Not Just “Study Drugs” For The Rich: Stimulants as Moral Tools For Creating Opportunities For...

This is a pre-publicationversion. The final version will be printed in American Journal of Bioethics.

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Not just “study drugs” for the rich: Stimulants as moral tools for creating

opportunities for socially disadvantaged students

ABSTRACT

A pervasive argument in the cognitive enhancement literature is that using

stimulants in populations of healthy but socially disadvantaged individuals

mistakenly attributes pathology to non-pathological individuals who experience

social inequalities. As the argument goes, using stimulants as cognitive-

enhancing drugs to solve the social problem of poorly educated students in

inadequate schools, misattributes the problem as an individual medical problem,

when it is really a collective socio-political problem. I challenge this argument on

the grounds that not all types of enhancement have to be explained in medical

terms, but rather a least one conception of enhancement can be explained in

social terms—opportunity maintenance. Therefore I propose that as a moral

requirement we ought to explore whether stimulants could be an adequate

means of remedying the social inequalities that are born from inadequate schools

based on the potential opportunities that are to be had from such use of

stimulants.


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A pervasive argument in the cognitive enhancement literature is that using

stimulants in populations of healthy but socially disadvantaged individuals

mistakenly attributes pathology to non-pathological individuals who experience

social inequalities.1 As the argument goes, using stimulants as cognitive

enhancing drugs2 to solve the social problem of poorly educated students in

inadequate schools, misattributes the problem as an individual medical problem,

when it is really a collective socio-political problem. The argument concludes that

medical interventions ought to be reserved for the treatment of deficiencies in

bodily, mental, or emotional functioning and not for the enhancement of normal

bodily functioning. This argument however, places more emphasis on a narrow

conception of proper uses of stimulants rather than ways that stimulants can help

us meet moral duties to the least well off individuals in our society. In this article I

examine this narrow conception of stimulants within the context of my proposal—

as a moral requirement we ought to explore whether stimulants could be an

adequate means of remedying the social inequalities that are born from

inadequate schools based on the potential opportunities that are to be had from

such use of stimulants.

I do not challenge the argument that using stimulants medicalizes a social

problem insofar as it identifies the problem of unlearned students in inadequate

schools as a social problem and not as a medical problem. However, I do

1 Alan Schwartz presents this argument in his 2013 article “The selling of attention deficit disorder” in the New York Times. I discuss this article later. 2 In this article I refrain from using the term “cognitive enhancing drugs” and opt to use the term “stimulants” because not all drugs that can benefit disadvantaged children will enhance their cognition. Some uses of drugs, or stimulants that can benefit disadvantaged children may be an increase of motivation.


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challenge the assumption that once the problem is identified, that stimulants, as

typical medical interventions, cannot be a proper solution to the problem. I

challenge this assumption on the grounds that not all types of enhancement have

to be explained in medical terms, but rather at least one conception of

enhancement can be explained in social terms.

To make my proposal clear, first I discuss common views of cognitive

enhancing drugs. Then I discuss why the treatment/enhancement distinction, a

conception of distributive justice is not an appropriate view of cognitive

enhancing drugs when they are used as potential tools to help correct social

deficits and facilitate wellbeing. In this article I propose that we consider

stimulants as a possible solution to social deficits when social institutions fail to

initiate other solutions. Theoretically, stimulants may not be the optimal solution

to the problem; the problem may be better met with a wide variety of policy

changes. However, stimulants may be a better practical and just solution in our

current unjust situation.

Since my proposed use of stimulants is not treatment, nor enhancement, I

propose a new term—opportunity maintenance. I argue that if we view stimulants

as opportunity maintenance, rather than treatment or enhancement, we are free

to from the constraints that the treatment/enhancement distinction places on

uses of stimulants. Next, I discuss objections to using stimulants as social tools.

Lastly, I discuss bigger questions that using stimulants as social tools pose but

do not have the space to address.


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The broad spectrum of stimulant use

Within the past couple of decades or so bioethicists, physicians, and

popular scholars have debated the ethical use of stimulants, such as Adderall,

Ritalin, Focalin, Vyvanse, and Concerta (Schwartz 2012; Schwartz 2012b).

Although they are sometimes used to treat disorders, such as narcolepsy and

depression, they are typically used to treat Attention Deficit Disorder (ADD) and

Attention Deficit Hyperactivity Disorder (ADHD). For example, Adderall is often

prescribed to individuals with ADD or ADHD (Adderall U.S. drug label) to give

them greater control over their behavior and cognitive functions, including

improved motivation and alertness, improved abilities to retain information, and

improved ability to sift through large amounts of information and determine what

is irrelevant (Sandberg, 2011). It has been questioned whether Adderall can offer

these same benefits to individuals without ADD or ADHD (Smith et al. 2013). The

belief that Adderall can augment capabilities has led to individuals without ADD

or ADHD to be frequent users of the drug. Typically, the debate over stimulants

concerns their use by pathological and non-pathological individuals. Since

stimulant use by individuals with cognitive, behavioral, or emotional disorders is

less debatable and somewhat less controversial, in this article I focus on a more

contentious use of stimulants—use by nonpathological individuals.

Individuals without cognitive, behavioral, or emotional disorders,

individuals who are otherwise healthy, have been known to take stimulants. It

has been reported that some Silicon Valley executives (Arrington 2008) and

military pilots (Talbot 2009) have been known to take the drug Provigil for


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increased alertness, a drug typically used to treat narcolepsy; however, a large

portion of the literature concerning the use of stimulants by individuals without

cognitive, behavioral, or emotional disorders are school age and college age

students. Alan Schwarz has written extensively on the use of stimulants by these

groups in the New York Times, therefore, I will rely on his depiction of the more

controversial uses of stimulants.

In a 2012 New York Times article, Schwarz gives an account of a non-

traditional approach to education reform by Dr. Michael Anderson, a physician in

the state of Georgia. Anderson intentionally, falsely diagnoses his school-age

patients with ADHD when the individual is performing poorly in school and is a

member of a low-income family. These false diagnoses allow him to prescribe

stimulants to his patients to help modify their behavior and/or cognition and

thereby facilitate their academic success in financially struggling schools. In this

instance, Adderall can be thought of as treating the adverse outcomes of social

barriers that impair his patients’ academic success.

In the following year, Schwarz (2013) wrote about Dr. Joseph Biederman,

a child psychiatrist and prominent advocate for stimulants. His studies, which are

financed by drug companies, have been used by some of those very same drug

companies to advocate for a more widespread use of stimulants, including

Adderall. Schwarz recalls a statement that Biederman made in 2006: “If a child is

brilliant but is doing just O.K. in school, that child may need treatment, which

would result in their performing brilliantly at school.” These thoughts on Adderall

sum up his beliefs (and the beliefs of many others) that stimulants can be used to


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make good students, better students. Although some believe that Biederman’s

intentions are to truly help children with ADHD, they worry that drug companies

will use Biederman’s studies to create more intense and targeted advertisements

for stimulants. The other concern is that more intense and targeted

advertisements for stimulants will result in an increase in using stimulants to treat

behavior that is not symptomatic of ADHD without adequate research to support

this as an appropriate use of stimulants (Schwarz 2013).

In the same 2013 article, Schwarz writes about Dr. Keith Conners, a

psychologist and professor who is one of those concerned about the current and

potential results of Biederman’s actions. Conners laments the rising diagnoses of

ADHD in school age students and the corresponding rise in prescriptions of

stimulants. Conners is representative of a growing concern that physicians are

falsely diagnosing children and adolescents with ADHD for many reasons,

including pharmaceutical companies increasingly marketing stimulants to families

and physicians, and on some occasion, marketing them directly to children.

Schwarz (2012) and others (Brandt et al. 2014; Moore et al. 2014; Smith

et al. 2013) have also written about another aspect of the stimulant debate—the

use of stimulants as “study drugs.” The most frequent users of “study drugs” are

students in affluent families who attend prestigious and academically rigorous

schools. There is a subset of students ranging from high school students to

college students who have not been diagnosed with ADHD, but who obtain

stimulants (most commonly Adderall) from friends who have prescriptions or by

persuading physicians to give them prescriptions for stimulants by telling false


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tales of anxiety and loss of concentration. Students then take the pills orally or

snort them through the nose believing them to be study aids. Some students

without ADHD claim that stimulants give them more motivation, more focus, and

increased alertness (Vrecko 2013), which is then used to perform well on

assignments in school,3 and balance academic demands, with extracurricular

activities, and domestic duties. Opponents of such use of stimulants cite the risks

of altering the developing minds of children and other potential risks to health

such as drug addiction, insomnia, and cardiovascular irregularities (Sussman et

al. 2006).

Another side of the stimulant debate is characterized by the belief that the

bigger problem is the pressure placed on students to succeed. This pressure

drives them to use stimulants to meet the expectations of their parents, teachers,

and coaches. In instances of this sort, Margaret Talbot of the New Yorker calls

stimulants “drugs that high-functioning, overcommitted people take to become

higher-functioning and more overcommitted” (Talbot 2009). Ultimately, those who

support this side of the debate argue that the problem is how we measure

success and that we need to change academic standards to reflect students’

wellbeing (Schwarz 2012). The concern is that such use of stimulants treats

students who cannot meet normative expectations, while the real problem of

enormous expectations is left untreated.

3 Some students without ADD or ADHD have also been known to use stimulants to perform well on the SATs making some question the fairness of college admissions.


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I have just canvassed the major topics in the cognitive enhancement

debate. These topics in the debate focus on maximizing resources or abilities

that individuals already possess, use, and benefit from in a desirable and

adequate environment, but seek greater benefit; however, the topic that I am

concerned with in this article is less discussed within the cognitive enhancement

debate. Here, I focus on maximizing abilities that individuals may or may not

possess and use, but cannot benefit from because of their undesirable and

inadequate environment.

Many schools in America do not have the resources to properly educate

children.4 For whatever reason, be it poor educational policies or a failure of

leadership, they lack the staffing, financial resources, and equipment necessary

to give students a proper education. Schools with these problems are typically in

lower socioeconomic communities, and commonly populated by marginalized

populations of a lower socioeconomic status. One way we know that these

schools are inadequate is by comparing them to schools that, unlike them,

produce well-educated students who successfully complete exams and

standardized testing,5 complete high school, and go on to pursue higher degrees

of education. Presumably, these schools (and perhaps the families that benefit

from them) have adequate resources to accomplish their academic goals. The

problem is that because some schools (and perhaps families) do not have the

4 I acknowledge that a children’s home life can also greatly influence their academic success. 5 Though test scores are not always a proper way to measure academic success, it is at least one measurement of success that we have that can reveal disparities in education.


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relevant resources, they produce improperly educated students, which puts these

students at a disadvantage when competing for social resources with students

who attend adequate schools.6

In the commonly cited A Theory of Justice, John Rawls states that the

circumstances of our birth ought not to determine the opportunities in life that are

available to us. In the case of disadvantaged children we are allowing the

circumstances of their birth to dictate the futures available to them when we do

not take on the moral obligation to remedy their academic environments. We

could say that their talent and effort ought to help them relieve themselves of

their circumstances, but their surroundings prohibit their talent and efforts from

being used to create opportunities for themselves (similar to the fallacy of the

commonplace “pull yourself up by your own bootstraps,” which is impossible to

do if you do not have any bootstraps).

What morally matters when we are disadvantaged through luck, or

through no choice of our own, is how disadvantages affect access to resources

and how we address these disadvantages. Stimulants could be one way to

address these disadvantages by giving students the tools to function within their

disadvantaged setting. Some may be unwilling to use stimulants for these

purposes for reasons that I have already addressed; however, I argue that we

have to be willing to consider stimulants as an option because we are not

6 This assumes, of course, that students in adequate schools are properly educated and can reap the benefits of their proper education. This is not to disregard those students in adequate schools who do not make good grades and those students in inadequate schools who do make good grades. The idea is that the former students start off with the resources in their favor, while the latter students do not.


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correcting students’ disadvantages in other, more traditional ways. Addressing

the problem of poor schools with increased funding, better training and pay for

teachers, and updated teaching resources are all ways that could improve poor,

underperforming schools, and make stimulants not needed (or less needed) but

are all avenues that we as a society have decided that we are unwilling to

pursue. So while we are ignoring the problem, some students are being deprived

of the social and health benefits of a good education, while other students whose

schools are not plagued by these issues are not.

I have presented a sketch of multiple kinds of uses of stimulants and the

purposes of those uses that are a part of the cognitive enhancement debate. I

have also presented the use of stimulants that I am more concerned with—the

use of stimulants by disadvantaged students. The different sides of the debate,

including the side that I offer, diverge on many issues related to the use of

stimulants, showing that the use of stimulants is complicated and at times

controversial. One source of their differing conclusions about cognitive enhancing

drugs maps onto the treatment/enhancement distinction.

The problem with the treatment/enhancement distinction

The treatment/enhancement distinction is a theory of just health care in

which there is thought to be a distinct line between treatment and enhancement.

Treatment is characterized as medical interventions necessary to feign off or

cure diseases. By contrast, enhancement is characterized as medically


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unnecessary interventions meant to improve upon normal functioning (Buchanan

2011; Daniels 2000, 2001).

The treatment/enhancement distinction relies on contentious explanations

of key concepts such as normal, health, and disease.7 It has even been

questioned in the literature if we can adequately discuss enhancement because

of these contentious terms (Wolpe 2002). Barring a long and in depth discussion

of each key concept, for my purposes here, it will suffice to say that the

therapy/enhancement distinction is used to separate justifiable uses of medicine

from unjustifiable uses of medicine. Per the treatment/enhancement distinction,

this is the normative conclusions that follows: it is justifiable to use stimulants for

therapeutic purposes, namely to treat mental or bodily deficiencies; any other use

of stimulants is enhancement, and therefore, unjustifiable (or at least not a

priority). For example, the idea that we ought not to diagnose students with

ADHD who have not met the proper diagnostic standards for the sake of their

academic success, relies on the idea that medical interventions are only

appropriate to treat biological deficiencies. When there are no biological

deficiencies, as for these students, enhancement practices are inappropriate.

A prominent explanation of enhancement includes enhancement as

interventions that increase human functioning beyond good health.8 Here is

7 I have discussed this elsewhere in “How empirical and social explanations of normal influence decisions to treat the neurodiverse.” 2013 In Ethics and Neurodiversity. (ed) C. Herrera and Alexandra Perry. Cambridge, UK: Cambridge Scholars Press. 8 There are a few explanations of enhancement in the current literature. Savulescu, J., A. Sandberg, and G. Kahane (2011) give a good overview of these explanations.


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where the limitations of the treatment/enhancement distinction fail positions like

mine. Because the treatment/enhancement distinction is thought of in medical

terms and enhancement is thought of as the negation of therapy, it imposes

gratuitous constraints on enhancement practices, namely that meeting social

needs (when biological deficiencies do not exist) is not a part of the

enhancement agenda.

Norman Daniels (2000) gives an objection to the treatment/enhancement

distinction that captures the limitations it poses on the use of medical resources.

Daniels’ objection is that the treatment/enhancement distinction does not have

the moral strength that we impose on it.9 He argues that some times the reasons

that we are obligated to assist people with diseases and disabilities may also

obligate us to assist people with nondisease conditions. For the sake of justice,

disadvantages obligate us to assist individuals with nondiseases; and individuals

can be disadvantaged by other states of being besides poor health. But if we rely

on the treatment/enhancement distinction to guide our moral obligations only

those disadvantages created by poor health ought to be treated with medical

resources. Daniels’ objection to the treatment/enhancement distinction shows

that the treatment/enhancement distinction does not always perfectly map onto

or obligations.

Not treatment, not enhancement, but opportunity maintenance

9 Daniels also questions whether we can distinctly draw a persuasive line between therapeutic services to ameliorate disease and disability and enhancing normal traits.


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I have argued that “treatment” is not an appropriate explanation of my

proposed use of stimulants—as a possible supplement for social

disadvantages— as the students that I am concerned with are not pathological. I

have also argued that “enhancement” is neither an appropriate explanation

because enhancement augments normal states and I’m arguing that

disadvantaged children are not normal in socially relevant ways. The dilemma

that my argument poses for the treatment/enhancement distinction is that I want

to explore stimulants’ ability to remedy social deficits, not biological deficits.

For my proposal we have to discard the treatment/enhancement

distinction because it ignores the problem of abnormal social health, which

includes socially disadvantaged children—a group who has a great stake in the

cognitive enhancement debate. Neither treatment nor enhancement can properly

address the ways in which they are disadvantaged and the ways in which

medical resources can potentially alleviate their disadvantages. Therefore, I

propose an alternative term—opportunity maintenance—a term that focuses on

the ways that opportunities can impact our ability to live the kind of lives that we

want to live.

Opportunities are important for many reasons. In “Bottlenecks: A new

theory of equal opportunity,” Joseph Fishkin (2014) lists why opportunities are

important and worth securing:

Opportunities open up the freedom to do and become the things we otherwise could not. […] Equal opportunity expands the range of paths open to us—educationally, professionally, and in other spheres—thereby giving us the freedom to pursue lives whose contours are to a greater degree chosen by us, rather than dictated by limited opportunities. (p. 2)


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The goal of opportunity maintenance is to make undesirable environments have

less control over the futures open to disadvantaged children and to explore

ways—medical and/or social—to create new opportunities for healthy lives.

Access to education (presumably good education) is a social determinant

of health (World Health Organization 2011). Good health and education are

therefore intimately intertwined, making opportunities the product of this intimate

relationship. Education promotes good health and together they help us to

secure those opportunities that help us live the kinds of lives that we desire. As

such we have to explore all possibilities for securing education and opportunities

for the sake of health. But when access to good education is not an option (likely

because we are not taking the appropriate actions to make it an option) we have

to find other ways for students to function within their current academic

environment and reap all of the possible benefits their situations have to offer.

Relinquishing the treatment/enhancement distinction and using the idea of

opportunity maintenance allows us to further explore these possibilities by

expanding the uses of our current resources to create more opportunities.

The problems that socially disadvantaged students pose for the

treatment/enhancement distinction are avoided if we rely on opportunity

maintenance. Opportunity maintenance uses medical resources, but not for

biological deficiencies. Without assigning pathologies to children, opportunity

maintenance uses medical resources to help secure opportunities that can lead

to better health. Just as biological deficiencies can limit the kinds of people that

we can become, social deficiencies can also be limiting. Opportunity


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maintenance recognizes the potentially limiting nature of social deficiencies and

medicine’s resources potential to help minimize the effects of social deficiencies.

Opportunity maintenance also acknowledges that abnormalities other than

biological abnormalities can impact opportunities, justifying opportunity

maintenance practices for individuals who are biologically normal, but who are

not socially normal. Enhancement practices, on the other hand, are for

individuals who are already functioning normally, without regard to social

normalcy. And if biological deficits obligate us to take moral action, then social

deficits ought to also obligate us to take moral action.

Opportunity maintenance allows us to explore whether students in

inadequate schools who do not have the academic and/or familial resources to

facilitate academic success could benefit from the full utility of stimulants without

having to view students as pathological. If we were to think of stimulants from the

viewpoint of opportunity maintenance, rather than treatment or enhancement, in

social terms rather than medical terms, the treatment/enhancement distinction

would matter less and the moral obligations that medical resources can help us

meet would matter more. Opportunity maintenance brings disadvantages, social

deficits, and opportunities to the forefront; it liberates us from the constraints that

the treatment/enhancement distinction places on medical practices and we are

free to do the empirical work necessary to determine if medical resources can

help compensate for inadequate social conditions that have a disparately

inhibiting effect on some groups of students’ health.


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Opportunity maintenance as wellbeing

Opportunity maintenance has the same ends as treatment and

enhancement—health. At least one way to explain health is in terms of wellbeing.

Opportunity maintenance allows us to use the resources that are available to us

to discover new ways for securing wellbeing, namely ways that secure

opportunities. Our available resources then become tools to shape our lives in

the ways that we want. Next, I look at possible conceptions of wellbeing in which

there is a relationship between opportunities, resources, and wellbeing.

Prioritarianism gives an account of the relationship between wellbeing and

resources. Prioritarianism, as a matter of justice, distributes resources by

prioritizing the wellbeing of individuals that are the least well off over individuals

that are better off. Wellbeing can be defined in terms of general wellbeing,

economic wellbeing and/or access to resources (Arneson 2010).

Prioritarianism has been criticized for being a leveling down principle that

sets the unattainable goal of strict equality. Putting an analysis of the criticisms

aside, it will suffice for my purposes here to say that in response to criticisms,

some prioritarians have adopted an equality of opportunity account of justice. Its

goal is not equality of outcomes but rather assuring that individuals have an

equal opportunity to obtain desirable resources or that we have fair shares of

total resources (Anderson, 1999).

Also focusing on resources and wellbeing, in numerous articles Julian

Savulescu writes that enhancement10 practices can be tools to acquire what we

10 What Savulescu views as enhancement, I view as opportunity maintenance.


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value in life. For example, Savulescu argues that we have a moral duty to use

the tools that biotechnology has afforded us to increase children’s wellbeing

(Savulescu 2005, 2006). Savulescu gives the example of the moral duty that

parents would have to prevent their child from contracting HIV if a simple

intervention were available, making failure to do so a moral wrong. If we have the

tools to treat medical conditions and we stand by and do nothing, we are acting

immorally. Similarly, if we have the tools to treat “social disabilities” and we do

not, we are acting immorally. The similarity in duty is derived from Savulescu’s

views on disease and treatment:

I don’t think there’s any moral difference between treatment of disease and enhancement. What ultimately matters to human beings is wellbeing…If that’s what really matters, then we have good reasons to treat disease. In so far as other things, like IQ or impulse control, affect our wellbeing, we have exactly the same reason to change them. (Maley 2008) Although we may have a moral duty to treat disease for the sake of health, health

is not an intrinsic good; health is an instrumental good that allows us to live a life

of wellbeing. But if wellbeing were an intrinsic good, then we would have a moral

duty to enhance our lives for the sake of wellbeing (Savulescu 2005).

Similar to prioritarianism and Savulescu’s idea that enhancement

practices are life’s tools, the goal of opportunity maintenance is that people have

equal opportunity to obtain resources so that they have an equal chance at

obtaining wellbeing. To obtain wellbeing we have to continuously make use of

the available tools that biotechnology affords us. Human ingenuity and curiosity

has allowed us to shape our environment to make it more conducive to our

wellbeing. We have transformed our small huts to lavish mansions and we have


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changed simple animal skins to designer clothing. We have always used tools to

shape our lives. Using biotechnology to create opportunities for people whose

environment has not naturally given them those opportunities is just another form

of human ingenuity to create wellbeing.

Wellbeing is a normative concept, and proper education is not the only

relevant factor when developing wellbeing. However, we can argue that schools

without the ability to properly teach their students are doing a great disservice to

their students and at the least are certainly not contributing to any reasonable

idea of their wellbeing. Schools with these problems are typically in lower

socioeconomic communities, and commonly populated by students in

marginalized populations. These students are already disadvantaged in other

ways that can jeopardize their wellbeing. Exploring all possible options for

alleviating the sources of their disadvantages, and certainly exploring ways not to

surplus their disadvantages is a moral obligation based on what is at stake to be

lost—a healthy life.

Stimulants are not magic pills, however, and they alone will not increase

wellbeing. Stimulants will not update outdated textbooks, stimulants will not

decrease class sizes, nor will stimulants teach teachers new and innovative

teaching practices when old ways have failed their students. Stimulants may

contribute best to wellbeing by being just one part of social reform, with the other

parts of social reform being reformation of these negative aspects of our

educational system. However, when we aren’t taking the necessary action to

remedy these negative aspects of our educational system it is our moral


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obligation to determine other routes of wellbeing. Stimulants are a route worth

exploring. We have to determine if stimulants can help students maximize the

minimal resources that they are given by improving their ability to function in their

undesirable environments. In this instance, stimulants would become tools of

morality, giving us the potential to remedy a social wrong.

Objections

In this article the main objection that I respond to is that it is improper to

use stimulants to help the disadvantaged if they have not been diagnosed with a

medical disorder. I have argued that the disadvantages that some students

experience can be detrimental to their health by limiting the opportunities

available to them, justifying at least further exploration of the social uses of

stimulants. I will now respond to other possible major objections to my argument.

It is likely that there are other objections, but I do not have the space to address

them all so I will only address the more prominent objections.

The first objection I will respond to is modeled after an example given by

Joseph Fishkin in “Bottlenecks: A new theory of equal opportunity.” Fishkin

(2014) gives the example of appearance discrimination in which opportunities are

withheld from individuals who do not meet certain standards for proper

appearances, e.g. misshapen noses or crooked teeth. In response to

appearance discrimination some individuals may prefer antidiscrimination laws,

but others may prefer the chance to change their appearance, e.g. orthodontia

and rhinoplasty, to meet the standards by which they are judged. One response

that Fishkin offers is to make health insurance cover medical treatments to


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resolve undesired appearances. Fishkin looks at situations like these in terms of

opportunity pluralism. By offering a chance to fix appearances so that individuals

are not subject to appearance discrimination, we are changing the diversity of

appearances found in our societies in a way that reduces opportunity pluralism.

We are also making strong normative claims about what is beautiful and ugly.

Most societies are not made up of people who all agree on what the standards

for beautiful and ugly are, or what are normal and abnormal appearances.

Fishkin’s point is that in our attempts to help people overcome disadvantages we

could be creating more hurdles that individuals have to overcome to secure

opportunities.

Fishkin’s example of undesired appearances and their relation to

opportunities parallels a concern that my proposal may inspire: When we use

drugs to try to change the ways that young students are disadvantaged by

education systems we are removing diversity from society by making strong

claims about what is normal and making students fit this idea of normalcy. To

respond to this concern, I follow Fishkin’s approach to appearance

discrimination. His response to appearance discrimination is to that we ought to

help the people whose extreme disfiguration puts them severely outside the

standards of normalcy, while attempting to avoid practices that suggest that

everyone must fit specific norms of appearances.

When applied to my proposal, Fishkin’s response would look something

like this: Help the students whose extreme disadvantages puts them severely

outside of the normal range of the opportunities we can expect individuals to


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have, while attempting to avoid prescribing specific ways of achieving wellbeing.

Using the idea of opportunity maintenance to explore new approaches to

disadvantages does not prescribe one way to be normal, but rather

acknowledges that our education system is unlikely to undergo drastic changes

any time soon. Therefore, there are certain confines in which students have to

work within to receive a good education. Helping students work within these

confines gives them the opportunity to be more autonomous and define wellbeing

for themselves as education tends to give us more control over our lives. But

they cannot have this control over their lives if they first do not have the proper

tools (i.e. education). Overall, education provides the opportunity to define

normalcy for our self.

Another possible concern that my proposal my raise surrounds the

question of privilege: Are we changing who is privileged? Are the once under-

privileged group now the privileged group, making the once privileged group now

the newly under-privileged group? I find this objection to be easily dismissed on

the groups that this is a classist argument concerned with maintaining current

power structures. At the heart of this objection is a desire to keep privileged

groups comfortable in their privileged positions and to recognize their privileges

by having an under privilege class to compare themselves to.

My proposal does not aim to take away stimulants from the privileged

class (currently the most frequent users of stimulants). Privileged groups will

likely continue to use stimulants and because many individuals in these groups

have the resources and environments to make stimulants more effective, they


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will likely continue to hold their position as the privileged class. My proposal aims

to explore more ways in which we can give more people the opportunity to be

relieved of the disadvantages that their environments impose on their futures. My

proposal may create some resentment from the always-privileged group, but we

have to seriously question the validity of that resentment when privileged groups

have other resources that do not impose disadvantages on their lives in the same

ways that poor education imposes disadvantages on some individuals.

Further questions

Exploring the use of stimulants to aid social deficits raises more questions

than those I have addressed in this article. In particular, my proposal raises

questions concerning disparities in wealth and health, how these disparities

impact opportunities, and the best ways to address these disparities.

Disadvantages that contribute to deficiencies in opportunities are rarely created

by one system or institution, but tend to be created by an interaction of multiple

systems and institutions. As such, solutions that target one aspect of the chain of

health may not be as desirable as comprehensive solutions that attack the

problem in its entirety. What this solution would look like, who would be the

agents of change, and who would enforce this solution and how are all questions

that we have to ask if we favor comprehensive solutions to disparities in wealth

and health, thus disparities in opportunities.

My proposal also raises questions about what is considered normal and

what threats to our normalcy ought to matter. More importantly, once we have


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established what is normal and what is outside of the range of normalcy, we then

have to determine what we are willing to do to as a society to put people within

normal ranges. Using stimulants to help free individuals of binding social

abnormalities raises the question of whether we can change what is considered

normal. Can stimulants make what was once normal, abnormal, changing the

threshold for what is considered normal? And if so, will we be forced to find new

ways to help the newly abnormal? These are all questions that we have to

consider when we search for news ways to address social abnormalities.

Conclusion

In this article I have responded to the argument that students without

biological deficits or abnormalities ought not to use stimulants because they are

normal. My response is that some students in disadvantaged environments,

namely poor, inadequate schools have morally relevant social disadvantages that

warrant an exploration of stimulants’ ability to remedy their situation. I have

argued that neither treatment nor enhancement is a proper explanation of this

proposed use of stimulants and opportunity maintenance is a better explanation

of my proposal. Opportunity maintenance focuses on the relationship between

good education and opportunities, and health in terms of wellbeing.

Changing the way that we talk about stimulants is one step in considering

the full uses of stimulants for disadvantaged students, while keeping in mind

what is at stake for this population—wellbeing. Opportunity maintenance avoids

assigning pathologies to socially deprived individuals who are not biologically


24

pathological. This view also avoids assuming that the problem is biological,

rather it is compatible with presuming that the problem is social, and concluding

that stimulants can effect a social solution.

For some, nonmedical uses of stimulants are morally impermissible

because of assumptions about the kind of practices used to enhance children

and assumptions about the results of these practices. We are morally concerned

about the kinds of people children who use stimulants will turn into when they

use stimulants as “study drugs.” In contrast, we don’t seem to apply these same

moral concerns to the kinds of people that disadvantaged children will turn into if

we do not explore broad uses for stimulants. And until we change how we view

nonmedical uses of stimulants, our tools to fight social justices will be limited by

our own assumptions. In our discussions of stimulants, we have to be less

concerned with abuses of stimulants and more concerned with stimulants

abilities to minimize the effects of social injustices and the ways in which

injustices limit the kinds of persons we can become.


25

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Not Just “Study Drugs” For The Rich: Stimulants as Moral Tools For Creating Opportunities For...

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