Bioethical evaluation of methylphenidate and atomoxetine for pediatric ADHD and cognitive enhancement

Abstract

Background: This article presents a bioethical analysis of the use of Methylphenidate and Atomoxetine, exploring their roles as cognitive enhancers and therapeutic agents for Attention Deficit Hyperactivity Disorder (ADHD).

Methods: The analysis centers around the principle of non-maleficence, examining the ethical implications of causing harm in the pursuit of cognitive enhancement and therapeutic benefits. It delves into the blurred boundaries between therapy and enhancement and the challenges of defining "necessary harm" in these contexts.

Results: When used for cognitive enhancement rather than therapeutic purposes, methylphenidate challenges the concept of "necessary harm," raising ethical concerns about seeking improvement at the cost of potential adverse effects. The very notion of neurocognitive enhancement remains controversial in the absence of a clinical pathology. In pediatric ADHD, there is a significant lack of long-term data on both therapeutic benefits and adverse effects beyond 30 weeks of treatment. Clinical trials have highlighted safety concerns, as methylphenidate has been linked to sleep disturbances, anorexia, nervous conditions, and, in rare cases, cardiac events. Additionally, exposure during pregnancy may pose risks of congenital malformations. While atomoxetine generally has minor side effects, occasional reports of suicidal tendencies warrant caution.

Discussion: The article discusses the philosophical and ethical underpinnings of human nature, individual autonomy, and the pursuit of enhancement, drawing on historical perspectives from figures like Julian Huxley and contemporary transhumanist ideals.

Conclusion: The study advocates for a cautious approach to cognitive enhancement, emphasizing the preservation of the individual's well-being over performance gains. In the context of ADHD treatment, it calls for an ethical examination of the long-term effects of Methylphenidate and Atomoxetine use in children and adolescents, recommending a preference for behavioral treatments when possible. Pediatric ADHD: There is a notable scarcity of data regarding the prevalence of therapeutic benefits and/or adverse effects in treatments exceeding 30 weeks. Furthermore, clinical trials concerning its safety and the lack of long-term data compromise the principle of non-maleficence, as we know that the use of Methylphenidate can lead to sleep disorders, anorexic conditions, nervous disorders, and has occasionally been associated with cardiac events. It also has effects on pregnancy that can lead to malformations in offspring. And although the unwanted effects associated with atomoxetine are generally minor, suicidal tendencies have been occasionally reported.

Keywords: Atomoxetine; Attention Deficit Hyperactivity Disorder (ADHD); Bioethics; Cognitive enhancement; Ethics in medicine; Human nature; Methylphenidate; Non-maleficence; Transhumanism.