What Ethical Framework Should We Use?
There are many ethical lenses that we could apply to the task at hand, but it is important to analyze which system would be of most relevance to this particular subject. In an effort to do this we will look at three different ethical frameworks in order to garner and apply the most useful. These frameworks are virtue ethics, Kantian ethics, and Utilitarianism.
Virtue ethics has a long and storied history that, in the West, can be traced back to Aristotle. It is strongly based in cultivating strong character, rather than following rules or considering the outcomes of one’s actions. Virtue ethics has three important concepts: arête, phronesis, and eudaimonia. The first of these is translated as virtue, the second practical or moral wisdom, and the third human flourishing.
This system concentrates on ingraining in oneself important attitudes and actions. To do this one must be constantly using these character traits in a way which creates a disposition to act with these character traits in mind in future interactions. Now, this habit is not a habit like smoking is a habit. It reaches deeper than that. Through cultivating virtue a person fulfills his purpose and comes to a state of flourishing. This moral flourishing is informed and representative of the positive moral character traits that the individual had been practicing. This is contrasted with the habit of smoking because there is no underlying character trait that the person has cultivated in order to be better. So, by cultivating virtue in oneself, an individual is achieving their self-actualization (to borrow a term from Abraham Maslow).
An important issue then arises when we look at psychopharmaceutical enhancement through this lens. If we can use pharmaceuticals to change our emotional and moral self, for instance by the application of Prozac, then how does virtue ethics still apply?
Aristotle writes in book II of his Nichomachean Ethics that, “The virtues then come to be in us neither by nature, nor despite nature, but we are furnished by nature with a capacity of receiving them, and are perfected in them through custom.” (26) This rules out the domain of psychopharmaceutical enhancement for several reasons. Firstly, though Aristotle does not insist that our virtue comes from our nature, he does say that we are furnished with an ability to receive them. While in a certain sense we are naturally inclined to receive benefit from psychopharmaceutical aid, it is by subsuming our nature that this is the case. For example, while our bodies do have the capacity to absorb an amphetamine and, in accordance with its pharmacology, markedly increase our cognitive abilities, this is a subversion of a natural bodily process and not an inherent capability of these processes themselves. To further clarify the point, Aristotle says that:
"the Virtues we get by first performing single acts of working, which, again, is the case of other things, as the arts for instance; for what we have to make when we have learned how, these we learn how to make by making: men come to be builders, for instance, by building; harp-players, by playing on the harp: exactly so, by doing just actions we come to be just; by doing the actions of self-mastery we come to be perfected in self-mastery”(27)
It is in this sense that psychopharmaceuticals do not follow the schema of virtue ethics, because there is no underlying virtuous character trait that informs the taking of a pill.
When we use a pharmaceutical aid we are not in fact enhancing our ability through the action which we wish to perfect. A pharmacological compound enhances us through its mechanism. While, yes, it is an action to ingest a pill, it is not ingesting pills that we hope to get better at. For this reason we can see that virtue ethics, though a relevant field for certain moral questions, does not inform us on how to engage with methods that bypass practice and provide a cognitive benefit.
The Kantian ethic is founded on a single unifying principle in his Foundations of the Metaphysics of Morals, that of the categorical imperative. As Kant describes it, “It is: Act only according to that maxim by which you can at the same time will that it should become a universal law”(44). This, at first look, gives us a very solid basis for our current inquiry. If we are to take the categorical imperative as a basis for pharmaceutical enhancement we need only appeal to what we would will to be a universal law. In this case, we can see that if one wills it to be a universal law that enhancement is permissible, then it is only logical that we should all be permitted to do so. Contrarily, if we will that the universal law dictates that we cannot use enhancement then we should all abstain.
Clearly there is a problem here, because it seems that either choice would be arbitrary due to the fact that it has no grounding in empiricism. While some have made the point that Kantian a priori ethics does not have practical value (as I appeared to just do), this is not the case. We must remember that the categorical imperative itself does not imply a maxim it only provides the framework by which we should go about judging the mechanism. As Paul Dietrichson puts it, “Issuing as it does from pure reason, the moral law is therefore by necessity a merely formal paradigm, an abstract norm, completely indeterminate in so far as a reference to the empirical dimension of reality is concerned. Our maxims, on the other hand, which need to be tested in some way or other by this prescriptive law, are material principles, concrete principles, namely empirically determinate (and subjective) rules of voluntary action”(166).
Now that I have avoided a strawman in regards to Kant, I do find a problem with the ethics in general. With something as variant as human biological and psychological makeup, along with the variant modalities of pharmaceuticals, we need something that does not universalize to a general maxim. For example, we bring in two patients looking for enhancement. The first receives a dose of Modafinil and responds positively, allowing him to achieve his intellectual goals with greater ease causing him to reach higher heights than he would have alone. The second receives the same dose, adjusted for size, and receives no benefits while complaining of periodic piercing headaches. In the first case the individual recognizes the benefits he receives from his treatment and taking the Kantian view develops a maxim, which permits individuals to use Modafinil for their betterment. The second does the opposite and develops a maxim by which individuals should not use Modafinil, due to its deleterious effects. Seeing as these are both universals there can be no arbiter between the two views, which leads to a contradiction.
There is an alternative to thinking that duties are perfect and able to be universalized in the case of cosmetic psychopharmacology. Kant says some duties are imperfect and are naturally unable to be universalized. However, Kant grounds these imperfect duties in the natural subjective preferences of human kind. But, we want to look at psychopharmaceuticals not as something we can wantonly choose between at any time on our subjective preference. Instead we want the selection and use of these compounds to be based in empiricism.
It is this inflexibility and lack of personalization inherent within the categorical imperative that ultimately hamstrings its attempts at rectifying cosmetic psychopharmacological problems. For if we cannot tailor our moral judgments to the intricacies of psychobiological needs, then we deny those who may benefit or prevent individuals from discovering they can attain a benefit in the first place. So, though the categorical imperative is powerful in dealing with ethical issues devoid of the idiosyncrasies of the individual, it does not allow for us to tailor pharmaceutical wants to those who do not conform to either of the two possible universal maxims.
It is with the prior two systems in mind that we come to utilitarianism as initially described by Bentham and consequently critiqued by Mill. Utilitarianism is founded on the principle of maximizing pleasure and minimizing pain. In this we can see that it has adaptability beyond that of Kantian ethics. Also, utilitarianism is not bounded by human nature in the same way as virtue ethics is, because it does not rest on a natural receptivity to cultivating one's own moral virtue by acting in accordance with that principle. It is for these reasons that we should take stock of this ethical system in an effort to analyze the permissibility of enhancement for individuals.
Bentham notes one stereotypic pleasure and one stereotypic pain that have relevance to the pharmaceutical enhancement question. The pleasure is that of skill: by using pharmaceutical enhancement we can sharpen our mental skills in accordance with our hopes of tackling questions of greater difficulty (68). The pain is that of the senses; by using pharmaceutical enhancement we could potentially cause adverse side-effects (69). It is by weighing these two potentialities against each other that we can come to a conclusion about the net benefit of enhancement. This seems relatively straight
forward. However, how does one measure one
qualia (the phenomenological experience of emotion) against another in a
It is with this question in mind that Mill can be called upon to provide insight. In Mill’s On Liberty he clarifies who must be the arbiter between an individual’s positive and negative qualia, “The only part of the conduct of any one, for which he is amenable to society, is that which concerns others. In the part which merely concerns himself, his independence is, of right, absolute. Over himself, over his own body and mind, the individual is sovereign”(135). So while it is impossible to objectively and quantitatively weigh qualia against one another, it is perfectly acceptable for an individual to be the sovereign arbitrator of his own state. This does not include drug users whose abuse cause the state harm through being monetary drains on society nor does it include those whose abuse affects their social and familial sphere. It does however include those individuals who can responsibly use enhancement for their own betterment.
While the right for a responsible individual to use his or her discretion in judging the benefit/harm net effect of enhancement is his or her prerogative, pharmaceuticals are still a material good (i.e., something you can purchase in a store) and as such are subject to a certain degree of interpersonal relation (because you have to purchase the good from someone). This is where doctors and manufacturers come into the equation.