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Against Pediatric Neuroenhancement

July 2, 2013

Against Pediatric Neuroenhancement

  1. Alain Joffe, MD, MPH, FAAPAU939

Three neurologic societies argue that prescribing stimulant medications to augment cognitive or affective function in healthy children and adolescents is not justifiable.

  1. Alain Joffe, MD, MPH, FAAPAU939

Have you ever been asked to prescribe stimulant medication for a child or adolescent without dysfunction? Concerned that neuroenhancenment is a growing trend in pediatric practice, the American Academy of Neurology, the Child Neurology Society, and the American Neurological Association explored ethical, legal, social, developmental, and professional issues of pediatric neuroenhancement and focus on the role and obligations of physicians.

Ethical issues

  • Evaluate patients before prescribing medications.

  • Prevent and treat illness in children and adolescents (beneficence), but refrain from unnecessary treatment and potential harm (nonmaleficence).

  • Protect vulnerable populations and promote the best interests of the child. Refuse requests by parents to provide neuroenhancement for a “decisionally incapable” child.

  • Prevent coercion or undue pressure. Resist prescribing when achievement-oriented parents, teachers, and school administrators promote neuroenhancement and children feel pressure from peers to use stimulant medication.

  • Resist over-medicalization (when typical human experiences and emotions become defined as medical conditions), and prevent medical child abuse (parents seeking unneeded medical care for deliberately exaggerated symptoms).

Developmental issues

  • Protect authenticity in childhood and adolescence (the capacity of children and adolescents to develop their unique individuality and achieve self-fulfillment throughout life). Although neuroenhancement may promote authenticity, drugs can alter personality and constrain individuals from living authentically. Whether neuroenhancement will foster or complicate a child's conception of personal responsibility for his or her behavior is unknown.

Social and legal issues

  • Be aware of principles of distributive justice (fairness and allocation of resources). Proponents of neuroenhancement argue that use of medications does not differ from private tutoring or prepatory courses and that their use might actually “level the playing field.” But how such drugs would be equitably distributed is challenging.

  • Prevent medication diversion. Instruct patients that diversion of stimulant medications (especially controlled substances) can lead to serious legal consequences and may pose life-threatening consequences.

Professional issues

  • Be aware of direct-to-consumer advertising of neuroenhancement medication. Physicians are obligated to uphold professionalism and resist trends toward consumer-provider relationships.

  • Physicians have a fiduciary responsibility to ensure that all medical care is used appropriately for patients and that prescribing medication for healthy patients may jeopardize the integrity of the profession.

Comment

I think the authors put forth a compelling argument against prescribing neuroenhancement medication for children. As they acknowledge, the issue becomes more complex as adolescents develop adult reasoning capacity or turn age 18. However, until we can be reassured that these drugs do not adversely affect adolescents' developing brains or their sense of authenticity and personal responsibility for their behavior, or exacerbate existing inequities in the educational system, neuroenhancement in adolescents is — in my opinion — not warranted.

  • Disclosures for Alain Joffe, MD, MPH, FAAP at time of publication Editorial boards Adolescent Medicine: State of the Art Reviews; JAMA Pediatrics

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