Written by Benjamin Pojer and Daniel D'Hotman in association with the Oxford Uehiro Centre for Practical Ethics, University of Oxford and the Faculty of Medicine, Nursing and Health Science, Monash University.

Modafinil, a medication prescribed in the treatment of narcolepsy and other sleep disorders, has gained popularity in recent years among students and professionals as a ‘smart drug’ capable of increasing alertness and focus. Humans have long been obsessed with enhancement. We embrace various methods to enhance our physical bodies, mood, cognition and even morality. We study to do well in exams and read books in the pursuit of knowledge. We design technologies to improve our capacity to work more efficiently. We exercise to improve our health and physical appearance. Underpinning these choices is a drive both for personal improvement and success, as well as a deeper desire to contribute to human flourishing.



For many people, however, pharmaceutical enhancement seems different. To enhance ourselves through the use of synthetic drugs feels unnatural and wrong. Films such as ‘Limitless’, where the protagonist discovers an experimental drug that allows him to “access the other 80% of his brain”, have sensationalised enhancement at the expense of scientific accuracy. But to put Hollywood aside, if you had access to a drug that improved concentration, memory and focus, with negligible side effects, would you take it?

Informal surveys suggest that up to one in five undergraduate university students in the UK admit to using modafinil as a study aid (1). Previously, the unknown safety profile of modafinil has been an obstacle to its more widespread use as a cognitive enhancer. Yet, a recent review published in the European Journal of Neuropsychopharmacology (2) on the efficacy and safety of modafinil in a population of healthy people has found that the drug “appears to consistently engender enhancement of attention, executive functions, and learning” without “preponderances for side effects or mood changes”.

These results suggest that modafinil has a number of cognitive benefits with limited short-term side effects. Admittedly, the long-term consequences of modafinil use remain unclear, however, given its growing popularity, this should not preclude a discussion of the ethics of the drug’s use for cognitive enhancement.

We argue that objections to the non-therapeutic use of modafinil do not stand up to ethical analysis. The use of cognitive enhancers, commonly known as ‘smart drugs’, is broadly opposed on two counts: (a) that the use of cognitive enhancers raises issues of fairness and inequity, where some individuals may have access to the drug while others may not, and (b) that cognitive enhancement could be regarded as a form of cheating in some circumstances. We challenge both of these claims.

Fairness and inequity

Opponents claim that the permissibility of cognitive enhancing drugs will perpetuate inequality. They argue that modafinil will provide unfair advantages to those who choose to use it, creating a hierarchy of cognitive abilities. We dispute this for three reasons.

First, there exist a myriad of other factors that influence academic and professional performance, which we choose not to restrict. For example, few would suggest that we should ban the use of private tutors in high schools, or prohibit the drinking of coffee in workplaces, simply because these allow some people to have an advantage. While these practices may provide benefits to some individuals but not others, it is commonly accepted that this ‘disparity’ does not offer a strong enough reason to restrict these practices. It is not immediately clear that modafinil offers so much of an advantage that it should be viewed any differently.

Moreover, individual biology and genetics are inherently discriminatory. The fact that some people are naturally more academically gifted, or physically capable, does not mean we should place restrictions on them with the aim of creating an equal playing field. In fact, we could alleviate natural inequality by allowing access to cognitive enhancing drugs, thus allowing people who are at a biological disadvantage greater opportunity to succeed. Potentially, fair distribution of enhancing substances could be regulated by selective state subsidization of drugs, such as modafinil, for those who are worse off (3). While the specifics of regulation require further discussion, this could mitigate some concerns over inequality.

Finally, banning the use of cognitive enhancers may in fact perpetuate inequality by leading to the development of a black market of smart drugs. This is the situation that exists currently – a majority of modafinil is procured from unregulated sources online. Such markets, by their very nature, limit access of enhancers to a select few and this only further entrenches the disparity in access. The legal and regulated provision of cognitive enhancers, such as modafinil, would allow all individuals equal access to the drug and diminish concerns of inequality.

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Smart drugs as a form of cheating

In addition to concerns regarding fairness and inequality, opponents (particularly in the education sector) claim that drugs such as modafinil may constitute a form of cheating. Notably, Duke University in the United States has recently updated their academic dishonesty policy, suggesting that “the unauthorized use of prescription medication to enhance academic performance” is a breach of academic integrity (4).

The question of whether using modafinil constitutes a form of cheating is contingent on what we understand to be the core goal of the education system. If we believe this goal is to advance an individual’s future job prospects, then perhaps we should ban cognitive enhancing substances in schools and colleges in order to offer equal employment opportunities for all students. However, most people would agree that education is not only about learning specific information from textbooks, competing for jobs, or maximizing professional success. Rather, and arguably more importantly, education is about expanding a student’s mind, providing them with the tools to critically appraise the world around them. These skills are invaluable whatever profession an individual opts to pursue and have societal value beyond that of individual economic gain. If modafinil enhances work efficiency and the learning experience, it is also likely to enhance the uptake of these skills. In this case, perhaps we should be less concerned by misguided protests from academic organizations who label a novel technology as cheating, and lend more weight to its possible benefit for the user and society as a whole.

Conclusion

In light of evidence suggesting modafinil to be safe, we believe the potential benefits of the drug’s use warrant its wider availability. Further, even if future research suggested side effects of modafinil yet to be considered, this would not preclude the drug’s use by competent and informed adults. Society already accepts the use of many substances (e.g. alcohol, tobacco) and participation in activities (e.g. base jumping, snow skiing) that have known risks. In line with modern understandings of autonomy, the potentially harmful consequences of an action do not disqualify its use, as long as it does not harm others. It is not clear why modafinil should be held to a different standard.

An intuitive objection to the use of cognitive enhancers is that there is something inherently wrong with unnatural or synthetic enhancement in the form of a pill. Such intuitions are inconsistent when we consider the widespread use of other drugs which society deems acceptable, such as the use of caffeine for wakefulness or paracetamol to alleviate a headache. This is not to say that modafinil should necessarily be available off the shelf. It would not be unreasonable for some level of regulation to be in place, for example restricting availability to minors who are unable to make informed choices. Ultimately, however, we argue that members of society who are able to weigh up the risks and benefits of using modafinil, should have access to the drug as a means of enhancing their performance and improving their lives.

References

Young-Powell, L. Page. One in five students have taken the study drug modafinil. The Guardian. Available online 8 May 2014 at: http://www.theguardian.com/education/abby-and-libby-blog/2014/may/08/one-in-five-students-have-taken-study-drug-modafinil

M. Battleday, A-K. Brem. Modafinil for cognitive neuroenhancement in healthy non-sleep-deprived subjects: a systematic review. European Neuropsychopharmacology, Available online 20 August 2015 at: http://www.sciencedirect.com/science/article/pii/S0924977X15002497

Savulescu. Justice, fairness, and enhancement. Annals of the New York Academy of Sciences (2006): 321-338.