Published online by Cambridge University Press: 16 October 2018
The moral enhancement (or bioenhancement) debate seems stuck in a dilemma. On the one hand, the more radical proposals, while certainly novel and interesting, seem unlikely to be feasible in practice, or if technically feasible then most likely imprudent. But on the other hand, the more sensible proposals – sensible in the sense of being both practically achievable and more plausibly ethically justifiable – can be rather hard to distinguish from both traditional forms of moral enhancement, such as non-drug-mediated social or moral education, and non-moral forms of bioenhancement, such as smart-drug style cognitive enhancement. In this essay, I argue that bioethicists have paid insufficient attention to an alternative form of moral bioenhancement – or at least a likely candidate – that falls somewhere between these two extremes, namely the (appropriately qualified) use of certain psychedelic drugs.
1 The author would like to thank Michael Hauskeller, Lewis Coyne, and Ole Martin Moen for helpful feedback on an earlier draft of this essay. Please note that a handful of sentences have been adapted from the earlier piece, ‘Moral Neuroenhancement’ by Brian D. Earp, Thomas Douglas, and Julian Savulescu – see reference below.
2 Persson, Ingmar and Savulescu, Julian, ‘The Perils of Cognitive Enhancement and the Urgent Imperative to Enhance the Moral Character of Humanity’, Journal of Applied Philosophy 25:3 (2008), 162–77CrossRefGoogle Scholar; Persson, Ingmar and Savulescu, Julian, ‘Getting Moral Enhancement Right: The Desirability of Moral Bioenhancement’, Bioethics 27:3 (2013), 124–31CrossRefGoogle ScholarPubMed.
7 For a recent review, see: Douglas, Thomas, ‘The Morality of Moral Neuroenhancement’, in Clausen, Jens and Levy, Neil (eds), Handbook of Neuroethics (Dordrecht: Springer, 2015), 1227–49Google Scholar.
8 The main contributions are: Earp, Brian D., Sandberg, Anders, and Savulescu, Julian, ‘Natural Selection, Childrearing, and the Ethics of Marriage (and Divorce): Building a Case for the Neuroenhancement of Human Relationships’, Philosophy & Technology 25:4 (2012), 561–87CrossRefGoogle Scholar; Earp, Brian D., et al. , ‘If I Could Just Stop Loving You: Anti-Love Biotechnology and the Ethics of a Chemical Breakup’, The American Journal of Bioethics 13:11 (2013), 3–17CrossRefGoogle Scholar; Earp, Brian D., Sandberg, Anders, and Savulescu, Julian, ‘Brave New Love: The Threat of High-Tech “Conversion” Therapy and the Bio-Oppression of Sexual Minorities’, AJOB Neuroscience 5:1 (2014), 4–12CrossRefGoogle ScholarPubMed; Earp, Brian D., Sandberg, Anders, and Savulescu, Julian, ‘The Medicalization of Love’, Cambridge Quarterly of Healthcare Ethics 24:3 (2015), 323–36CrossRefGoogle Scholar; Savulescu, Julian and Earp, Brian D., ‘Neuroreductionism about Sex and Love’, Think 13:38 (2014), 7–12CrossRefGoogle ScholarPubMed; Earp, Brian D., et al. , ‘Addicted to Love: What Is Love Addiction and When Should It Be Treated?’, Philosophy, Psychiatry, & Psychology 24:1 (2017), 77–92CrossRefGoogle ScholarPubMed; Earp, Brian D. and Savulescu, Julian, ‘Love Drugs: Why Scientists Should Study the Effects of Pharmaceuticals on Human Romantic Relationships’, Technology in Society 52:2 (2018), 10–16CrossRefGoogle Scholar.
9 Wiseman, Harris, ‘SSRIs Moral Enhancement Interventions: A Practical Dead End’, AJOB Neuroscience 5:3 (2014), 21–30CrossRefGoogle Scholar; Crockett, Molly, ‘Moral Enhancement? Evidence and Challenges’ (Presentation at the “The Moral Brain”, New York University, New York, March 2012)Google Scholar.
10 Crockett, Molly J., ‘Moral Bioenhancement: A Neuroscientific Perspective’, Journal of Medical Ethics 40:6 (2014), 370–71CrossRefGoogle Scholar; Maslen, Hannah, et al. , ‘Brain Stimulation for Treatment and Enhancement in Children: An Ethical Analysis’, Frontiers in Human Neuroscience 8:953 (2014), 1–5CrossRefGoogle Scholar.
11 Tom Douglas has pointed out that, even if such side-effect-free fine-tuning is not likely to be possible any time soon, or even ever, we do not normally require that brain-level pharmaceutical interventions be quite so precise in their effects for us to find their use (for, e.g., medical purposes) appropriate. He writes, ‘most medical interventions are rather blunt, and it is thus difficult to prevent them from having overall negative effects in some cases (this is perhaps particularly true of psychiatric interventions)’. However, ‘we do not, and should not, regard this as providing us with decisive reasons to abstain from medical treatments. Rather, we take it as giving us reasons to exercise caution in using such treatments, and to try to reduce the risks posed by the treatments over time, for example, by making them more precise’. Douglas, Thomas, ‘Moral Enhancement via Direct Emotion Modulation: A Reply to John Harris’, Bioethics 27:3 (2013), 160–68CrossRefGoogle Scholar, 166–167.
12 Robert Sparrow illustrates the problem: ‘[e]ncouraging empathy and a sense of justice in individuals may usually be a good thing, but enhancing either of these faculties may make individuals more likely to behave unethically in various situations, as when, for instance, a judge declares a person “not guilty” as a result of empathic concern for them, despite the presence of overwhelming evidence that they are in fact guilty of the crime with which they are charged, or when a parent neglects a child out of an excessive concern for duties of justice toward strangers’. Sparrow, Robert, ‘Egalitarianism and Moral Bioenhancement’, The American Journal of Bioethics 14:4 (2014), 20–28CrossRefGoogle ScholarPubMed, 20–21.
13 de Melo-Martín, Inmaculada and Salles, Arleen, ‘Moral Bioenhancement: Much Ado About Nothing?’, Bioethics 29:4 (2015), 223–32CrossRefGoogle ScholarPubMed; Wiseman, The Myth of the Moral Brain; Harris, John, ‘Moral Enhancement and Freedom’, Bioethics 25:2 (2011), 102–11CrossRefGoogle ScholarPubMed.
17 John Harris, ‘Moral Enhancement and Freedom’, 102.
18 Bostrom, Nick and Sandberg, Anders, ‘Cognitive Enhancement: Methods, Ethics, Regulatory Challenges’, Science and Engineering Ethics 15:3 (2009), 311–41CrossRefGoogle Scholar; Outram, Simon M., ‘Ethical Considerations in the Framing of the Cognitive Enhancement Debate’, Neuroethics 5:2 (2012), 173–84CrossRefGoogle Scholar; Maslen, Hannah, Faulmüller, Nadira, and Savulescu, Julian, ‘Pharmacological Cognitive Enhancement – How Neuroscientific Research Could Advance Ethical Debate’, Frontiers in Systems Neuroscience 8:107 (2014), 1–12CrossRefGoogle ScholarPubMed; Earp, Brian D., et al. , ‘When Is Diminishment a Form of Enhancement? Rethinking the Enhancement Debate in Biomedical Ethics’, Frontiers in Systems Neuroscience 8:12 (2014), 1–8CrossRefGoogle Scholar.
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20 I mean essay in its original sense of trying something out – I am only planting a seed here, which others may water if they wish.
23 Schaefer, ‘Direct vs. Indirect Moral Enhancement’, 262–263.
24 Schaefer, ‘Direct vs. Indirect Moral Enhancement’, 265.
26 Cole-Turner, Ron, ‘Spiritual Enhancement’, in Mercer, Calvin and Trothen, Tracy J. (eds), Religion and Transhumanism: The Unknown Future of Human Enhancement (Denver: Praeger, 2015), 369–83Google Scholar, 369.
27 For critical discussion, see: Arianne Shahvisi and Brian D. Earp, ‘The Law and Ethics of Female Genital Cutting’, in Sarah Creighton and Lih-Mei Liao (eds), Female Genital Cosmetic Surgery: Solution to What Problem? (Cambridge: Cambridge University Press, forthcoming).
28 Cole-Turner, ‘Spiritual Enhancement’, 369.
31 Jones, Peter N., ‘The Native American Church, Peyote, and Health: Expanding Consciousness for Healing Purposes’, Contemporary Justice Review 10:4 (2007), 411–25CrossRefGoogle Scholar; Halpern, John H., et al. , ‘Psychological and Cognitive Effects of Long-Term Peyote Use among Native Americans’, Biological Psychiatry 58:8 (2005), 624–31CrossRefGoogle ScholarPubMed.
32 The quote finishes with ‘to everyone, but especially intellectuals’. Huxley, Aldous, The Doors of Perception (London: Chatto and Windus, 1954)Google Scholar: http://nacr.us/media/text/the_doors_of_perception.pdf. See page 53 of the version available online at the preceding link.
33 I am just flagging my use of the word ‘personal’ in this sentence. In this essay, I am concerned only with mature individuals’ voluntary attempts to morally self-enhance, which is prima facie not only morally permissible, but desirable. Top-down or coerced moral enhancement of others – particularly if psychedelics were involved – would be much harder to justify from a moral perspective and I will make no attempt to do so here. Still, you might ask, what about drug-mediated moral enhancement of children by their parents or guardians? In some contexts, such enhancement may indeed be appropriate – the careful administration of methylphenidate to children with severe conduct disorders, for example, may be consistent with moral neuroenhancement as I have defined it, and in some cases is presumably justified – but a full discussion of the ethics of such interventions is beyond the scope of this essay. See: Klein, Rachel G., et al. , ‘Clinical Efficacy of Methylphenidate in Conduct Disorder with and without Attention Deficit Hyperactivity Disorder’, Archives of General Psychiatry 54:11 (1997), 1073–80CrossRefGoogle Scholar.
34 I have made similar arguments using the example of “love drugs” in greater depth elsewhere: Earp, Brian D., Sandberg, Anders, and Savulescu, Julian, ‘The Medicalization of Love: Response to Critics’, Cambridge Quarterly of Healthcare Ethics 25:4 (2016), 759–71CrossRefGoogle Scholar; Earp, Brian D. and Savulescu, Julian, ‘Is There Such a Thing as a Love Drug? Reply to McGee’, Philosophy, Psychiatry, & Psychology 23:2 (2016), 93–96CrossRefGoogle Scholar; Wudarczyk, Olga A., et al. , ‘Could Intranasal Oxytocin Be Used to Enhance Relationships? Research Imperatives, Clinical Policy, and Ethical Considerations’, Current Opinion in Psychiatry 26:5 (2013), 474–84CrossRefGoogle ScholarPubMed.
35 Richards, William A., ‘Understanding the Religious Import of Mystical States of Consciousness Facilitated by Psilocybin’, in Ellens, J. H. and Roberts, B. (eds), The Psychedelic Policy Quagmire: Health, Law, Freedom, and Society (Denver: Praeger, 2015), 139–44Google Scholar, 140.
38 James, The Varieties of Religious Experience, 388.
40 Móró, et al., ‘Voice of the Psychonauts’. Paraphrased.
41 There is some debate about whether MDMA should be counted as a psychedelic (for an interesting discussion, see the YouTube video, ‘Is MDMA a Psychedelic?’: https://www.youtube.com/watch?v=yuXWDVLaRzQ). Psychedelic drugs are typically serotonin receptor agonists: they mimic serotonin and tie to serotonin receptors in serotonin's place. MDMA, on the other hand, causes a very significant release of serotonin, as well as dopamine and norepinephrine, and it has a higher potential for abuse and neurotoxic effects. See: Nichols, David E., ‘Differences Between the Mechanism of Action of MDMA, MDBD, and the Classic Hallucinogens: Identification of a New Therapeutic Class: Entactogens’, Journal of Psychoactive Drugs 18:4 (1986), 305–13CrossRefGoogle Scholar; Check, Erika, ‘Psychedelic Drugs: The Ups and Downs of Ecstasy’, Nature 429:6988 (2004), 126–28CrossRefGoogle ScholarPubMed; McCann, Una D., et al. , ‘Serotonin Neurotoxicity after (±)3,4-Methylenedioxymethamphetamine (MDMA; “Ecstasy”): A Controlled Study in Humans’, Neuropsychopharmacology 10:2 (1994), 129–38CrossRefGoogle Scholar. I thank Ole Martin Moen for calling my attention to these distinctions.
42 Móró, et al., ‘Voice of the Psychonauts’, 190.
45 See, e.g., Hermle, Leo, Ruchsow, Martin, and Täschner, K. L., ‘Hallucinogen Persisting Perception Disorder (HPPD) and Flashback Phenomena – Differential Diagnosis and Explanation Models’, Fortschritte der Neurologie-Psychiatrie 83:9 (2015), 506–15Google ScholarPubMed; and Halpern, John H. and Pope, Harrison G., ‘Hallucinogen Persisting Perception Disorder: What Do We Know After 50 Years?’, Drug and Alcohol Dependence 69:2 (2003), 109–19CrossRefGoogle Scholar. Hermle, et al. note in their abstract that persisting hallucinations can occur in the form of ‘flashbacks’, which refer to ‘brief visual perceptual, mood, and altered states of consciousness effects reminiscent of acute hallucinogen intoxication effects’, and that ‘many users regard flashback phenomena as benign and even pleasant’. If altered perception persists for months or years, however, and causes severe individual distress, then Hallucinogen Persisting Perception Disorder (HPPD) may be diagnosed. According to Halpern and Pope (see second reference), HPPD is uncommon and is associated mostly with the unmonitored, recreational use of LSD.
49 Móró, et al., ‘Voice of the Psychonauts’, 190. As with the issue of moral disagreement discussed above, it is likely that people will also disagree about what constitutes the ‘proper conceptual and ideological background’ for a successful drug-mediated experience, as well as the appropriate setting in which the experience should take place. Following Foucault, for example, one might worry that, rather than psychologically emancipating people, an institutionalised or clinical setting could perform an ideological function in terms of producing people who better conform to societal expectations (I thank Lewis Coyne for bringing this possibility to my attention). That certainly may turn out to be the case – however, the deeper question is whether or when societal expectations are consistent with one's moral enhancement aims as opposed to in conflict with them, and this is something that will have a different answer depending on the individual. There are no simple solutions here. Any person who seeks to improve herself as a moral agent, whether with the adjunctive use of drugs or through more conventional means, will have to grapple with such contextual matters. Should one attend church services, and follow the teachings of a particular religious leader? If so, which one? Should one embed in this spiritual community or that one? And so on. Needless to say, there are many institutions in place already to try to get people to conform to (potentially problematic) societal expectations, even setting drug use aside. If anything, the voluntary use of psychedelic substances as part of a carefully considered programme of moral self-development seems more likely to bring such institutions into a sceptical light than to blindly reinforce them or compel conformity. Nevertheless, the basic point Coyne raises is right: the social, physical, and ideological setting of the drug experience could undoubtedly influence which of those outcomes was more likely, and a “clinical” atmosphere in particular may very well pose special risks.
50 Harris, Sam, Waking Up: A Guide to Spirituality Without Religion (New York: Simon and Schuster, 2014)Google Scholar; Roberts, Thomas B., The Psychedelic Future of the Mind: How Entheogens Are Enhancing Cognition, Boosting Intelligence, and Raising Values (New York: Simon and Schuster, 2013)Google Scholar.
51 Móró, et al., ‘Voice of the Psychonauts’, 190.
54 Winkelman, Michael J., ‘Psychedelic Medicines’, in Ellens, J. H. and Roberts, B. (eds), The Psychedelic Policy Quagmire: Health, Law, Freedom, and Society (Denver: Praeger, 2015), 93–117Google Scholar, 108.
56 Soler, J., et al. , ‘Exploring the Therapeutic Potential of Ayahuasca: Acute Intake Increases Mindfulness-Related Capacities.’, Psychopharmacology 233:5 (2016), 823–29CrossRefGoogle ScholarPubMed; Witkiewitz, Katie, Marlatt, G. Alan, and Walker, Denise, ‘Mindfulness-Based Relapse Prevention for Alcohol and Substance Use Disorders’, Journal of Cognitive Psychotherapy 19:3 (2005), 211–28CrossRefGoogle Scholar.
57 This caveat is important to highlight as there are now serious concerns about the reproducibility of many published findings across medicine and social psychology. See: Earp, Brian D. and Trafimow, David, ‘Replication, Falsification, and the Crisis of Confidence in Social Psychology’, Frontiers in Psychology 6:621 (2015), 1–11CrossRefGoogle ScholarPubMed.
58 E.g., Ahlskog, Rafael, ‘Moral Enhancement Should Target Self-Interest and Cognitive Capacity’, Neuroethics 10:3 (2017), 1–11CrossRefGoogle ScholarPubMed; Tennison, Michael N., ‘Moral Transhumanism: The Next Step’, The Journal of Medicine and Philosophy: A Forum for Bioethics and Philosophy of Medicine 37:4 (2012), 405–16CrossRefGoogle ScholarPubMed.
59 That is not to say that philosophers or ethicists generally have not written about psychedelic drugs and the moral implications of their use; rather, it is the ethicists involved in the moral bioenhancement debate specifically who seem not to have noticed the potential relevance of these substances to their arguments. For good introductions, see: Luper-Foy, S. and Brown, C. (eds), Drugs, Morality, and the Law (New York: Garland Publishing, 1994)Google Scholar; Husak, Douglas N., Drugs and Rights (Cambridge: Cambridge University Press, 1992)CrossRefGoogle Scholar; Lovering, Rob, A Moral Defense of Recreational Drug Use (New York: Springer, 2015)CrossRefGoogle Scholar.
60 Nicolas Langlitz, Neuropsychedelia: The Revival of Hallucinogen Research Since the Decade of the Brain (University of California Press, 2013), 233. Following up on this idea, Ole Martin Moen (personal correspondence) suggested to me that ‘one possible path from psychedelics to moral enhancement might be that, used in the right way, psychedelics can help make people become more happy and satisfied. Of course, happy and satisfied people might do pretty bad things (vote for bad parties, support practices that are cruel toward animals, etc.), but it is presumably uncommon that happy and satisfied people commit atrocities’.
61 Langlitz, Neuropsychedelia, 233.
63 Holland, Julie, Ecstasy: The Complete Guide: A Comprehensive Look at the Risks and Benefits of MDMA (Rochester, VT: Inner Traditions / Bear & Co, 2001)Google Scholar.
65 Greer and Tolbert, ‘A Method of Conducting Therapeutic Sessions with MDMA’, 365.
66 Greer and Tolbert, ‘A Method of Conducting Therapeutic Sessions with MDMA’, 372.
67 Greer and Tolbert, ‘A Method of Conducting Therapeutic Sessions with MDMA’, 377.
68 Greer and Tolbert, ‘A Method of Conducting Therapeutic Sessions with MDMA’, 371.
69 Greer and Tolbert, ‘A Method of Conducting Therapeutic Sessions with MDMA’, 372.
70 Greer and Tolbert, ‘A Method of Conducting Therapeutic Sessions with MDMA’, 378.
71 Greer and Tolbert, ‘A Method of Conducting Therapeutic Sessions with MDMA’, 378. Generally this sort of outcome is a good thing, but it is obviously possible to be “too trusting” toward one's partner, particularly if the partner habitually takes advantage of one's trust. This consideration highlights how important it will be, if drugs ever are to be used in a context such as the one illustrated here, to ensure that they are used thoughtfully and that their personal and interpersonal effects are monitored and reflected upon both during the drug-mediated experience and after the effects of the drug have worn off. That said, insofar as psychedelics do allow one to gain deeper insights into one's mind and situation, as is often claimed by those who use them, then it is quite possible that (to pursue the present example) the partner's tendency to betray one's trust would become more, rather than less, apparent to the user while under the influence of the drug, thereby allowing her to make a better informed decision about whether the relationship should continue. In other words, at least anecdotally, psychedelics such as MDMA do not seem to have a context-insensitive or generalised “trust-enhancing” (or other similar) effect, whereby one simply becomes more trusting (etc.), regardless of the dynamic between oneself and the other people in one's life. Rather, the idea is precisely that greater genuine insight into the nature of what is really going on can be facilitated by the use of psychedelics (under the right circumstances), at least in many cases.
72 Greer and Tolbert, ‘A Method of Conducting Therapeutic Sessions with MDMA’, 378.
73 Smith, ‘Do Drugs Have Religious Import?’, 529.
74 Smith, ‘Do Drugs Have Religious Import?’, 529.
76 Hughes, ‘Using Neurotechnologies to Develop Virtues', 32, internal citations ommitted.
78 Sessa, ‘Is There a Case for MDMA-Assisted Psychotherapy in the UK?’, 223.