US Neurologen über Neuro-Enhancement
Mitglieder des American Academy of Neurology – Ethics, Law and Humanities Committee haben in der aktuellen Ausgabe von Neurology einen “richtungsweisenden Bericht” (guidance) über den Umgang mit Patientenwünschen für Neuroenhancements veröffentlicht. Sie wollen die Einnahme von Neuroenhancements weder anregen noch verurteilen, und konzentrieren sich auf die Rolle der Ärzte und der Medizin. Dies sind ihre 14 Punkte (die es hier lesefreundlicher als Word-Datei gibt):
Table 2: ETHICS, LAW AND HUMANITIES COMMITTEE GUIDELINES FOR RESPONDING TO REQUESTS FROM ADULT PATIENTS FOR NEUROENHANCEMENT MEDICATIONS
| Definition of Neuroenhancement | Neuroenhancement is defined as prescribing medications to normal adult patients for the purpose of augmenting their normal cognitive or affective function. | |
| Definition of “normal adult patients” | Normal adult patients in the context of neuroenhancement may be defined as patients who, after appropriate evaluation, neither 1) satisfy accepted criteria for medical or mental health disease, disorder, or injury (collectively described as medical or mental health condition), nor 2) satisfy accepted criteria to be considered at risk for a medical or mental health condition that can be prevented with appropriate measures. | |
| The prescription of medications for neuroenhancement occurs within the context of the physician–patient relationship. | The physician–patient relationship generally is established by the mutual consent of the patient and the physician to enter into the relationship, usually at the time that the first encounter with the patient begins. If the request for neuroenhancement occurs before the neurologist has seen the patient for a new patient encounter, the neurologist may ethically choose whether to agree or refuse to enter into the physician–patient relationship. Once the physician–patient relationship is established, it continues until the relationship is ended in accordance with professional standards for doing so. | |
| Neurologists who provide neuroenhancement have ethical and legal responsibilities to patients. | Neurologists have the same ethical and legal responsibilities to normal adult patients for whom they prescribe neuroenhancement medications as they do for adult patients whom they evaluate and treat for medical and mental health conditions. | |
| Neurologists should respond to a request for neuroenhancement as they would respond to a chief complaint. | An appropriate history and physical examination should be performed. If clinically indicated, appropriate tests or consultations should be ordered to determine whether the patient has an underlying medical or mental health condition that, if found, should be addressed appropriately. Treatment in this context would not be neuroenhancement. If no medical or mental health condition is found, the patient would be considered normal and prescription of a medication would constitute neuroenhancement. | |
| The prescription of medications for neuroenhancement is 1) not legally obligatory, 2) not legally prohibited, and therefore, 3) is legally permissible in the United States. | The prescription of medications for neuroenhancement is permissible based on existing legal and regulatory frameworks in the United States and, as of 2009, occurs only as off-label prescription of medications approved by the FDA for other clinical indications. | |
| The prescription of medications for neuroenhancement is 1) not ethically obligatory, 2) not ethically prohibited, and therefore, 3) is ethically permissible. | The prescription of medications for neuroenhancement is permissible based on existing, widely accepted ethical principles, including those contained in the Code of Professional Conduct of the American Academy of Neurology Professional Association. | |
| Limited evidence exists regarding the efficacy and safety of medications prescribed to normal adults for neuroenhancement. | The idea of “making a person smarter” by prescribing neuroenhancement medications is belied by the complex nature of cognitive function. The risks of the long-term use of medications for neuroenhancement in normal patients without a medical or mental health condition are not known and may not be known for many years. | |
| The liability risks associated with prescribing medications for neuroenhancement are uncertain. | Neurologists who wish to offer neuroenhancement to their patients should do so in accordance with their best medical judgment and in accordance with federal laws and the laws in the states in which they practice medicine. It is likely that legal disputes regarding negligence and standard of care for neuroenhancement will be analyzed by the courts in a manner similar to other areas of professional liability. It is also possible that judges and legislatures will make policy decisions to dissuade physicians from prescribing neuroenhancement. | |
| A refusal to prescribe medications for neuroenhancement is ethically and legally permissible. | Refusing to prescribe the requested medication does not constitute failure to treat a medical or mental health condition if, after appropriate evaluation, no underlying medical or mental health condition has been found. Neurologists can respectfully refuse the request by explaining the rationale in terms that the patient can understand. Because the refusal does not constitute failure to treat a medical or mental health condition, the physician has no obligation to refer the patient to another physician for neuroenhancement. | |
| The medical principles for prescribing medications for neuroenhancement are identical to those for prescribing medications to treat medical conditions. | The potential for medication interactions and patient allergies should be considered, and appropriate dosages, dosage intervals, and routes of administration should be prescribed. The goals of care should be clarified with the patient prior to initiating the medication. The goals should be realistic and have a reasonable likelihood of being reached. The neurologist and patient together should prospectively define: 1) indicators of success or failure, 2) the method of assessment, 3) the timing of the assessments, and 4) side effects or complications that would warrant stopping the medication. | |
| The principles of informed consent apply to the use of medications for neuroenhancement. | Neurologists should discuss the rationale for prescribing a medication for neuroenhancement. Neurologists should explain the known risks of the medication, if any, as they relate to the potential benefits, if any. Patients should be apprised whether the long-term risks of the medication for neuroenhancement in a normal population are known or unknown. Neurologists should also discuss alternative interventions that could achieve the same goal without the use of neuroenhancement medication. Discussions should be documented in the medical record. Patients should be provided with the opportunity to ask questions before starting the medication. | |
| The potential influence of neuroenhancement medications on the patient’s decision-making capacity should be considered. | Because neuroenhancement medications carry the theoretical risk of altering or diminishing the patient’s decision-making capacity, the physician may wish to have the patient identify a surrogate decision maker and may wish to establish individualized criteria for declaring that the patient lacks decision-making capacity. | |
| Ending the prescription of a neuroenhancement medication after it has been initiated is ethically and legally permissible. | Neurologists who have initiated neuroenhancement for a patient may stop prescribing the medication for neuroenhancement even if the patient wishes to continue it. When stopping the medication, neurologists should use accepted medical principles, consider the potential for medication-associated withdrawal effects, and if clinically appropriate, establish a schedule to taper the dose gradually. Neurologists who stop providing neuroenhancement have not abandoned their patients. |
Ein wegen Promotions- und anderer Krisen nur unregelmäßig gepflegter Blog über ethische und rechtliche Fragen, die durch die Neuro- und Biowissenschaften aufgeworfen werden und in meinen auditiven & visuellen Cortex gelangen. Hinweise, Kommentare und kritisch-kontroverse Gastbeiträge sind gern gesehen. 