Cognitive Enhancement: Treating or Cheating?

In this article I provide an overview of the moral and medical questions surrounding the use of cognitive enhancers. This discussion will be framed in light of 4 key considerations: (1) is there a difference between therapy and enhancement? (2) How safe are these interventions? (3) Is the use of nootropics cheating? (4) Would enhancers create a further divide of social inequality where only the very wealthy have access to them?

Ethical challenges in assisted reproduction: the place of preimplantation genetic diagnosis in a just society.

The purpose of this article is to provide an overview of preimplantation genetic diagnosis and identify the relevant moral questions it raises. In the course of this discussion, the scope of parental rights and the inherent difficulty in defining disease/disability will be considered.

Advanced directives and treatment decisions in the intensive care unit.

Prospective medical decision-making through the use of advanced directives is encouraged and frequently helpful in guiding treatment for the critically ill. It is important to recognize the attendant shortcomings when using such tools in clinical practice.

Bench-to-bedside review: when is dead really dead--on the legitimacy of using neurologic criteria to determine death.

This review explores the legitimacy of the whole brain death (WBD) criterion. I argue that it does not fulfill the traditional biologic definition of death and is, therefore, an unsound clinical and philosophical criterion for death. I dispute whether the clinical tests used to diagnose WBD are sufficient to prove all critical brain functions have ceased, as well as examine the sets of brain functions that persist in many WBD patients.

Ethics review: dark angels--the problem of death in intensive care.

Critical care medicine has expanded the envelope of debilitating disease through the application of an aggressive and invasive care plan, part of which is designed to identify and reverse organ dysfunction before it proceeds to organ failure. For a select patient population, this care plan has been remarkably successful. But because patient selection is very broad, critical care sometimes yields amalgams of life in death: the state of being unable to participate in human life, unable to die, at least in the traditional sense.

Ethics roundtable debate: withdrawal of tube feeding in a patient with persistent vegetative state where the patients wishes are unclear and there is family dissension.

The decision to withdraw or withhold life supporting treatment in moribund patients is difficult under any circumstances. When the patient becomes incompetent to clarify their wishes regarding continued maintenance in long-term facilities, surrogates sometimes cannot agree, further clouding the issue. We examine a case where the State's interests come into play, forcing a controversial resolution.

Ethics roundtable: Using new, expensive drugs.

Costly genetically engineered therapies, which threaten to cripple the health care industry economy and undermine the common good if applied indiscriminately, loom on the horizon. The spectrum of applicable candidates include moribund nursing home patients at the end of life. They will be fair game for therapy that will ultimately send them back to nursing homes to return later with the same condition.