At least since the publication of the President’s Commission on Bioethics’ report in 2003, “Beyond Therapy: Biotechnology and the Pursuit of Happiness”, there has been an ongoing debate about the ethics of using drugs to modify emotional memories. Rather than focus on the Hollywood-type total memory erasure featured in the Eternal Sunshine of the Spotless Mind, many ground the debate in the molecular neuroscience of memory reconsolidation (for an excellent overview, see here). In the process of memory reconsolidation, a newly reactivated memory triggers certain molecular events that are necessary for it to return to long-term storage; during these events, the memory is temporarily susceptible to disruption by certain drugs like the beta-blocker, propranolol. Further work with people with Post-Traumatic Stress Disorder (PTSD) suggests that using propranolol in this way doesn’t erase a memory, but may blunt the reconsolidation of the memory’s negative emotional content. In the ethical discussion, most agree that 1) it should usually be acceptable to use drugs to modify memories in cases of PTSD where the emotional content of memories becomes debilitating, but 2) the use of memory modifying drugs is usually morally problematic when the target is everyday unpleasant memories, disappointments, and rejections.
Existing debate has focused on intentional memory modification. But what about those who modify memories in these problematic ways unintentionally? Conspicuously under-discussed is the ethics of continuing to use drugs with potential memory-modifying properties for the treatment of other medical conditions. Propranolol, for example, is on the Department of Veterans Affairs (VA) National Formulary for treatment of patients with severe liver disease (liver cirrhosis). This (not-small) population of people, in theory, risks unintentionally (and pre-emptively) modifying memories every day!
One might anticipate that those objecting to every-day memory modification should be aghast to learn of such prolific use. But could the fact that the memory modification is unintentional, a side-effect of treating a medically important illness, make an otherwise objectionable memory modification permissible? Some might argue precisely this through an appeal to the doctrine of double effect, which can be simplified to the idea that “sometimes it is permissible to bring about as a merely foreseen side effect a harmful event that it would be impermissible to bring about intentionally.” The doctrine of double effect might be appealed to, for example, to argue that it is permissible to use large amounts of pain medication to relieve the pain of a terminally ill patient with the foreseen but unintended side-effect of shortening the patient’s life.
Even if one accepts the doctrine of double-effect as valid, however, the appeal to it in this case is weak because the unintended, harmful side-effect may not be necessary in order to achieve the good end: there are other beta-blockers, like timolol, that would treat the liver disease but do not cross the blood brain barrier as effectively as propranolol (minimizing risk of the memory effect). Unintentional memory modification, therefore, would not be the necessary side-effect of treating liver dysfunction.
Of course the elephant in the room (elephant in the blog?) is that the memory modification we are discussing is not merely unintentional, but also most likely unwitting from the perspective of the liver patients. Should doctors inform these patients of the possible risk of memory modification? Should doctors give the option of a different beta-blocker? Since these other beta-blockers are more expensive than propranolol, should the VA cover the cost of the more expensive drug?
Have thoughts about unintentional memory-modification? Continue the discussion below!