Discussions about the ethical permissibility of pediatric cognitive enhancement frequently revolve around arguments about welfare, and often include an appeal to the child’s right to an open future. Both proponents and opponents of cognitive enhancement claim that their respective positions best serve the interests of the child by promoting an open future. This article argues that this right to an open future argument only captures some of the risks to the welfare of children, therefore requiring a broader ethical approach. Further, it suggests that a thorough moral assessment of the ends pursued is needed before concluding on the moral permissibility of cognitive enhancement in children, which ultimately hinges on the effect on the overall welfare of the child, beyond an open future.
1. General intelligence g is not to be confused with the popular understanding of intelligence as IQ; g is the scientific term used to describe general cognitive ability. Gottfredson LS. The General Intelligence Factor. New York: Scientific American, Incorporated; 1998.
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3. As I have argued elsewhere, the link between cognitive abilities and well-being is far from established. See Krutzinna, J. Can a welfarist approach be used to justify a moral duty to cognitively enhance children? Bioethics 2016;30(7):528–35.
4. For example, Jürgen Habermas expresses concern about the negative effect genetic interventions will have on our self-understanding. Habermas J. The Future of Human Nature. Polity; 2003, at 25.
5. Although there may be concerns about CE in general, when autonomous adults are concerned there is less contention, partly because of the right to respect for autonomy.
6. Davis, D. Genetic Dilemmas: Reproductive Technology, Parental Choice, and Children’s Futures, 2nd ed. Oxford: Oxford University Press; 2010, at 97. There is general consensus that parents are responsible for their children’s well-being, morally and legally.
7. I deliberately draw a distinction between “ends” and “outcomes” of CE interventions: the ends are the goals being pursued (whether successfully or not), whereas the outcomes are the actual results achieved.
8. Feinberg, J. The child’s right to an open future. In: Aiken, W, LaFollette, H, eds. Whose Child? Children’s Rights, Parental Authority, and State Power. Totowa, NJ: Littlefield, Adams & Co.; 1980.
9. See note 8, Feinberg 1980, at 130.
10. See note 8, Feinberg 1980, at 131.
11. This was the issue in State v Garber. In: 419 P.2d 896 (Kan. 1966); 1966.
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13. See note 12, Feinberg 2007, at 114.
14. This condition of governing oneself entails the possession and practice of certain virtues, such as self-determination, authenticity, and self-legislation (among others). This raises many questions about the precise nature and extent of autonomy; however, an in-depth critique of Feinberg’s approach is beyond the scope of this article. See Feinberg J. Autonomy. In: Christman JP, ed. The Inner Citadel: Essays on Individual Autonomy. New York: Oxford University Press; 1989:27–53.
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16. See note 15, Glover 2006, at 71.
17. See note 15, Glover 2006, at 71.
18. See note 15, Glover 2006, at 81.
19. See note 8, Feinberg 1980, at 136.
20. Davis D. The child’s right to an open future: Yoder and beyond. Capital University Law Review 1997;26:93–105, at 97.
21. See note 20, Davis 1997, at 96.
22. Davis acknowledges that the case of the Amish appears relatively uncontroversial because of the Amish’s particular characteristics. However, she gives the example of female genital mutilation (FGM) to point out the importance of protecting a child’s open future from any infringement for the sake of community values or membership.
23. Dworkin, G. Is more choice better than less? Midwest Studies in Philosophy 1982;7(1):47–61, at 60.
24. See note 23, Dworkin 1982, at 59.
25. See note 23, Dworkin 1982, at 59.
26. Schwartz B. The Paradox of Choice: Why More Is Less. New York: HarperCollins; 2005.
27. See note 23, Dworkin 1982, at 60. Note that Dworkin assumes the infinite divisibility of utility for his example.
28. This explains the case of the Amish, in which the future option of becoming full members of the community might well be taken away from children in favor of their future capacity to make their own self-determined decisions about their lives.
29. Parental authority and/or choice have different origins in law and in philosophy. Whereas in law all rights of parents ultimately derive from their responsibility for their children, philosophy also recognizes parental autonomy as an ethical value.
30. Davis believes that the concept of the child’s right to an open future provides a new pathway toward resolving the tension between “the beneficence model of patient care and the rights of parents to their own autonomy and to the protection of their family units.” See note 6, Davis 2010, at 98.
31. Moen, OM. Bright new world. Cambridge Quarterly of Healthcare Ethics 2016;25(2):282–7.
32. See note 31, Moen 2016, at 283.
33. See note 31, Moen 2016, at 283.
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37. That this results in treatment as mere means seems unlikely, and mixed motives appear more plausible, as is often argued in the case of savior siblings, when children are created/selected for a specific purpose, but are also loved for themselves.
38. A view I do not share. See note 3, Krutzinna 2016, at 530. Moen later clarifies that he does not believe in the intrinsic value but rather the instrumental value of intelligence. Moen OM. Smarter Babies. Cambridge Quarterly of Healthcare Ethics 2016;25(3):515–17, at 515.
39. Sandberg A. Cognitive enhancement: upgrading the brain. In: Savulescu J, ter Meulen R, Kahane G, eds. Enhancing Human Capacities. New York: John Wiley & Sons; 2011, at 85.
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41. Given that there are highly gifted members of our society, I have reasonable doubt that genius creation would work in the way proposed by Moen.
42. It can, therefore, not be used as an argument against genetic selection.
43. Schwarz A. Attention disorder or not, pills to help in school. The New York Times, October 9, 2012. http://www.nytimes.com/2012/10/09/health/attention-disorder-or-not-children-prescribed-pills-to-help-in-school.html (last accessed 25 May 2016).
44. Ray K. Not just “study drugs” for the rich: stimulants as moral tools for creating opportunities for socially disadvantaged students. The American Journal of Bioethics 2016;16(6):29–38, at 29.
45. See note 44, Ray 2016, at 33.
46. Ray R, Davis G. Pharmacists can’t administer opportunity: the role of neuroenhancers in educational inequalities. The American Journal of Bioethics 2016;16(6):41–3, at 43: “Neuroenhancers do not bring needed resources into schools; thus we ask, even if they do increase one’s attentiveness, what good is such attentiveness without teachers, books, and computers to learn from?”
47. There are obvious practical and empirical issues with Ray’s proposal. These are beyond the scope of this article, but see, for example, Sattler S, Singh I. Cognitive enhancement in healthy children will not close the achievement gap in education. The American Journal of Bioethics 2016;16(6):39–41, at 40: “The lack of attention to the practical and health dimensions of stimulant drug use is ironic in an article that promotes equality of opportunity and child well-being.”
48. Ragan CI, Bard I, Singh I. What should we do about student use of cognitive enhancers? An analysis of current evidence. Neuropharmacology 2013;64:588–95.
49. Stevenson C. Self-pathologizing and the perception of necessity: two major risks of providing stimulants to educationally underprivileged students. The American Journal of Bioethics 2016;16(6):54–6, at 56.
50. Sandel, M. The Case Against Perfection. Cambridge: Harvard University Press; 2009, at 61.
51. Stein Z, Della Chiesa B, Hinton C, Fischer KW. ethical issues in educational neuroscience: raising children in a brave new world. In: Illes J, Shahakian B, eds. The Oxford Handbook of Neuroethics. Oxford University Press; 2011:803–22, at 813–4. The authors also point out that at least in the United States, some schools already require the administration of stimulants to students with certain behavioural profiles, and they caution that “[m]andated prescriptions establish an educational process in which the failure to meet specific behavioral expectations is thought to warrant a physical intervention aimed at changing the brain chemistry of the child—the strategic alteration of the child’s dispositions, regardless of the child’s (or her parent’s) dissent.”
52. See note 46, Ray, Davis, at 42; and Warren KB. Promoting stimulants to increase educational equality: some concerns. The American Journal of Bioethics 2016;16(6):52–4. Note that these are not necessarily in conflict.
53. Harris J. Enhancing Evolution: The Ethical Case for Making Better People. Princeton: Princeton University Press; 2007, at 14.
54. See note 39, Sandberg 2011, at 81.
55. For further details see Chadwick R. Gene therapy. In: Kuhse H, Singer P, eds. A Companion to Bioethics: Oxford: Blackwell Publishing; 1998:189–97, at 193.
56. See note 39, Sandberg 2011, at 81.
57. See note 4, Habermas 2003.
58. Wasserman D. My fair baby: What’s wrong with parent’s genetically enhancing their children? In: Gehring V, ed. Genetic Prospects—Essays On Biotechnology, Ethics And Public Policy. Lanham, MD: Rowman & Littlefield Publishers; 2003.
59. Some countries, such as Norway, have been known to remove children from their birth families on the grounds of religious indoctrination and radicalization, even in the absence of corporal punishment. See Berglund N. Norway defends its child welfare laws. newsinenglish.no; January 11, 2016. http://www.newsinenglish.no/2016/01/11/norway-defends-its-child-welfare-laws/ (last accessed 25 May 2016).
60. Buchanan A, Brock DW, Daniels N, Wikler D. From Chance to Choice: Genetics and Justice. Cambridge: Cambridge University Press; 2001, at 198.
61. See note 50, Sandel 2009, at 61–2.
62. See note 6, Davis 2010, at 149.
63. For example, parents choosing sport over music for their child, regardless of the child’s own preferences and talents.
64. See note 51, Stein et al. 2011, at 814–5.
65. Harris J. Why human gene editing must not be stopped. The Guardian, December 2, 2015. https://www.theguardian.com/science/2015/dec/02/why-human-gene-editing-must-not-be-stopped (last accessed 25 May 2016).
66. See note 39, Sandberg 2011, at 84: “We face many pressing problems which we would be better able to solve if we were smarter or more creative. An enhancement that enables an individual to solve some of society’s problems would produce a positive externality: in addition to benefits for the enhanced individual, there would be spillover benefits for other members of society.”
67. See note 51, Stein et al. 2011, at 811.
68. Achievement expectations were found to be most harmful: Ablard KE, Parker WD. Parents’ achievement goals and perfectionism in their academically talented children. Journal of Youth and Adolescence 1997;26(6):651–67.
69. In a particularly pessimistic scenario, one could argue that parents are selfishly motivated by what is good for them, rather than only by what is good for their children. The truth in most cases probably lies somewhere in between.
70. For example, parents might hope for a particularly beautiful or smart child in the hope that this will automatically translate into success and/or happiness.
71. See note 6, Davis 2010, at 37.
72. See note 6, Davis 2010, at 37.
73. Many cryobanks are offering a special category for “smart” or highly educated donor sperm, for example, https://fairfaxcryobank.com/us/about-our-donors#Categories. (last accessed 25 May 2016). Research shows preference for certain nonmedical traits over physical resemblance: Flores H, Lee J, Rodriguez-Purata J, Witkin G, Sandler B, Copperman AB. Beauty, brains or health: trends in ovum recipient preferences. Journal of Women’s Health 2014;23(10):830–3.
74. American company Xytex Corp. recently received much media attention when it was revealed that an ex-convict was marketed as “genius donor”: Hauser C. Sperm donor’s profile hid mental illness and crime, lawsuits say. The New York Times, April 17, 2016. http://www.nytimes.com/2016/04/18/world/americas/sperm-donors-profile-hid-mental-illness-and-crime-lawsuits-say.html (last accessed 23 May 2016).
75. See note 6, Davis 2010, at 175.
76. See note 6, Davis 2010, at 37.
77. Some maintain that high cognitive ability has intrinsic value, and even advocate a duty to cognitively enhance children. See Savulescu J, Sandberg A, Kahane G. Well-being and enhancement. In: Savulescu J, Ter Meulen R, Kahane G, eds. Enhancing Human Capacities. New York: Wiley-Blackwell; 2011:3–18.
78. We already have somewhat analogous situations; for example, training children for sport or music from a very young age.
79. Albeit with currently limited success: see note 2, Yong 2013.
80. Many of these studies are already available, see, for example, Freeman J. Gifted Lives: What Happens when Gifted Children Grow Up. Abingdon, UK: Routledge; 2013.
81. See note 3, Krutzinna 2016, at 532.
82. Some evidence can be drawn from longitudinal studies into gifted children and adults. See note 80, Freeman 2013.
83. See note 6, Davis 2010, at 168.
84. See note 15, Glover 2006, at 63–4.
85. See note 50, Sandel 2009, at 97.
86. See note 55, Chadwick 1998, at 195.
87. See note 6, Davis 2010, at 162.
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