Pills which change the child

By Henning Köhler, January 2012

The Swiss National Advisory Commission on Biomedical Ethics (NEK-CNE) published an opinion at the end of last year called: “Human enhancement by means of pharmacological agents”. The scandal of the ever increasing use of drugs such as Ritalin or Concerta for children diagnosed with ADHD is commented on in detail.

The opinion deals with the general problem of “human enhancement”. That refers to “any medical and biotechnological interventions whose aim is to change human beings in terms of their skills and appearance in such a way that the change is seen as an improvement in their respective sociocultural contexts, and whose purpose is not primarily of a therapeutic or preventive nature.” “The concept of man is changing” through medicinal measures with the aim of adapting children to enhanced social expectations, the Commission warns. At the same time “medical ethos undergoes a disturbing change”. The “tolerance of otherness” is at stake. 

I can go on: “Special attention should be given to enhancement in children”, particularly the prescription of psychopharmaceuticals with the excuse of only wanting “what is best” for them, whereby “‘the best’ is often defined in terms of the child’s future life in society”.

The diagnosis of ADHD was problematical because of the “shift in standards as to which behaviours of a child or adolescent are socially compatible and ‘normal’, and which ones are considered pathological. The expectation “that children ‘fit in’ in kindergarten and at school” played a major role in this respect. As a consequence: “The pressure to conform imposed upon children by their parents and educational institutions enforces a standard of normalcy that decreases the tolerance towards childishness.”

The diagnostic all-purpose tool of ADHD and the massive use of psychopharmaceuticals, for which it appears to provide justification, a sign of decreased tolerance towards childishness! That is what I have been saying for the last twenty years. The response was to misunderstand my point, sometimes deliberately. “Köhler rejects diagnoses,” people said. How could I. The Swiss specialists in medical ethics draw to attention “from an ethical perspective” that it is difficult “to differentiate between normal and pathological behaviours in children” precisely because of the shift in standards mentioned.

The Commission’s report ends with the remarkable sentence: “The NEK-CNE advocates the adaptation of living conditions to the interests and needs of children.” There is nothing further to add.

Links: www.nek-cne.ch, www.adhs-konferenz.de

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