Tuesday, August 12, 2014

An Ethical Framework for the Use of Enhancement Drugs

Debate about the merits of enhancement tends to be pretty binary. There are some — generally called bioconservatives — who are opposed to it; and others — transhumanists, libertarians and the like — who embrace it wholeheartedly. Is there any hope for an intermediate approach? One that doesn’t fall into the extremes of reactionary reject or uncritical endorsement?

Probably. Indeed, a careful reading of many pro- and anti-enhancement writers suggests that they are not, always and everywhere, in favour or against the use of enhancement. But to sustain the intermediate approach, we need some framework for deciding when enhancement is permissible and when it is not. In their paper, “Who Should Enhance? Conceptual and Normative Dimensions of Cognitive Enhancement”, Filippo Santoni di Sio, Philip Robichaud and Nicole Vincent try to provide one such framework. They base it on set of tools for determining the “nature of an activity”. They argue that for certain practice-oriented activities, the use of cognitive enhancement may not be permissible, but for goal-directed activities, it probably is permissible (maybe even obligatory).

In this post I want to outline their proposed framework, and offer some (minor) critical comments along the way. On the whole, I find the approach promising, but I think there are some practical difficulties (as I will explain). I’ll divide my discussion into two parts. First, I’ll set out the conceptual toolkit proposed by the authors for analysing human activities. Second, I’ll explain the implications of this toolkit for the enhancement debate.

1. The Nature of Activities Approach
Santoni di Sio and his colleagues claim that the permissibility of cognitive enhancement depends on the nature of the activity we are interested in. To back this up, they present us with a toolkit of concepts for understanding the nature of an activity. This toolkit consists of three pairs of related concepts.

The first pair of concepts is the distinction between practice-oriented activities and goal-oriented activities. This is probably the most important pair of concepts and forms the backbone of their approach to understanding the permissibility/impermissibility of cognitive enhancement.

The idea is that every human activity has definitional limits, i.e. qualities or attributes that render it distinct from other activities. “Walking” is distinct from “running”; “trading on the stock exchange” is distinct from “performing surgery”; “engaging in academic research” is distinct from “being educationally assessed”. At a very broad level, one of the key differentiators of activities is whether the activities are externally-focused or internally-focused. That is to say, whether they are concerned with producing or bringing about a certain outcome, or engaging in a particular kind of performance.

Arguably, performing surgery is an externally-focused activity. We care about surgery to the extent that it produces a particular kind of outcome: healing or curing the patient. The precise manner in which it is performed matters less. Indeed, surgical techniques and methods are evolving all the time, usually with the explicit goal of improving patient-outcomes. Contrariwise, running the 100m sprint is, arguably, an internally-focused activity. There is an outcome that we care about, to be sure (viz. who crosses the line first), but we care about the way in which that outcome is brought about even more. You must run down the track in order to perform that activity; you cannot rollerblade or cycle.

Still, as the sprinting example suggests, there is some need for nuance here. Most human activities are hybrid in nature: they are partially externally-focused and partially internally-focused. To get around this problem, Santoni di Sio et al suggest that we can still look on activities as being predominantly externally-focused and predominantly internally-focused. The former they call goal-oriented activities; the latter they call practice-oriented activities.

The second pair of concepts employed by Santoni di Sio and his colleagues is the distinction between constitutive rules and regulative rules. I’ve covered this many times before so I’ll just offer a brief explanation here. A regulative rule is one that ascribes certain standards of performance to an independently intelligible activity. The rules of the road, for example, are regulative. They take the activity of driving — which is intelligible in itself — and tell us how to perform that activity safely. Constitutive rules are different. They actually create (or “constitute”) an activity. Apart from those rules, the activity is not in itself intelligible. A classic example is the rules of chess. Those rules actually determine what it is to perform the activity of playing chess. Without those rules, you simply have the activity of moving bits of carved wood around a checkered board. You don’t have chess.

Why is this distinction relevant to this debate? It is relevant because Santoni di Sio et al argue that goal-oriented activities are governed by regulative rules, whereas practice-oriented activities are governed by constitutive rules. A goal-oriented activity like surgery is all about the production of a particular outcome. There are no internal limits on how it can be performed. Consequently, the only standards that are applied to it are regulative in nature: they tell us how to perform surgery safely and ethically. A practice-oriented activity is different. It does have some internal limits on how it can be performed. Consequently, it must be governed (at least in part) by constitutive rules, i.e. rules that specify what the activity is to be.

The third and final pair of concepts employed by Santoni di Sio and his colleagues is the distinction between coarse-grained and fine-grained descriptions of activities. A coarse-grained description of an activity abstracts away from most of the particular details of the performance, and focuses instead on general, macroscopic features of the performance. A fine-grained description is the opposite: it doesn’t abstract from particular details. Obviously, these are not binary categories: descriptions exist along a continuum from the extremely fine-grained to the extremely coarse-grained.

Why is this important? Santoni di Sio et al think that, when it comes to practice-oriented activities, the level of description can make a normative difference. They use an example involving car racing; I’ll use an example involving golf (which I am more familiar with). Imagine how golf was played 150 years ago. It was played on poorly-kept courses, with gutta-percha (rubber-like) balls that became misshapen with use, and with wooden clubs (with wooden or steel shafts). Now think about how golf is played today. It is played (usually) on well-kept courses, with durable multi-layered, synthetic golf balls, and with titanium and graphite golf clubs. At a coarse-grained level, golf is still the same game it always was: it is about getting a ball into a hole. But at a more fine-grained level, it is a different game: the changes in technology and course preparation have seen to that. The question that needs to be asked is whether those changes somehow subvert the practice-oriented point of the game. For the most part they do not. We have, after all, tolerated most of these technological changes. But sometimes they do. This is why certain types of golf-related technologies have been banned (e.g. club faces with a high COR or distance finders in competitive play). They are thought to subvert or alter the nature of the activity.

2. The Ethical Framework
With the conceptual toolkit in place, we can now build the ethical framework. I think the easiest way to do this is to imagine it as a flow-chart. You start with a given activity (e.g. academic research, surgery, education, financial trading etc.). You then proceed through a series of nodes on the flow chart. At each node in the flow-chart you ask and answer a question. At the end of the process you reach an ethical evaluation about the use of enhancement in that particular activity.

The first question you need to ask yourself is: what is the nature of the activity in question? In other words, is it goal-oriented or practice-oriented? As noted above, this can be a complicated question as many activities are a bit of both. So how can you settle on one category? Santoni di Sio and his colleagues propose a simple test. They say:

…to realize whether a certain activity is goal- directed or practice-oriented…try to mentally eliminate either the realization of the internal or external goals of a given activity, and see which one would result in the loss of that activity’s point. Would it make sense, for instance, to go out with friends if one did not enjoy their company, or to play a certain game if one did not find the activity amusing or challenging or interesting? As the answer to both questions is negative (setting aside other goal like wishing to develop the friendship or to acquire an appreciation for the games), one may conclude that those are practice-oriented activities.
(Santoni di Sio et al, 2014, p. 182

This is an intuitively appealing test. You could probably also ask yourself whether the activity seems to be governed by regulative or constitutive rules. Nevertheless, I think there are problems lurking here. The reality is that activities might take on different characteristics for different performers. For example, it might seem natural to say that a sport like the 100m sprint or golf is practice-oriented. But is that true for all players? I suspect that for some professional athletes the external goods of the activity (the winning; the money; the sponsorship deals; the fame etc.) may swamp the internal ones. Thus, for them, the sport will seem very much like a goal-directed activity. This may, in turn, explain why some athletes adopt a “win at all costs” attitude. (Consider all the professional diving and fouling at this year’s World Cup). I suspect something similar may be true of certain students in university education. For them, education will be about outcomes (good grades and good jobs). They will care rather less about the internal goods of learning.

You can, of course, argue that these athletes and students have a distorted view of the nature of their respective activities; that their attitude subverts and undermines the point of those activities. In that case you are presupposing some normative view of those activities that is independent of the attitudes of particular performers (and, perhaps, independent of the test proposed by Santoni di Sio and his colleagues). This may be the right perspective to adopt. Still, I think the different perspectives are worth bearing in mind. This for two reasons. First, there may be borderline or fuzzy cases where we’re just not sure what the correct categorisation is. Second, the fact that different performers will view the activity differently will make any proposed enhancement policy more or less difficult to implement.

Leaving those criticisms to the side, let’s suppose that we can answer the initial question. In that case, we will have two diverging branches. Along one of those branches we will be dealing with practice-oriented activities, along the other we will be dealing with goal-directed activities. Let’s focus on practice-oriented activities for the time being.

In order to determine whether the use of enhancement should be permissible or impermissible in practice-oriented activities, we have to ask two separate questions. First, is the activity one with some high social or moral value? In other words, is it something whose integrity we would like to preserve? In the case of education (which we will assume to be practice-oriented) we would probably say “yes”: it is something of high social value whose integrity we would like to preserve. In the case of something like stamp-collecting or amateur sudoko, we would probably say “no”: there is nothing of huge social or moral value hinging on the current way in which those activities are performed.

What difference does this make? Well, if the activity is of low social or moral value, then we probably shouldn’t care all that much whether people use enhancers while performing it. If my father wants to use modafinil when solving his sudoko puzzles, then so be it. Its use should be permissible in this and similar cases (note: this is assuming there are no severe side effects). If, on the other hand, the action is of high social value, we proceed to the next question.

That next question is: would the use of cognitive enhancement subvert the valuable point of the activity? In answering that question, we will need to look at different levels of description. If enhancement makes a difference at a coarse-grained level of description (i.e. if it seems to alter the activity at that abstract level), then it should probably be impermissible: in that case it is definitely subverting the point of the activity. If it makes a difference at a fine-grained level, then the issue is more complex. We will have to ask whether that description accurately captures the point of the activity. If it does, then once again we have reason to deem the use of enhancement impermissible.

Santoni di Sio and his colleagues think that education might be one example of an activity where this is true. They suggest that education is about doing things with a certain kind of effort (i.e. with certain obstacles in place), and that the use of enhancers may reduce that effort (or remove those obstacles). The result would be that the point of education is undermined. I have say I find this dubious. I think we would need to be much more precise in our account of the “effort” required in education. And I think, given what we know about how existing cognitive enhancers work, it is unlikely that they really do subvert the point of education. That, however, is an argument for another time.

So much for practice-oriented activities. Let’s switch focus now and consider goal-directed activities. The ethical analysis of these activities is much more straightforward. Basically, if the activity is goal-directed, then all that matters is whether the goal is attained, not how the activity is performed (except, of course, it should not be performed in a way that breaches other ethical standards). So, in a sense, we shouldn’t care about the use of enhancement in these activities: if it makes us more likely to attain the goal, we should be allowed to use it.

Of course, that’s not quite true. We still have to ask ourselves the question: is the goal something of high social or moral value? If it is, then not only would enhancement be permissible, it may even be obligatory. For example, the goal of surgery is something of high moral and social value. If there is anything we could do to make it more likely that the surgery is successful we should do it. In fact, if the stakes are high enough, we might even be obliged to do it. For example, pretty much everyone would say that hand-washing is obligatory prior to surgery. Why? Because it reduces the risk of infection and the complications that could arise from that. But if the use of cognitive enhancers would have a similar positive effect, why wouldn’t that be obligatory too?

Santoni di Sio and his colleagues argue that it could be, but only if the use of the enhancers is necessary, efficacious, easy and safe. In other words, only if it is proven that it does make the user more likely to reach the goal, there is no other way of achieving the same gains, and it doesn’t impose significant costs on the user (either in terms of effort or health). The “easy and safe” requirement may actually be overly-cautious: it may be that in certain cases even hard and unsafe practices are obligatory in order to achieve a particular goal. But it’s easier to make the argument for the easy and safe cases.

That’s it for the ethical framework. A diagram depicting the flow chart and the conclusions it brings us to is depicted below.

3. Conclusion
In summary, the notion that there is a “middle ground” in the enhancement debate is appealing, but it needs to be plausibly mapped out. Santoni di Sio and his colleagues have tried to do that with their “nature of activities” approach to the ethics of enhancement. Their claim is that working out the nature of a given activity can determine whether enhancement is permissible/impermissible/obligatory.

I think the best way to sum up the results of their framework is as a series of tests:

Impermissibility Test: If the activity is (a) practice-oriented; (b) has a valuable point; and (c) the use of enhancement would subvert that point, then the use of enhancement should be impermissible in that particular activity.
Permissibility Test: If the activity is (a) practice-oriented but lacks a valuable point; or (b) goal-directed, then the use of enhancement should be permissible in that particular activity.
Obligatoriness Test: If the activity is (a) goal-directed; (b) has a high value; and (c) the use of enhancement is a necessary, efficacious, easy and safe means of achieving that goal, then the use of enhancement should be obligatory in that particular activity.

Anyway, that’s it for this post. As a final note, I would like to point out that Santoni di Sio and his colleagues’ work on this framework is part of a research project called Enhancing Responsibility. The project is being jointly run by TU Delft in the Netherlands, and the University of Oxford. I would recommend checking out some of the other work being done as part of that project.

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