American informed consent law assumes that a patient's values and decision-making framework remain stable from the moment they authorize a treatment through the period when they experience its effects. Psychedelic-assisted therapy, using compounds like psilocybin and MDMA, deliberately alters patients' values, self-concept, and evaluative frameworks as a therapeutic goal, breaking that continuity. This article argues that when a treatment transforms the cognitive architecture through which risk is assessed, standard consent doctrines—materiality, causation, and capacity—fail. The author proposes a dynamic consent model with pre-session identity-impact disclosures, staged reaffirmation checkpoints, integration-phase consent validation, and longitudinal documentation reforms.
Psychedelic-assisted therapy is moving toward clinical legitimacy in the United States, with the FDA granting Breakthrough Therapy designations to psilocybin and MDMA and major research investments underway. However, the legal framework for malpractice liability in this field remains undeveloped. The article identifies three structural challenges: the standard of care is unclear because the profession lacks settled credentialing and practice standards; causation analysis is complicated when treatment intentionally alters a patient's evaluative framework; and damages calculations face a paradox when identity transformation may later be viewed as beneficial. The article argues these are permanent structural features, not transitional problems, and proposes doctrinal adaptations such as prospective consent architectures and tiered standard-of-care frameworks.