Enhancing Autonomy by Reducing Impulsivity: The Case of ADHD
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Enhancing Autonomy by Reducing Impulsivity: The Case of ADHD Jonathan Pugh
Received: 13 November 2013 / Accepted: 11 February 2014 # Springer Science+Business Media Dordrecht 2014
Abstract In a recent article in this journal, Schaefer et al. argue that it might be possible to enhance autonomy through the use of cognitive enhancements. In this article, I highlight an example that Schaefer et al. do not acknowledge of a way in which we already seem to be using pharmacological agents in a manner that can be understood as enhancing an agent’s autonomy. To make this argument, I begin by following other theorists in the philosophical literature in claiming that impulsivity can serve to undermine an agent’s autonomy. I then explain that we are already able to reduce impulsivity through the use of pharmacological interventions, as is evidenced by the use of Methylphenidate in the treatment of ADHD. Keywords Autonomy . Enhancement . Cognition . Impulsivity
Impulsivity Can Undermine Autonomy Rather than endorsing a particular view of autonomy, Schaefer et al. argue (using both a theory based approach and a case based approach) that an agent’s general reasoning ability is central to their autonomy according to all prominent, and plausible theories of autonomy. In the part of their paper in which they adopt a case based approach, they go on to argue that one way in
J. Pugh (*) Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK e-mail: [email protected]
which enhancing an agent’s general reasoning capacities might serve to enhance that agent’s autonomy is that doing so will serve to reduce the influence of many interventions that are widely understood to undermine autonomy, such as brain-washing, deception, and manipulation [1]. This seems right; however, notice that these are interventions in which an agent’s autonomy is undermined by another agent. Whilst these interventions undoubtedly can undermine autonomy, it seems that an agent’s autonomy can also be inhibited without the direct intervention of another agent. One salient example of such a case that Schaefer et al. do not consider is the case of an agent who acts only the basis of their impulsive desires. It is widely understood that agents who are alienated from their motivating desires lack autonomy with respect to them, and the actions to which they give rise. For example, consider Frankfurt’s example of an unwilling addict who desperately wants (at a second order level) to be rid of his craving for heroin, but nonetheless finds this first-order desire effective in moving him to act [2]. Frankfurt suggests that the unwilling addict lacks autonomy because an autonomous agent must endorse their first-order motivating desire with a second order volition that that first-order desire be effective in moving him to act [2]. Of course, different accounts of autonomy give different accounts of the nature of the alienation that the unwilling addict experiences, and of the reasons why such alienation undermines autonomy.
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