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Decision Making & the Ethics of “Smart Drugs” – Professor Barbara Sahakian

bad-moves-barbara-sahakianMy new book, Bad moves: How decision making goes wrong and the ethics of smart drugs, co-authored with Jamie Nicole LaBuzetta, explores ‘hot’ and ‘cold’ decision-making and the possible improvement of bad or risky decisions with cognitive enhancing drugs.

The book also discusses the increasing lifestyle use of ‘smart drugs’ by healthy people and the ethical issues that arise from this practice as well as the possible effects on society in the future.

The role of emotions in decision-making is not fully understood, but the knowledge about it is increasing. For example, we know that we have to exert cognitive control by our prefrontal cortex over emotional areas of the brain such as the amygdala in order to have good emotional regulation.

We also know that there are two forms of decision making: ‘hot’ cognition, which includes emotional and risky decisions, and ‘cold’ cognition, which includes rational or non-emotional decisions. Understanding the differences between these two forms of cognition can help us to further discover how emotions are involved in decision making.

In healthy students, an example of ‘hot’ decision-making could be opting to go out the night before an exam which could affect their exam grade. An example of a problem of ‘hot’ cognition could be highly risky behaviour such as when a patient who is in the manic phase of bipolar disorder maxes out their credit cards. In contrast, ‘cold’ cognition might include such decisions as how to organise your day in the most effective way or deciding on ingredients for a meal.

At the laboratory of psychopharmacology at the University of Cambridge, research is being done which uses cognitive enhancing drugs (‘smart drugs’) and psychological treatments to improve cognition, including decision-making, in patients with psychiatric disorders including Alzheimer’s disease, frontotemporal dementia, attention deficit hyperactivity disorder (ADHD), mania and depression. The aim is to improve the ability of patients to function successfully in their daily living at school, university, work or home, and to have a better quality of life and wellbeing.

However, there are issues around the safety and ethical issues in regard to the increasing lifestyle use of ‘smart drugs’ by healthy people. In particular, there are no long term studies of the use of ‘smart drugs’ in healthy people. Another concern is the accessing of these ‘smart drugs’ over the Internet.

Furthermore, there are ethical issues involved in the use of these drugs by healthy people, such as coercion, ‘cheating’ in competitive situations such as exams and the impact this will have on our society. These issues need to be discussed by an informed public.

“Bad moves: How decision making goes wrong and the ethics of smart drugs” by Barbara J Sahakian and Jamie Nicole LaBuzetta is published by Oxford University Press and is also available to download for Kindle.

About Barbara Sahakian

Barbara Sahakian
Professor Barbara Sahakian FMedSci is Professor of Clinical Neuropsychology at the Department of Psychiatry and MRC/Wellcome Trust Behavioural and Clinical Neuroscience Institute, University of Cambridge. She works in the fields of cognitive psychopharmacology, neuroethics, neuropsychology, neuropsychiatry and neuroimaging.Professor Sahakian is a Fellow of Clare Hall, Cambridge and Bye-Fellow of Christ's College, Cambridge. She is currently President of the British Association for Psychopharmacology (BAP).

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