Recommendations for the ethical use of pharmacologic fatigue countermeasures in the U.S. military

Culture and public opinion strongly influence debates on ethics-and what may be ethically acceptable to one nationality may be unacceptable to others. In military operations, some cognitive performance enhancement technologies are more ethically controversial than others. Of the enhancement technologies, use of psychoactive pharmaceuticals to alter behavior in healthy humans possibly presents the most controversial ethical challenge. Discussion of the bioethics of psychoactive enhancement agents is advisable because their military use is increasing while doctrine for their use remains limited. This paper focuses on psychoactive pharmaceuticals to enhance cognitive performance of military members. The topics addressed include: the use of psychoactive pharmaceuticals within a coalition framework; if ethical circumstances do exist for their use, what are these circumstances in clear and operationally useful terms; and guidelines to aid leaders in making ethically acceptable decisions. These questions should be answered: 1) Is use truly informed and voluntary--e.g., is an individual soldier requesting the medication with full understanding of its primary effects and side effects; 2) Is the medication safe for use in this individual, and safe within the context of the operational environment?; 3) Is the use of the medication consistent with its dosage and pharmacological function--i.e., is a sleep-inducing medication being used at appropriate doses, for a specified period, to facilitate sleep; and 4) Have available non-pharmacologic alternatives been fully utilized? This paper addresses a very narrow segment of the larger bioethics discussion: the use of pharmacologic enhancing agents in military members in times of war or national emergency.