Pediatric neuroenhancement
Ethical, legal, social, and neurodevelopmental implications
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Abstract
The use of prescription medication to augment cognitive or affective function in healthy persons—or neuroenhancement—is increasing in adult and pediatric populations. In children and adolescents, neuroenhancement appears to be increasing in parallel to the rising rates of attention-deficit disorder diagnoses and stimulant medication prescriptions, and the opportunities for medication diversion. Pediatric neuroenhancement remains a particularly unsettled and value-laden practice, often without appropriate goals or justification. Pediatric neuroenhancement presents its own ethical, social, legal, and developmental issues, including the fiduciary responsibility of physicians caring for children, the special integrity of the doctor–child–parent relationship, the vulnerability of children to various forms of coercion, distributive justice in school settings, and the moral obligation of physicians to prevent misuse of medication. Neurodevelopmental issues include the importance of evolving personal authenticity during childhood and adolescence, the emergence of individual decision-making capacities, and the process of developing autonomy. This Ethics, Law, and Humanities Committee position paper, endorsed by the American Academy of Neurology, Child Neurology Society, and American Neurological Association, focuses on various implications of pediatric neuroenhancement and outlines discussion points in responding to neuroenhancement requests from parents or adolescents. Based on currently available data and the balance of ethics issues reviewed in this position paper, neuroenhancement in legally and developmentally nonautonomous children and adolescents without a diagnosis of a neurologic disorder is not justifiable. In nearly autonomous adolescents, the fiduciary obligation of the physician may be weaker, but the prescription of neuroenhancements is inadvisable because of numerous social, developmental, and professional integrity issues.
GLOSSARY
- ADHD=
- attention-deficit/hyperactivity disorder;
- DSM-V=
- Diagnostic and Statistical Manual of Mental Disorders, 5th edition;
- DTCA=
- direct-to-consumer advertising;
- ELHC=
- Ethics, Law and Humanities Committee;
- MTF=
- Monitoring the Future
Footnotes
Members and staff of the Ethics, Law and Humanities Committee are listed in the appendix.
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Supplemental data at www.neurology.org
- Received July 2, 2012.
- Accepted December 5, 2012.
- © 2013 American Academy of Neurology
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Disputes & Debates: Rapid online correspondence
- Pediatric NeuroenhancmentSteven M. RothmanPublished April 16, 2013
- Reply to RothmanWilliam D. GrafPublished April 16, 2013
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- Abstract
- GLOSSARY
- METHODS
- PEDIATRIC NEUROENHANCEMENT AND EMERGING PRACTICE TRENDS
- ETHICAL DECISION-MAKING PRINCIPLES FOR NEUROENHANCEMENT IN PEDIATRIC POPULATIONS
- DEVELOPMENTAL ISSUES RELEVANT TO NEUROENHANCEMENT
- SOCIAL AND LEGAL ISSUES RELEVANT TO NEUROENHANCEMENT
- PROFESSIONAL ISSUES RELEVANT TO NEUROENHANCEMENT
- DISCUSSION
- AUTHOR CONTRIBUTIONS
- STUDY FUNDING
- DISCLOSURE
- APPENDIX
- ACKNOWLEDGMENT
- Footnotes
- REFERENCES
- Figures & Data
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