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Source: (consider it)
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Thread: Is it ethical to medicate for morality?
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Curiosity killed ...
Ship's Mug
# 11770
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Posted
This comes out of the recording of the Philosopher's Arms I attended last night (and no, I don't know when it will be broadcast) looking at the ethics of using drugs to enhance morality.
How moral is it to use drugs to change behaviour?
The examples discussed were: - propanalol which is a drug prescribed for high blood pressure and anxiety but also has been found to make the (nice compliant)* adult volunteers tested less racist. The guy who was proposing this was Julian Savulescu of the Oxford Centre of Neuroethics, who is an *interesting* character now I've googled him;
- ritalin to treat ADHD - this was described by a mother and now adult daughter, both with ADHD, the daughter was prescribed ritalin at 6 to cope in school;
- the other panellist was Essi Viding who was talking about psychopathy;
- Alan Turing was mentioned in passing - sexual castration.
The other strand was about whose morality? To illustrate there was someone there, a London Muslim, whose name I didn't catch. He was brought up in a strict Islamic household and spent time fighting in Afghanistan as part of that radicalisation, admitted to rejoicing after 9/11. He now believes that Jihad is against Islam and is working with London gangs† to change things around. But my thoughts while I was listening to the debate were about the teenagers I work with in London gangs whose moral code is almost Omertà - to the point I have been threatened with being knifed if I grass.
* "nice compliant" was one of the reasons Essi Viding gave for finding universal roll out of medication challenging, because who knows what morality some of these medications will reinforce.
† many of the gangs in Tower Hamlets are Asian and most of the work to support gangs is against those Asian gangs (means it's very difficult to find support for the Afro-Caribbean, mixed race and white British boys caught up in gangs too)
So how moral is using chemistry to change behaviour? Who sets the morality? And what about consent? or side effects?
[ 23. July 2014, 10:54: Message edited by: Curiosity killed ... ]
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Mugs - Keep the Ship afloat
Posts: 13794 | From: outiside the outer ring road | Registered: Aug 2006
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Adeodatus
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# 4992
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Posted
Medical ethics is a fuzzy thing, and this is one of its fuzziest areas.
The first thing to notice is that all sorts of medications change behaviour, but sometimes tangentially to their intended effect. And then there are drugs that don't change behaviour by chemical means, but by treating a disorder allow a person to become calmer, happier, or whatever, because they're no longer being limited by the disorder.
However, it's also the case that diagnostic medicine is not an exact science (some would say it's not a science at all). Here's an example quoted to me by one of my old Medical Humanities tutors. In France, you might be diagnosed with - and medicated for - a disorder called "spasmophilia". In the USA, the symptoms might be recognised as a kind of panic attack. In the UK, there's simply no such thing. (My tutor wryly commented that in some parts of France, the cheapest treatment for spasmophilia would be a ticket to the UK where the disease doesn't exist.)
A third factor here is that in the world of healthcare - and particularly in mental health - there are powerful lobbying groups at work to try to find disorders that their drugs can cure. Some critics of diagnostic tools sych as DSM-5 have noted the links that some diagnosticians have with the pharmaceuticals industry.
I think that generally, what's ethical is to medicate for the recipient's own benefit. For instance, if you can't cope with my behaviour, why should I accept medication for that? But if my behaviour causes me distress, then go ahead and gimme the pill. Obviously this principle's force is lessened if, along with my behavioural "problem", my ability meaningfully to consent to treatment is also compromised.
And in all of this, I think the most important "red flag" issue is the one you mention - whose morality is being imposed?
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anteater
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# 11435
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Posted
quote:
[1] So how moral is using chemistry to change behaviour? [2] Who sets the morality? And [3]what about consent? or [4] side effects?
Well nothing like having four issues to solve in one thread. I added the numbers.
The source of moral codes is separate, and is IMO more appropriate to setting law codes. Whatever the law code, we can question ways to get people to conform: propaganda, sentencing policy and policing policy and, of course, the education system - all of which can be misused.
I'm not convinced drugs can change behaviour directly, unless they incapacitate it. They may change what we perceive as feelings, and this may make you feel more at peace with the world. What experience I have had of psychotropic drugs has been good, so I tend to be biased in their favour.
So if the question is whether, even supposing there are no severe side effects, and consent is there, we should still think it dubious of offer medication to help people cope with their internal world and external behaviour, they why ever not?
Of course it can be abused. Lots of things can.
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chive
Ship's nude
# 208
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Posted
I find this interesting in relation to mental health particularly. One question I'm interested in is to what extent medication is used to make people more 'socially acceptable'? Yes, I know the horrendousness of being mentally ill - I've been through half the diagnoses in the DSM in my time - but I question the timing and nature of some interventions.
With NHS resources being cut, particularly in community and inpatient mental health facilities, it appears that secondary treatment will increasingly be limited to those whose mental health problems impact on more than themselves. I've been told I'm going to be discharged from secondary services because they're going to be focussed on people with psychotic disorders. I've been told that access to the crisis team is going to be limited to those who have been arrested under a s136 (ie. those the police have arrested because their behaviour in a public place is of concern to the police).
It appears to me that the treatment of those with mental illness is therefore being increasingly focussed on people who offend public norms for want of a better term.
This also raises the issue of whether it is correct and right to medicate/treat/forcibly detain those whose behaviour is bothering other people even if it is not bothering themselves. I'm not talking about the rare extreme cases where violence is involved, just the general principle.
Sorry, I'm aware this is a bit of a tangent, its just been something I've been thinking about for a while.
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Curiosity killed ...
Ship's Mug
# 11770
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Posted
Well, the whole problem of medical ethics is that it does involve several overlapping questions.
The big problem is whose morality. I was listening to that part of the debate and wondering about the very strongly held morality of the young gang members I know and thinking I would not want to reinforce that morality. But we, as an audience, were quite keen to give our politicians any possible medications to make them more moral.
There are huge questions in the US about the use of ritalin, where parents are pushing their children to answer the right questions to get prescribed ritalin as being given the drug is seen as an unfair advantage. But those who take it, the girl in the programme, talk about how they don't have any fun, and it makes teenagers resistant to that boring flat existence.
My daughter was diagnosed as having ADHD when she was being diagnosed as dyslexic the first time. I agreed with the paediatrician that I would see if I could put dietary and behavioural interventions in place first to see if we could improve the ADHD without medication because of the side effects (weight gain is another one).
Now I know a number of other students diagnosed with ADHD. Quite often, not always, these children come from dysfunctional families with inconsistent parenting, diet and chaotic lifestyles. Should we be giving those children ritalin? Or should we be giving the parents parenting lessons?
Talking to Essi Viding afterwards, the Walter Mischel delayed gratification experiment looks very cut and dried - a child who can delay their gratification will do better in the long term. But further experiments have shown that if the child is with someone who they know to be an inconsistent carer that child will choose instant gratification. It is a very logical and sensible solution in their situation. So if there was a medication that allowed children to delay their gratification, should we use it, or teach the parents how to parent consistently?
No, it isn't straightforward, and we didn't come to any conclusions last night. A few people changed their minds, but not many (you vote at the beginning and at the end by tapping beer glasses).
Xpost with chive - but yes, a lot of my queries are around being socially normal - and the example of Alan Turing was brought up by someone in the audience as an example of social mores changing - so what normality. I was also thinking ASD while this debate was going on.
[ 23. July 2014, 13:52: Message edited by: Curiosity killed ... ]
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Pomona
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# 17175
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Posted
Actually lots of people with ADHD go undiagnosed because they don't fit the 'traditional' profile, ie they are not from a dysfunctional family and are female. Women are particularly under-diagnosed, and it's the same with ASD/AS.
ADHD is a neurological condition related to OCD, which interestingly does not have the 'bad parenting' stigma.
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Curiosity killed ...
Ship's Mug
# 11770
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Posted
One of the problems with medicating anything neurological is that the brain is plastic, so anything we do changes the brain or physiology.
For example, and this was an example given last night, a cyclist can improve his EPO levels and hence improve their performance by:
- training at high altitide;
- training in a low oxygen chamber;
- injection with EPO;
- injection with additional blood (usually their own, stored from earlier)
Only 1 and 2 are allowed by sporting bodies.
Similar things happen with the brain. Inconsistent care giving is recognised as providing the worst outcomes for children and will change brain structure and make a neurological difference. And I'll put my hand up and say that the behavioural modification was far more about me becoming more consistent in parenting, explicitly consistent.
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Leorning Cniht
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# 17564
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Posted
A huge number of US schoolchildren, mostly boys, have been prescribed ritalin for ADHD. There is controversy over whether these children actually all require medication, or whether some display ADHD symptoms due to a lack of stimulation in school.
There is at least folk wisdom that ADHD symptoms are significantly reduced in populations that are able to exercise, run around, have decent-length recesses and so on.
But I'm no expert. I know enough to know that if my kids started showing ADHD symptoms, I'd want to go away and do a lot of reading.
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Schroedinger's cat
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# 64
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Posted
Chive - I think that is actually the core of the issue. Many people with mental illness only get treatment when - and to the extent that - it interferes with their ability to engage with society.
I think it is a logical extension from this to other medication that is used - voluntarily or not - to bring individuals into a more "normal" state. Their "illness" is being differently wired, differently engaged with society. So I am medicated to allow me to continue to work, to exist and to interact with society.
Am I "ill"? Well that depends what you mean by ill. Is being depressed - in a society that is as dysfunctional as the one we are in - illness or sanity?
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Enoch
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# 14322
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Posted
quote:
Originally posted by Curiosity killed ...:
... But my thoughts while I was listening to the debate were about the teenagers I work with in London gangs whose moral code is almost Omertà - to the point I have been threatened with being knifed if I grass. ...
Tangent alert
Doesn't everybody believe in some sort of Omertà? Isn't the moral question not whether Omertà is inherently wrong but how far up the ethical scale some other moral obligation needs to rise to pip it?
If you are the state, that threshold is invariably lower than where most natural persons would place it. If you are a member of a criminal gang, it is usually higher.
End of tangent alert
Simple but abstract ethical question which often helps crystallise discussion on the OP issue.
If - which I believe not to be the case, but just suppose - it were discovered that medical castration correctly carried out would prevent a person from even wanting to commit paedophilia, would it be a legitimate or illegitimate interference with their human rights,
a. To castrate them, whether they agreed or not, or
b. To offer them a choice of castration or imprisonment, or
c. To offer them the procedure voluntarily?
Remember, those rights include a right of respect for ones family life and a right to marry and start a family.
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Palimpsest
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# 16772
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Posted
I've always thought the dealyed gratification marshmallow testexperiments needed to see if having siblings correlated with eating the marshmallow right away.
In the United States treating schoolchildren with drugs like Ritalin happen a lot more for poor children in overcrowded schools, in part because the parents don't protest. My favorite story was one of some schools in Montana with huge prescription rate (20-30%). It turned out that a lot of the children were simply reselling their drugs on the black market to recreational drug users. That seemed like a very sane response.
[ 23. July 2014, 21:55: Message edited by: Palimpsest ]
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Byron
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# 15532
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Posted
What specific ethical concerns are there with using pharmaceuticals for behavior-modification?
Informed consent, obviously, so there are issues with, say, handing Ritalin out like candy.
Safety is another obvious one.
But so long as a drug is reasonably safe, and taken by a person who understands the risks, I don't see any ethical problem. There might be abstract debates about free will and "morality," but that's for the philosophy department, not ethics in the field.
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Gramps49
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# 16378
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Posted
I have a granddaughter who was very much out of control when she was younger. She really did not like what was happening to her. She could not focus or stay on task. She had problems sleeping and would be very cranky most of the day. Kids did not want to play with her. She was not progressing in school. When she was around six she asked to be put on Ritalin. She is now 11. The outcome has been amazing. She is in the top 10% of her class. Loves to read everything. She is very considerate of her five year old sister. She has a lot of friends. Her own quality of life is ten times better than it was without.
Medication is not so much about behavioral change as it is about helping someone obtain stability.
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Curiosity killed ...
Ship's Mug
# 11770
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Posted
Essi Viding gave some statistics of the number of prison inmates with ADHD 40% according to some studies - is it unreasonable to offer ritalin to those prisoners? That one I would argue was reasonable as is testing criminals to see if they have undiagnosed ADHD, but this is very much in society's interest.
And that lack of attention, easy distractability may well be a trait that is good for hunting on the plains - for checking the environs and being aware of other things around. So are we medicating to make people fit their current urban environments?
Enoch - the problem with the morality of Omertà, as I've encountered it, is how small the society that are protected and how big the "other". To live together in cities and a wider society we need to see our societal groups as wider and not limit it to just our family group or religious group.
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cliffdweller
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# 13338
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Posted
quote:
Originally posted by Curiosity killed ...:
Essi Viding gave some statistics of the number of prison inmates with ADHD 40% according to some studies - is it unreasonable to offer ritalin to those prisoners? That one I would argue was reasonable as is testing criminals to see if they have undiagnosed ADHD, but this is very much in society's interest.
Although ritalin alone may not cause the desired benefit (crime reduction).
My hypothesis re: this well-established stat has always been that you have a group of people (undiagnosed ADHD) who have spent decades being held to a standard of behavior they are unable to comply with (e.g. sitting still in a classroom, focusing on task) and being punished then for failing to meet that standard. This leads to a sort of "learned helplessness"-- i.e. "there's no point in trying to 'be good'-- I'm just a 'bad' person". There's nothing inherent to ADHD itself that would turn someone into a criminal. It's (I'm supposing) the learned helplessness-- the end result of giving up with complying with authoritarian demands-- that leads to the criminal acts.
Understanding ADHD and it's effects coupled with pharma-therapy might be helpful in terms of gaining remedial education and job skills, but I'm guessing first you have to deal with that learned pattern. Unfortunately, in the US at least, that sort of therapeutic intervention for inmates just doesn't happen.
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seekingsister
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# 17707
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Posted
quote:
Originally posted by cliffdweller:
My hypothesis re: this well-established stat has always been that you have a group of people (undiagnosed ADHD) who have spent decades being held to a standard of behavior they are unable to comply with (e.g. sitting still in a classroom, focusing on task) and being punished then for failing to meet that standard. This leads to a sort of "learned helplessness"-- i.e. "there's no point in trying to 'be good'-- I'm just a 'bad' person". There's nothing inherent to ADHD itself that would turn someone into a criminal. It's (I'm supposing) the learned helplessness-- the end result of giving up with complying with authoritarian demands-- that leads to the criminal acts.
And what types of criminal acts?
One of the smartest guys I knew in college - lived across the hall from me - was diagnosed with ADHD in his late teens. He said Ritalin dulled his mind and hurt his academic performance. So he self-medicated with marijuana. I saw him with my own eyes go from being hyperactive and distractable, to then smoking a joint and hitting the books. If I had any reservations about marijuana's medical uses they certainly evaporated over that year I lived near him. It was a dramatically positive drug for him.
But it's also illegal (in most states anyway, and the UK of course). And I read somewhere that a lot of people who use drugs are partially self-medicating underlying psychological disorders. Given that the US loves to throw people into prison for drug offenses, I would guess a sizable number of those got involved in drugs because of undiagnosed mental illness or disorder.
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Penny S
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# 14768
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Posted
This seems related to something that I came across a while back, promulgated by a rather odd chap who is now dead.
He was of the opinion that it would be possible to devise a test for a moral quotient, in the same way as intelligence. (He was in Mensa, which may be relevant.) That raised a lot of questions which he did not consider worth discussion. Such as who gets to define what is moral. And how on earth you ensure that people of low MQ don't fake their results. (Not of course a problem with IQ.)
It seems to me that before considering the medication for morality question, establishing who gets to define which particular morality is medicated for, and what that morality is is much more important. Or we are all headed for daily doses of soma.
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itsarumdo
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# 18174
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Posted
Beta blockers tend to flat-line people's adrenaline response, so there is a general increase in lassitude and decrease in peak adrenaline - so it makes it harder to be aggressively angry, just as it makes harder to be motivated about anything or to have that extra get up and go. The effects vary on dose an between individuals.
It has been suggested that they are used prophylactically after a traumatic event, which appears to reduce the memory of emotional intensity - that's probably a good thing. Just one or two low doses and possibly years of PTSD nipped in the bud. Well - if it works.
But using propanolol or ritalin or fluoride or anything else as a general mood stabiliser to make the general population more passive is utterly unethical imo.
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cliffdweller
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# 13338
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Posted
quote:
Originally posted by seekingsister:
[QUOTE]
But it's also illegal (in most states anyway, and the UK of course). And I read somewhere that a lot of people who use drugs are partially self-medicating underlying psychological disorders. Given that the US loves to throw people into prison for drug offenses, I would guess a sizable number of those got involved in drugs because of undiagnosed mental illness or disorder.
We are finding that among the homeless as well-- that often their drug/alcohol addiction is a way of self-medicating to deal with mental illness. Sadly, in the US it's far easier to get ahold of weed or a jug of wine than it is to get needed meds.
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"Here is the world. Beautiful and terrible things will happen. Don't be afraid." -Frederick Buechner
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Curiosity killed ...
Ship's Mug
# 11770
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Posted
Self-medication on alcohol or weed is a huge problem.
And the other point about the use of beta-blockers to prevent PTSD, that came up in the discussion too. It is being trialled with US soldiers. Is it a good idea to remove the horror of shooting people for soldiers? Julian Savulescu wasn't certain of the morality of this, but he thought that maybe using beta-blockers to remove the horror of rape would be moral.
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Mugs - Keep the Ship afloat
Posts: 13794 | From: outiside the outer ring road | Registered: Aug 2006
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Pomona
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# 17175
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Posted
quote:
Originally posted by Curiosity killed ...:
Essi Viding gave some statistics of the number of prison inmates with ADHD 40% according to some studies - is it unreasonable to offer ritalin to those prisoners? That one I would argue was reasonable as is testing criminals to see if they have undiagnosed ADHD, but this is very much in society's interest.
And that lack of attention, easy distractability may well be a trait that is good for hunting on the plains - for checking the environs and being aware of other things around. So are we medicating to make people fit their current urban environments?
Enoch - the problem with the morality of Omertà, as I've encountered it, is how small the society that are protected and how big the "other". To live together in cities and a wider society we need to see our societal groups as wider and not limit it to just our family group or religious group.
ADHD is often co-morbid with other developmental/neurological conditions, such as dyscalculia.
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Consider the work of God: Who is able to straighten what he has bent? [Ecclesiastes 7:13]
Posts: 5319 | From: UK | Registered: Jun 2012
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Curiosity killed ...
Ship's Mug
# 11770
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Posted
Yes, ADHD is also linked to ASD and dyslexia.
But ... there are a number of ways of rewiring / reconfiguring the brain: behaviour modification does it, practising new skills changes the wiring of the brain, as does living in danger or under stress, or brain injury or drug induced brain rewiring, either legal medication or illegal. How we live and how we think changes our brain function ... it's why it's so difficult to definitely say anything about gender.
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Mugs - Keep the Ship afloat
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