Clarifying the ethical landscape of psychedelic-assisted psychotherapy

Summary

The paper discusses the ethics of psychedelic-assisted psychotherapy (PAP) and argues that informed consent is feasible for transformative therapies like PAP. It highlights a key risk, termed epistemic vulnerability, where patients are highly susceptible to environmental influences. The author suggests that warnings about this vulnerability should be included in the informed consent process. Additionally, a nondirective approach to PAP is proposed as more ethically sound, allowing patients to manage their own experiences and fostering autonomous transformation.

Study at a glance

Abstract

This paper attempts to integrate ongoing conversations about the nature and ethics of psychedelic-assisted psychotherapy (PAP) in order to clarify some outstanding ethical questions. First, I address a debate about whether informed consent is possible for “transformative” therapies like PAP, and I conclude that reasonable approaches to informed consent should not be considered especially difficult for PAP. Next, I argue that a focus on potential barriers to information about PAP has obscured a more central risk for the therapy – that posed by a PAP patient’s radical susceptibility to environmental influence, or what I call epistemic vulnerability. After expanding on this concept, I conclude that warnings about epistemic vulnerability should be a part of informed consent to PAP in all cases. Finally, I discuss more broadly the complexities of informed consent in PAP, drawing on analogous concerns for regular psychotherapy that may be addressed by a “process view” of consent. I propose that a “nondirective” approach to PAP may be more ethically supportable than other approaches, in part because of the theoretical benefit to patients from managing their own experience, prioritizing the potential for autonomous transformation.

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