Within the patient-physician relationship, the request for neuroenhancement becomes a chief concern, and the physician has a duty to take a history and perform a physical exam to determine whether the patient’s current level of function represents significant change.
Some question whether plastic surgeons bear responsibility for promoting suspect norms of beauty, given that certain types of cosmetic enhancements reinforce common conceptions of normality that are harmful to society.
The guidelines for patients’ eligibility for bariatric surgery have not changed since 1991, although recent data suggest there may be indications for broadening application of the surgery.
Advance directives, substituted judgment, and the best-interest standard all have limitations that constrain their usefulness in making medical decisions for patients who cannot choose for themselves.
Because regulatory approval of cognitive enhancement drugs is likely, physicians may want to consider whether they would condone the practice for restoration of function only or for enhancement purposes as well.
Advance directives do not always resolve questions about the best care for patients who no longer have decision-making capacity; physicians and patient surrogates can take alternative approaches to arrive at the best care decision.