Added stakeholders, added value(s) to the cognitive enhancement debate: are academic discourse and professional policies sidestepping values of stakeholders?

Background: The debate on the nonmedical use of prescription medication for the enhancement of cognitive function (e.g., attention, memory, concentration, vigilance), accompanied by heated public discussions in the media, has spurred the interest of scholars and the public. Methods: In this article, we present qualitative data from a focus-group study with university students, parents, and health care providers. We identified ethical, social, and legal issues related to the nonmedical use of methylphenidate for cognitive enhancement (CE) and closely examined the positions taken on these issues and their supporting arguments. Results: The ethical, social, and legal issues we identified (e.g., authenticity, cheating) were similar to those identified in a previous discourse analysis of the bioethics literature but indicate the existence of moderately and highly contentious issues as well as factors and values underlying these issues. The model we generated from these findings shows how interplay between values (e.g., effort and honesty) and external factors (e.g., regulation and access) may lie at the root of contentious ethical issues in CE. Conclusions: Our discussion points to an unsuspected complexity in understanding the values of stakeholders and an unclear relationship to academic discourse and professional societies. We propose deliberative or other democratic processes as a way to recognize and incorporate the complexity of the CE debate.