Moral Modification and the Social Environment

In light of the recent focus in bioethics on questions of deliberate moral enhancement through the use of psychoactive drugs, Levy et al. (2014) argue that the more pressing issue may be the incidental effect that prescription drugs could already be having on moral agency. Although concerns have focused on the possibility of altering moral psychology through direct effects on brain function, the authors point out that this may already be a reality, albeit an unintentional one. They conclude from their survey of prescription drugs already in use, that we should urgently investigate the ways they may be “influencing the shape of our societies” (2014, 123). The question of how we ought to respond to this possibility, I believe, must be considered in the broader context of existing attitudes and policy in response to substances with similar effects; and the relative significance of these drug effects compared with other factors, in particular social factors that shape society through their developmental influence on moral psychology.

First, it is important to consider the drugs described by the authors alongside widely used drugs with known, comparable effects. For example, alcohol has profound effects on features of cognition that seem relevant to moral agency, in altering risk assessment and increasing aggression (Bushman and Cooper 1990; George et al. 2005). Its impairing of inhibitory control arguably undermines the reflective processes that are often considered central to moral agency (Craigie 2011; Field et al. 2010). However, by and large the current policy adopted in liberal democratic societies is to educate people about these dangers but leave it up to adults to choose whether they use alcohol. Exceptions to this position are grounded in reasons of public protection, for example, in the case of blood alcohol limits for drivers in order to protect people against injury or death as a result of drunk driving. Restrictions are also sometimes placed on inebriation in the context of particular public roles, for example, serving on a jury, although the issue remains controversial (Law Reform Commission 2010, s. 8.21, 8.26, 8.27). This approach to alcohol regulation offers an established model for responding to the kinds of drugs in question. Broadly, it suggests that concerns about the effect of a drug on moral agency are only considered serious enough to warrant restricting its use when this puts others at risk of serious harms, or when a person is fulfilling a public role where sound decision making is of great importance (e.g., in maintaining trust in institutions such as the criminal justice system). Although at first it may be an alarming thought that pharmaceuticals could be influencing individual moral psychology, the example of alcohol suggests that this this is a familiar experience, and something for which states already have a policy framework.

Caffeine is another commonly used drug with psychoactive properties that seem likely to affect moral agency. Along with potentially morally relevant effects on attention and aggression (Einöther and Giesbrecht 2013; Kuhns et al. 2010), research suggests a connection between cortisol—a hormone that is elevated by caffeine—and the processing of social cues relating to threat (Montoya et al. 2012; Putman et al. 2007). There are little in the way of restrictions on the use of caffeine. Nonetheless, one might be concerned about the possible effects of caffeine on moral agency and society, particularly if the effects are less obvious than in the case of alcohol (Kuhns et al. 2010). The same concern might apply to the pharmaceuticals in question. Perhaps there is a need to investigate these effects on thought and behavior because they are not easy to detect. The greater danger might be in the fact that people do not recognize how these drugs change their appraisals and decisions, rather than in the effects themselves. It seems a reasonable suggestion that if a drug has significant enough effects on interpersonal relationships, then this information should be made available as a part of an informed consent procedure.

Pursuing the idea that patients should be alerted to socially relevant side effects that are not...