the fault of the creator of the neurological enhancement nor the neurological enhancement itself, should abuse be present. 

 

1.   Unfair Use

 

One of the main questions regarding neurological enhancements is the regulation of them so that individuals do not obtain an unfair advantage. Although neurological enhancements will likely be initially marketed as treatments for disorders or diseases (i.e. methylphenidate or Adderall for ADHD), there will undoubtedly come a time when such drugs will be considered for recreational purposes or other uses outside of treatment. Neurological enhancements could be used to obtain an unfair advantage in certain settings such as in an intellectual contest or exam. The status quo of neurological enhancement regulation (unregulated) is insufficient to prevent such situations from becoming commonplace; rather, certain regulations on neurological enhancements must be enforced. 

On the simplest level, the current IOC Anti-Doping Regulations [25] (as applicable to the Tokyo 2021 Olympic Games) may serve as a foundation for neurological enhancement regulations. To prevent individuals from obtaining an unfair advantage in intellectual competitions or exams, individuals can be tested for traces of neurological enhancements prohibited in such competitions. Although testing may be a substantial way to determine a person’s eligibility in such events, the question remains whether to prohibit students from using neurological enhancements during exams. Neurological enhancements could create advantages for certain individuals while proving a disadvantage to others, especially if those of high socioeconomic status are able to more readily obtain such enhancements. If the consensus is to ban students from taking neurological enhancements, regular testing can be enforced to ensure that students do not take such enhancements. This type of testing would only work for temporary enhancements, however. If an individual is doped with a permanent enhancement at a young age, it may prove difficult to even the playing field. In such a case, more research must be done to ensure fairness.

Another perspective that is in contrast with current regulations, is that athletic doping should be legalized. With illegal doping and genetic or socioeconomic factors influencing the success of honest athletes against their control, legalizing doping in sports may grant disadvantaged athletes access to enhancements that give them an equal chance to succeed [26]. This, however, is very unlikely to occur. There is a slight possibility though, because young people are conflicted as to whether doping should be permitted; recent studies suggest that young people do not hold extremely negative views of doping, unlike sporting bodies and governments. In one study, more than 50% of 18–34-year-old sporting fans had ‘little or no objection’ to doping and 19% were in favour of legalizing it under medical supervision [27]. One reason for their views may be the clear drawbacks of choosing to not engage in doping in an environment where one’s competitors do. If an athlete is unaware of whether or not his or her competitors will engage in doping, it will always be more advantageous for said athlete to engage in doping themselves. Without deterrents like health risks or the risk of being banned, choosing to take performance enhancing drugs allows an athlete to, at worst, break even with other cheating competitors [28]. The same inclinations may emerge in students learning or taking exams in competitive academic settings, where the unregulated nature of neurological enhancements may further promote their use. 

The previous two perspectives lie on opposite sides on the spectrum, but there also lies much middle ground. It has been discussed that outlawing all neurological enhancements won’t be able to prevent access from illegal or international markets— driving up both their cost and their possible hazards [29]. Giving disadvantaged learners and students, but not the entire population, free access to neurological enhancements may reduce educational inequality, while vain efforts to prohibit all access to neurological enhancements may turn “smart drugs” into yet another privilege held by the wealthy or well-connected over the poor. 

If entirely prohibiting the use of neurological enhancements is not a favorable outcome, it can be said that completely encouraging its use may also be discouraged. As discussed in “II. Regulation,” the long term effects of many neurological enhancements are not well understood, with the safety of brain enhancement treatments being poorly defined in vulnerable subjects like children. In a 2014 study summarizing the results of public opinion surveys on concerns towards neurological enhancements, “safety” and “coercion” emerged as two of the three most common issues raised by participants. They discussed their concerns over pharmacological enhancements becoming a requirement for workers occupying high-responsibility or high-difficulty positions in fields such as medicine or the military— where direct or indirect coercion (through observing peers) to enhance oneself may push a professional towards taking neurological enhancements against their will [30]. 

This issue of professional coercion arose in the US military, when two US National Guard pilots serving in Afghanistan in the year 2002 given a performance enhancing stimulant called Dexedrine were acquitted from accidentally bombing a friendly Canadian military base while under the influence of the drug. Both of the pilots were given Dexedrine with informed consent, but they claimed that they were unfairly pressured into taking it. There was no certain indication of whether or not they would have been allowed to fly if they refused to take the drug [31]. While fully banning neurological enhancements may restrict the freedom of individuals who wish to consume them, the utility of neurological enhancements in professional settings may put workers in situations where their freedom to refuse an enhancement is compromised. Here, Dexedrine may have taken the autonomy of two pilots and led them to unintentionally engage in friendly fire, or it may have been used as a scapegoat for the poor judgement of two pilots who simply happened to be under its influence while they made a fatal mistake. 

Two focuses of achieving fair regulations of neurological enhancements should be limiting disparities which may arise from unequal access and ensuring that individuals will not face insurmountable pressures in favor of either taking or not taking neurological enhancements in daily life or in the workplace— all while ensuring the safety of all treatments. Neither complete prohibition nor the open encouragement of all neurological enhancement use may achieve these ends, and one should seek a nuanced, case-by-case solution to regulation. 

Therefore, it is paramount to bring both clear definitions to both what is known as recreational use and what is known as pharmaceutical use because of the way that the lines are blurred, this would only lead to further deregulation of the neuroenhancements [32]. However, the line can be drawn when the medical issue is cured yet the drug is still used to induce a sense of pleasure that they received before while on the medication. Pharmaceutical use becomes recreational once the need for the drug to cure an illness is over. Without an illness, if a user keeps on using the drug, they are using it for recreational purposes. 

This would help with stemming unfair use by keeping the two kinds of use separate and easier to regulate. By drawing a distinct line between pharmaceutical and recreational use, and not allowing for self determination, use can be further regulated to prevent any doping under the pretense of pharmaceutical use.

 

• Autonomy

 

With the increase in novel neuro-enhancements in recent years, questions have come up as to whether neurological enhancements affect a user’s autonomy, which is the first basic principle of bioethics. For example, in a 2016 report, a man using a stimulator to increase neural activity to treat depression noticed that he was saying things he deemed inappropriate in hindsight. He said that “it blurs to the point where I’m not sure… frankly, who I am” [24].  Another case resulting in a loss of autonomy, brought up by Yuste et al., is the development of an “auto-complete” or “auto-correct” feature that allows the users thoughts to flow easier, once again leading to a loss of full control over a user’s thoughts and actions [24]. Their report argues for the establishment of an international convention to define prohibited actions related to machine learning and neuro-enhancements with respect to this loss of autonomy. They compare this to the establishment of the 2010 International Convention for the Protection of All Persons from Enforced Disappearance, which also defined clear prohibitions. We also agree that the establishment of well-defined rules regulating neurological enhancements is crucial. However, we must address the extent to which some degree of autonomy can be lost for the greater benefit of the user and society before such conventions are held, so that we have a common ground to define such prohibitions.

Consider the following situation. A teenager is bullied constantly in school for the way he looks. His family provides no support, and he lacks the resources to seek a counselor. He decides to go home and bring his family’s hunting rifle to school the next day, shooting anyone in sight as a means for revenge. However, he is wearing a BCI, which recognizes the teenager’s violent thoughts. The BCI soothes him, making him change his mind into not bringing the rifle to school the next day. This saves the lives of the individuals that would have died the next day. One question that arises from this situation is: if the loss of human autonomy saves lives, is this ethical?

In answering this question, we must realize that technology itself is created by human beings, and is therefore subject to human bias. Thus, as much as we would like a BCI that could save human lives, any degree of control we give the BCI over a human being’s autonomy will be subject to the will of the human beings that created such a device. There are a variety of ethical dilemmas, and in these cases it is up to the personal values of the actor as to what decision they make. If we were to enforce a specific decision using a BCI, we may go against the personal values of an individual, and make them act in ways they would not otherwise, leading to a clear loss of identity. Another issue is if we make humans always follow the law (which were also created by human beings), we would never have civil disobedience, advancing society forward. Therefore, having the BCI have too much control over a human being’s thoughts and actions is unethical. Instead, we must try to find a balance where both safety and human autonomy is preserved.

Deep brain stimulation (DBS) has also been a topic of conversation due to questions about autonomy because of its direct modulation of the brain. DBS is a procedure that involves the implantation of electrodes into an individual’s brains to allow qualified medical professionals to alter brain function. These changes in the brain have been widely adopted to treat neurological conditions, such as Parkinson’s Disease, dystonia, depression, and anorexia [33]. Although there have been successes when DBS is implemented in patients, there have been adverse effects triggered by the side-effects of DBS such as impulse-control issues, hypersexuality, and other cognitive, psychiatric, and behavioral issues [34, 35]. Such issues warrant a question of autonomy and consent, especially if DBS were to be applied recreationally; if a person undergoing DBS is experiencing side-effects that adversely affect the people around them, are they cognizant enough to decide whether or not they want DBS treatment? This question stems from the main question of whether or not a person’s thoughts when under DBS treatment, or any neurological treatment, reflect an authentic self.

To increase the efficiency of some devices, offloading computations and the usage of closed-loop programming have also been implemented, which interfere with a user’s autonomy [36]. While offloading computations allow for the generation of predictive movements that make tasks like moving objects seem easier, it results in many of the movements not being controlled by the user. For example, one case is a treatment for mood disorder where an individual has reported not feeling sad as often, even during a funeral [36]. Similarly, closed-looped programming is often used to detect and automatically suppress seizures, failing to ask for the user’s consent. When the device is modified to ask the user to provide input on medication instead of being automatic, users have reported that they rarely go against the BCI and feel a loss of autonomy as they follow the actions recommended by the BCI, and one user even reported depression [36]. Additionally, certain individuals have found to associate their identity with preconditions that they already have [33]. They may not realize this until after receiving the neurological enhancement.

Another loss of autonomy can occur when a BCI prevents the user from committing a crime. As mentioned previously, the decisions of the BCI are prone to human bias, and so allowing a BCI to have complete control over a human is similar to allowing a group of humans to have complete control over a human. Although laws exist, there is currently no way to make someone follow the law exactly as it is written, and not think of a single disobedient thought. This is a topic that has been discussed for centuries, and philosophers from Aristotle and Plato to Immanuel Kant have agreed on the importance of individual autonomy [37].

In addition to issues caused by side-effects of the DBS treatment itself, a risk that has been an increasing concern is the risk of ‘brainjacking’, which is where unauthorized control of an individual’s brain implant is exercised [33]. This has been seen with BCI’s and, although it hasn’t explicitly been seen, there’s adequate assumption to believe that this can be extended to the Implanted Pulse Generators (IPGs), which are integral to DBS systems. In a situation where brainjacking would occur, the individual receiving DBS has no control over the way in which they are neurologically stimulated. In most simplistic cases, the user loses autonomy and it raises concerns of whether or not the potential adverse effects of allowing DBS treatment outweighs the benefits. In situations where DBS is used for medical treatment, the patient may feel that improvement for their conditions is worth the adverse effects; yet, the use of DBS as pure enhancement is more grey. A question arises of whether or not it is worth the risk of losing autonomy and control over recreational enhancements. Thus, ethical concerns about individual autonomy have been raised for fear of influence from a malevolent third-party.

The topic of autonomy in neurological enhancements resides largely in a grey area; researchers argue that finding the balance between safety and autonomy has continued to be difficult. When receiving neurological enhancements, people are more generally accepting when the risks are short term side effects. Yet, the prospect of long term side effects tends to deter a larger population from agreeing to the neuroenhancement [11]. Thus, if a law were instilled wherein individuals were expected or forced to undergo neurological enhancement for the perceived benefit of society, this may violate the autonomy of users [38]. 

Since each individual likely has their own perceptions of when safety overrides the benefit of neurological enhancement, coerced neurological enhancement for the benefit of society should not be allowed. If recreational neurological enhancements are allowed, a set maximum should be put in place based on the degree of alteration to the brain to avoid risks of loss of autonomy. In addition, actions from the neurological enhancement should be sure to receive confirmation from users. 

 

• Policy Proposals

 

Currently, neurological enhancements do not fall under any existing regulatory regimes beyond basic safety requirements. The most basic level of regulation, such as the rules surrounding alcohol and tobacco, would not serve well for enhancements such as methylphenidate or Adderall due to the serious known side effects. With neuroenhancements available to all at the moment, policies must be put into place to help with keeping neuroenhancements safe and regulated for all types of people to use. In general, policies put in place must have a level of regulation for a neuroenhancement that stems from possible benefits gained from the neuroenhancements, with tighter regulation for the neuroenhancements that give greater benefits. This would help to mitigate any negligent use of powerful neuroenhancements and provide a safer segue to the use of neuroenhancements in the future.

 

• Proposal #1

For any procedure, safety must be the most important concern. However, current methods for safety evaluation can easily underestimate the risks of neurological enhancements. Thus, new ways of safety evaluation with a focus on long term impacts and the buildup of effects should be developed. Manufacturers of neurological enhancements should be supervised to ensure complete clinical trials. They should also be required to provide detailed reports of the potential risks of their products and clearly label such risks. In terms of risks resulting from the administration of neurological enhancements, such dangers should be minimized by providing a standardized certification for people administering neurological enhancements. Products such as “DIY-tDCS” should not be allowed. Products with a known tradeoff should not be allowed for the purpose of enhancement among children. Products in which potential tradeoffs are not yet known should also not be used on children.

 

• Proposal #2

Similarly to gun violence reform, there should be extensive laws surrounding the use of neurological enhancements. To begin, minors without parental consent and convicted criminals should not be given access to such technology. Additionally, background checks must be mandated for all attempting to operate a device. Before humans are allowed access to these instruments, extensive research must be conducted proving it is not hypersensitive and that it will not harm its occupant. After research deems such devices safe, users must agree to take full responsibility for their actions while being treated with an enhancement. They also must purchase the tool with the intent of benefitting society, and not harming others. Ultimately, if abuse is present, then the user must suffer the consequences, as he/she knew and agreed to the possibilities beforehand. 

 

• Proposal #3

To prevent neurological enhancements with a clear actionable output, such as a BCI, from being too sensitive to human thoughts and acting in ways the human did not intend, regulation of neurological enhancement devices should require explicit confirmation from the user before any external action is performed. Although the removal of predictive mechanisms such as closed-loop programming and offloading computation may reduce efficiency, a user’s autonomy should be prioritized.This will ensure the creation of safe BCIs and ensure that the user is fully responsible for any actions carried out through the BCI. Additionally, an international code must be established requiring extensive testing of BCIs to ensure human users are always in control of their BCI. The required confirmation before actions will allow for a person’s autonomy to be maintained when dealing with issues related to closed-loop programming and offloading computations as well.

 

• Proposal #4

A second option would be to require neurological enhancement licenses, and individuals must pay for and pass a course about lawful use and effects (including side effects). To maintain a safety standard, a maximum dosage per drug could be enforced and individuals would be tested (frequency depending on the drug) to ensure that use of the neurological enhancement does not go beyond such a set threshold. Another possible route to approach this would be to maintain a maximum action or extent that the neuroenhancement can alter the brain. This would likely change with each form of neuroenhancement, but implementing a law with a set maximum would allow for a spectrum of recipients of neuroenhancements to maintain an allowance of autonomy. 

While banning neurological enhancements will act against the self interests of people in competitive intellectual environments or drive up inequalities in access to enhancements, freely allowing the distribution and permeation of neurological enhancements into society may pose both safety and autonomy issues— such as those which can arise in a workplace where employees are pressured to take an enhancement with potentially dangerous or poorly understood effects.Thus, it is  recommended that the regulation, and not the complete prohibition or promotion of neurological enhancements is pursued. 

Enhancement licenses, however, could prove a disadvantage for individuals who cannot afford such a course. Furthermore, people with low cognitive capacity—who would find the most benefit from neurological enhancements—may find difficulties in learning and passing the course. Undoubtedly, however, individuals without licenses could obtain neurological enhancements illegally. In such a case, testing for the general public could be administered regularly. 

In intellectual competitions and exams, neurological enhancements could lend unfair benefits to certain individuals. For enhancements that provide temporary benefits, regulations can follow those of the WADA regulations for doping, such as the rules used in the Tokyo 2021 Games. Permanent enhancements, on the other hand, will require more research for definitive regulation to be determined.

 

• Conclusion

 

As the use of neuroenhancements increases, the question of safety, security, and autonomy for users and their surroundings must be addressed. The policies outlined here help to ensure the drugs are taken safely and for the correct purposes. They also allow for better regulation of neuroenhancements and confirm that necessary medical professionals are available to those who need them. Furthermore, this paper helps to provide a safety net for any loss of autonomy or unwarranted actions resulting from device use as this would help to mitigate unfair use in competitions and create a system where people are held accountable for their doping. Realizing these concerns about safety and security helps to establish a full understanding of the ethical dilemmas faced by neuroenhancement users, and addressing such concerns keeps everyone safe from harm and on a level playing field. 

Moreover, as awareness and knowledge of neuroenhancements grow, acting on socioeconomic issues related to neuroenhancements will become a concern. For example, affirmative action brings the question of  “should people from less advantaged backgrounds (esp. athletes) be able to take enhancement drugs to balance the competition?” Everyone should be awarded the same opportunities since they are all considered equal, yet in reality that is not the case. While neuroenhancements could help with that, it poses several concerns as to whether artificial boosting should be allowed. Society strives for perfect health, but should the same be done for intelligence? If everyone were given the same intelligence, is it still a spectrum? Is a spectrum necessary? A spectrum provides a distinct population with unique perspectives and this allows for greater innovation. If administered, would individuals become less motivated and driven to achieve, or would people all feel elevated and excited to work together? These questions need to be addressed in the future to further understand the role of neuroenhancements in the coming world and shed light on proper regulatory practices.

 

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