Personal Autonomy and Authenticity: Adolescents’ Discretionary Use of Methylphenidate

The ethics of AI-assisted warfighter enhancement research and experimentation: Historical perspectives and ethical challenges

The military applications of AI raise myriad ethical challenges. Critical among them is how AI integrates with human decision making to enhance cognitive performance on the battlefield. AI applications range from augmented reality devices to assist learning and improve training to implantable Brain-Computer Interfaces (BCI) to create bionic "super soldiers." As these technologies mature, AI-wired warfighters face potential affronts to cognitive liberty, psychological and physiological health risks and obstacles to integrating into military and civil society during their service and upon discharge. Before coming online and operational, however, AI-assisted technologies and neural interfaces require extensive research and human experimentation. Each endeavor raises additional ethical concerns that have been historically ignored thereby leaving military and medical scientists without a cogent ethics protocol for sustainable research. In this way, this paper is a "prequel" to the current debate over enhancement which largely considers neuro-technologies once they are already out the door and operational. To lay the ethics foundation for AI-assisted warfighter enhancement research, we present an historical overview of its technological development followed by a presentation of salient ethics research issues (ICRC, 2006). We begin with a historical survey of AI neuro-enhancement research highlighting the ethics lacunae of its development. We demonstrate the unique ethical problems posed by the convergence of several technologies in the military research setting. Then we address these deficiencies by emphasizing how AI-assisted warfighter enhancement research must pay particular attention to military necessity, and the medical and military cost-benefit tradeoffs of emerging technologies, all attending to the unique status of warfighters as experimental subjects. Finally, our focus is the enhancement of friendly or compatriot warfighters and not, as others have focused, enhancements intended to pacify enemy warfighters.

Losing Meaning: Philosophical Reflections on Neural Interventions and their Influence on Narrative Identity

The profound changes in personality, mood, and other features of the self that neural interventions can induce can be disconcerting to patients, their families, and caregivers. In the neuroethical debate, these concerns are often addressed in the context of possible threats to the narrative self. In this paper, I argue that it is necessary to consider a dimension of impacts on the narrative self which has so far been neglected: neural interventions can lead to a loss of meaning of actions, feelings, beliefs, and other intentional elements of our self-narratives. To uphold the coherence of the self-narrative, the changes induced by neural interventions need to be accounted for through explanations in intentional or biochemical terms. However, only an explanation including intentional states delivers the content to directly ascribe personal meaning, i.e., subjective value to events. Neural interventions can deprive events of meaning because they may favor a predominantly biochemical account. A loss of meaning is not inherently negative but it can be problematic, particularly if events are affected one was not prepared or willing to have stripped of meaning. The paper further examines what it is about neural interventions that impacts meaning by analyzing different methods. To which degree the pull towards a biochemical view occurs depends on the characteristics of the neural intervention. By comparing Deep Brain Stimulation, Prozac, Ritalin, psychedelics, and psychotherapy, the paper identifies some main factors: the rate of change, the transparency of the causal chain, the involvement of the patient, and the presence of an acute phenomenological experience.

Negev Bedouin Teachers' Attitudes Toward ADHD and Its Pharmacological Treatment

Little is known about the attitudes of Negev Bedouin toward attention-deficit/hyperactivity disorder (ADHD) and its pharmacological treatment. This study examines the perspectives of Negev Bedouin teachers on pharmacological treatment. Thirty-six teachers are asked to consider how their views influence the way they relate to pupils' parents. A grounded-theory analysis of semistructured interviews illuminates ambivalence in teachers' attitudes. Teachers, like the rest of their community, when asked about the implications of an ADHD evaluation for their children, respond that ADHD and its pharmacological treatment cause dishonor. When asked what ADHD means when it is their pupils who are diagnosed and treated, however, teachers, like the education establishment, accept the need for medication. However, they fail to communicate this need to parents because their attempts to do so show parents that they consider their children "flawed"-causing parents to oppose treatment even more lest they succumb to social stigma.

Managing Complexity: Exploring Decision Making on Medication by Young Adults with ADHD

Attention-deficit hyperactivity disorder (ADHD) causes difficulties with hyperactivity, impulsivity and inattention. Treatment of ADHD includes both medication and non-pharmacological options. Knowledge of treatment preferences by young adults with ADHD is sparse. The objective of this study was to explore the beliefs and experiences of young adults with ADHD related to their medication treatment decisions. Data were collected in Denmark in 2016 through a focus group and individual in-depth interviews. Conventional content analysis was used. Ten young adults with ADHD (22-to 29-year-old) participated. Three major themes were identified: (1) the patient’s right to choose concerning ADHD medicine; (2) the patient’s decision of whether or not to treat ADHD with medication; and (3) factors affecting the patient’s decision on whether to take ADHD medication or not. The latter theme contained 15 factors, which were distributed across three levels: individual, between-individuals, and societal. The dominant factors were increasing quality of life and improving oneself e.g., improving social skills. For counselling at the pharmacy and by prescribers, it is important to be aware of the different factors that affect young adult patients’ decisions on whether to take ADHD medication or not. This knowledge will aid to understand reasons for non-adherence and to determine appropriate treatment for the individual patient.