The ethics of stimulant use in healthy students

Verster, Gerrit Christiaan (Stellenbosch : Stellenbosch University, 2012-03)

Thesis (MPhil)--Stellenbosch University, 2012.

Thesis

ENGLISH ABSTRACT: The quest for enhancement has been part of human culture for thousands of years. Progress in scientific developments and especially in the field of medical science has allowed for previously unthinkable advances to be employed in the endeavours to improve human functioning in its various forms. Whereas in the past, enhancement has been focused on aspects such as prolonging life, improving the immune system or cosmetic enhancements, cognitive enhancement is receiving substantial attention at the moment. Recent reports have commented on the use of stimulants such as methylphenidate, especially amongst students at tertiary institutions with the aim of enhancing cognitive abilities. This raises various concerns, ranging from safety issues and the risk of drug abuse to the moral issues relating to enhancement in the broader context. Enhancement therapies are easily justified where the required enhancement is needed to improve functioning where a specific deficit is present or where such enhancement could prevent illness. But where no illness or disorder is present, these issues cause marked ambivalence amongst medical practitioners. The legal restrictions placed on the access to stimulants require the participation of a doctor as these drugs may not be sold across the counter and a prescription is needed to acquire them. The doctor is then put in the position where a request is made for medication where illness or a disorder is not present. Medical paternalism could easily dictate that the decision does lie with the doctor because of statutory rules, but this would be at the risk of ignoring the possible rights of students to enhance. This thesis examines the concerns mentioned related to safety risks as well as the abuse potential of methylphenidate. Although there are precautions that need to be taken into account when prescribing methylphenidate, this is not sufficient to warrant a blanket refusal by medical practitioners to prescribe it to healthy students. The arguments used to debate both the promotion of enhancement therapies as well as the reasons for restricting and possibly even preventing any use thereof, are discussed. There are various reasons why enhancement may be needed in current and future society and to ignore these would raise moral issues in itself. There are various arguments used to disapprove of enhancement, but this thesis concludes that although the concerns raised should be considered on an ongoing basis, as enhancement is an ongoing process, enhancement should be allowed to continue to be explored and employed where appropriate. Finally, potential guidelines for the individual and also for tertiary institutions relating to enhancement, especially relating to cognitive enhancement with stimulants such as methylphenidate, are proposed.

AFRIKAANSE OPSOMMING: Die soeke na verbetering is reeds vir duisende jare deel van die menslike kultuur. Vordering in wetenskaplike ontwikkelings en veral op die gebied van die mediese wetenskap het toegelaat dat voorheen ondenkbare vooruitgang toegepas kan word in die pogings om menslike funksionering in sy verskillende vorme te verbeter. In die verlede het verbeteringstegnieke merendeels gefokus op aspekte soos verlenging van lewe, die verbetering van die immuunstelsel of kosmetiese verbeterings, maar tans geniet kognitiewe verbetering aansienlike aandag. Onlangse verslae lewer veral kommentaar oor die gebruik van stimulante soos metielfenidaat, veral onder studente by tersiêre instellings, met die doel om die verbetering van kognitiewe vermoëns teweeg te bring. Dit lei tot verskeie bekommernisse, wat wissel van veiligheidskwessies en die risiko van dwelmmisbruik tot die morele kwessies met betrekking tot verbeteringstegnieke in die breër konteks. Terapieë gemik op verbetering is maklik geregverdig waar die verbetering nodig is om funksionering te verbeter, waar 'n spesifieke tekort teenwoordig is of waar so' n verbetering 'n siekte kan voorkom. Maar waar daar geen siekte of afwyking teenwoordig is nie, veroorsaak hierdie terapieë beduidende ambivalensie onder mediese praktisyns. Die wetlike beperkings wat geplaas is op die beskikbaarheid van stimulante vereis die betrokkenheid van 'n dokter aangesien hierdie middels nie oor die toonbank verkoop mag word nie en 'n voorskrif nodig is om dit te bekom. Die dokter word dan in die posisie geplaas waar daar 'n versoek is vir medikasie waar siekte of 'n versteuring nie teenwoordig is nie. Mediese paternalisme kan maklik dikteer dat die besluit suiwer as gevolg van statutêre reëls wel alleen by die dokter lê, maar die risiko bestaan dan dat die regte van studente om hulself te verbeter ignoreer word. Hierdie tesis ondersoek die potensiële probleme met betrekking tot die veiligheidsrisiko's sowel as die misbruikpotensiaal van metielfenidaat. Alhoewel daar voorsorgmaatreëls in ag geneem moet word wanneer die voorskryf van metielfenidaat oorweeg word, is dit nie voldoende om 'n totale weiering deur geneeshere om dit voor te skryf aan gesonde studente te regverdig nie. Die argumente wat gebruik word om sowel die bevordering van die verbeteringsterapieë as die redes vir die beperking en moontlik selfs die voorkoming van enige gebruik daarvan te debatteer, word bespreek. Daar is verskeie redes waarom verbetering in die huidige en toekomstige samelewing nodig is en om dit te ignoreer sou op sigself morele beswarte opper. Daar is wel verskeie argumente wat gebruik kan word om verbetering af te keur, maar hierdie tesis wys daarop dat hoewel die kommer wat geopper word in ag geneem moet word op 'n deurlopende basis, aangesien verbeteringstegnieke ‘n voortdurende proses is, bevordering van hierdie terapieë toegelaat moet word en waar toepaslik in diens geneem moet word. Ten slotte word moontlike riglyne vir die individu en ook vir tersiêre instellings met betrekking tot verbetering, veral met betrekking tot kognitiewe verbetering met stimulante soos metielfenidaat, voorgestel.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/20330
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