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The ethics of stimulant use in healthy studentsVerster, Gerrit Christiaan 03 1900 (has links)
Thesis (MPhil)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: The quest for enhancement has been part of human culture for thousands of years.
Progress in scientific developments and especially in the field of medical science has
allowed for previously unthinkable advances to be employed in the endeavours to improve
human functioning in its various forms. Whereas in the past, enhancement has been
focused on aspects such as prolonging life, improving the immune system or cosmetic
enhancements, cognitive enhancement is receiving substantial attention at the moment.
Recent reports have commented on the use of stimulants such as methylphenidate,
especially amongst students at tertiary institutions with the aim of enhancing cognitive
abilities. This raises various concerns, ranging from safety issues and the risk of drug
abuse to the moral issues relating to enhancement in the broader context. Enhancement
therapies are easily justified where the required enhancement is needed to improve
functioning where a specific deficit is present or where such enhancement could prevent
illness. But where no illness or disorder is present, these issues cause marked
ambivalence amongst medical practitioners. The legal restrictions placed on the access to
stimulants require the participation of a doctor as these drugs may not be sold across the
counter and a prescription is needed to acquire them. The doctor is then put in the
position where a request is made for medication where illness or a disorder is not present.
Medical paternalism could easily dictate that the decision does lie with the doctor because
of statutory rules, but this would be at the risk of ignoring the possible rights of students to
enhance. This thesis examines the concerns mentioned related to safety risks as well as
the abuse potential of methylphenidate. Although there are precautions that need to be
taken into account when prescribing methylphenidate, this is not sufficient to warrant a
blanket refusal by medical practitioners to prescribe it to healthy students. The arguments
used to debate both the promotion of enhancement therapies as well as the reasons for
restricting and possibly even preventing any use thereof, are discussed. There are various
reasons why enhancement may be needed in current and future society and to ignore
these would raise moral issues in itself. There are various arguments used to disapprove
of enhancement, but this thesis concludes that although the concerns raised should be
considered on an ongoing basis, as enhancement is an ongoing process, enhancement
should be allowed to continue to be explored and employed where appropriate. Finally,
potential guidelines for the individual and also for tertiary institutions relating to enhancement, especially relating to cognitive enhancement with stimulants such as
methylphenidate, are proposed. / AFRIKAANSE OPSOMMING: Die soeke na verbetering is reeds vir duisende jare deel van die menslike kultuur.
Vordering in wetenskaplike ontwikkelings en veral op die gebied van die mediese
wetenskap het toegelaat dat voorheen ondenkbare vooruitgang toegepas kan word in die
pogings om menslike funksionering in sy verskillende vorme te verbeter. In die verlede het
verbeteringstegnieke merendeels gefokus op aspekte soos verlenging van lewe, die
verbetering van die immuunstelsel of kosmetiese verbeterings, maar tans geniet
kognitiewe verbetering aansienlike aandag. Onlangse verslae lewer veral kommentaar oor
die gebruik van stimulante soos metielfenidaat, veral onder studente by tersiêre instellings,
met die doel om die verbetering van kognitiewe vermoëns teweeg te bring. Dit lei tot
verskeie bekommernisse, wat wissel van veiligheidskwessies en die risiko van
dwelmmisbruik tot die morele kwessies met betrekking tot verbeteringstegnieke in die
breër konteks. Terapieë gemik op verbetering is maklik geregverdig waar die verbetering
nodig is om funksionering te verbeter, waar 'n spesifieke tekort teenwoordig is of waar so'
n verbetering 'n siekte kan voorkom. Maar waar daar geen siekte of afwyking teenwoordig
is nie, veroorsaak hierdie terapieë beduidende ambivalensie onder mediese praktisyns.
Die wetlike beperkings wat geplaas is op die beskikbaarheid van stimulante vereis die
betrokkenheid van 'n dokter aangesien hierdie middels nie oor die toonbank verkoop mag
word nie en 'n voorskrif nodig is om dit te bekom. Die dokter word dan in die posisie
geplaas waar daar 'n versoek is vir medikasie waar siekte of 'n versteuring nie
teenwoordig is nie. Mediese paternalisme kan maklik dikteer dat die besluit suiwer as
gevolg van statutêre reëls wel alleen by die dokter lê, maar die risiko bestaan dan dat die
regte van studente om hulself te verbeter ignoreer word. Hierdie tesis ondersoek die
potensiële probleme met betrekking tot die veiligheidsrisiko's sowel as die
misbruikpotensiaal van metielfenidaat. Alhoewel daar voorsorgmaatreëls in ag geneem
moet word wanneer die voorskryf van metielfenidaat oorweeg word, is dit nie voldoende
om 'n totale weiering deur geneeshere om dit voor te skryf aan gesonde studente te
regverdig nie. Die argumente wat gebruik word om sowel die bevordering van die
verbeteringsterapieë as die redes vir die beperking en moontlik selfs die voorkoming van
enige gebruik daarvan te debatteer, word bespreek. Daar is verskeie redes waarom
verbetering in die huidige en toekomstige samelewing nodig is en om dit te ignoreer sou
op sigself morele beswarte opper. Daar is wel verskeie argumente wat gebruik kan word
om verbetering af te keur, maar hierdie tesis wys daarop dat hoewel die kommer wat
geopper word in ag geneem moet word op 'n deurlopende basis, aangesien verbeteringstegnieke ‘n voortdurende proses is, bevordering van hierdie terapieë toegelaat
moet word en waar toepaslik in diens geneem moet word. Ten slotte word moontlike
riglyne vir die individu en ook vir tersiêre instellings met betrekking tot verbetering, veral
met betrekking tot kognitiewe verbetering met stimulante soos metielfenidaat, voorgestel.
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