The authors state, “Neuroenhancement in legally and developmentally non-autonomous children and adolescents without a diagnosis of a neurologic disorder is not justifiable. In nearly autonomous adolescents … the prescription of neuroenhancements is inadvisable because of numerous social, developmental, and professional integrity issues.”1

Unique Challenges Posed by Children and Adolescents


Continue Reading

Unlike adults, children cannot exercise individual autonomy, thus the relationship is a triad between physician, child, and parent. This involves “a unique set of ethical health care decision-making principles, including developing patient autonomy, nonmaleficence, beneficence … justice, and parental authority.”9 Adolescents are more mature and cognitively developed, so “physicians are obligated to give due weight to the preferences of adolescents with decision-making capacity.” Nevertheless, as adolescents are not yet adults, parents are ultimately the “surrogate decision-makers.”1

Safety Concerns

The authors review safety concerns of stimulants in children and adolescents, noting that ADHD medications, such as methylphenidate and amphetamines, are sympathomimetic amines that may potentially have adverse cardiac and CNS effects.1

Recommendations of the Position Paper

In addressing a request for neuroenhancement with parents and children or adolescents, physicians should:

  • Explain drug use in healthy children and adolescents.
  • Explain the ethical and legal obligation of the physician.
  • Emphasize the limited evidence regarding efficacy and safety.
  • Consider that requests for neuroenhancement may reflect other medical, social, and psychological issues.
  • Inquire about the child’s natural talents and weaknesses.
  • Explore the family’s expectations of neuroenhancement.
  • Explain principles of informed parental permission.
  • Explain that imposing neuroenhancements upon a child or adolescent may alter the developmental process of learning autonomous decision-making.
  • Explore potential coercion or undue pressure.
  • Emphasize nonmedication alternatives.
  • Discuss misuse of controlled medication.
  • Explain that use of neuroenhancements in nonautonomous healthy children and adolescents is not justifiable and their use in nearly autonomous healthy adolescents remains inadvisable.

POLL: Is Neuroenhancement Justifiable in Certain Cases?

Physicians’ Ethical Obligations

Physicians are ethically obligated to:

  • Evaluate patients
  • Respect developing autonomy of pediatric patients and to assess decision-making capacity
  • Protect vulnerable populations
  • Prevent coercion or pressure
  • Resist over-medicalization
  • Prevent medical child abuse
  • Protect the child’s or adolescent’s authenticity (ie, unique individuality)

Social and Legal Obligations

Physicians also should:

  • Promote distributive justice
  • Prevent medication diversion
  • Be aware of direct-to-consumer advertising of neuroenhancement medication
  • Uphold professionalism and resist trends toward consumer-provider relationships

Conclusion

The authors conclude that prescribing drugs for healthy pediatric patients is a response to “dubious goals” and may “jeopardize the integrity of the profession and the special doctor-child-parent relationship.”