Journal of Medical Ethics
May 27, 2020
William Smith, Dominic Sisti
142 citations
Recent early-phase trials suggest psychedelics offer novel benefits for treating mental health and substance use disorders, producing experiences unlike other treatments, such as feelings of unity, loss of self-importance, and encountering deep reality or God. Focusing on psilocybin, the authors argue these unique features pose novel risks that require an enhanced informed consent process—more comprehensive than typical for psychiatric medications. They highlight key issues for consent, suggest discussion prompts, and respond to objections, concluding with ethical considerations as psychedelics move from controlled research into mainstream clinical psychiatry.
Journal of Medical Ethics
July 12, 2021
70 citations
Early US psychedelic research (1950-1980) exploited people of colour and other vulnerable groups, including incarcerated individuals and inpatients with psychotic disorders. A review of empirical publications from that era, assessed against current ethical standards, reveals that participants were often administered drugs without proper informed consent and under conditions of undue influence. The Central Intelligence Agency covertly funded some of this work. These historical abuses demand that contemporary psychedelic researchers adopt culturally inclusive and socially responsible methods to avoid repeating past harms.
Journal of Medical Ethics
April 12, 2023
Daniel Villiger, Manuel Trachsel
40 citations
Psychedelic-assisted therapy makes patients highly suggestible and sensitive to context by increasing the influence of bottom-up input, which can revise rigid beliefs. This heightened vulnerability, where patients lose control and become dependent on the therapeutic setting, raises ethical concerns. Some therapists have exploited this vulnerability in the past. To ensure valid informed consent, patients must be well informed about these mechanisms and their implications. Additional security measures are needed to protect patients in current research and future mainstream medical settings.
Journal of Medical Ethics
November 4, 2020
Riccardo Miceli Mcmillan
12 citations
Psychedelic-assisted psychotherapy shows promise for treating psychiatric conditions, with therapeutic outcomes predicted by mystical experiences characterized by profound meaning. This suggests psychedelics may work as meaning enhancers, triggering a meaning response similar to placebo effects. The paper argues that if psychedelics operate this way, their use can be ethically justified from a hedonistic moral perspective. It addresses an anti-hedonistic objection based on Nozick's Experience Machine thought experiment, concluding that even if pleasure and pain are not the only morally relevant factors, therapeutic meaning enhancement remains justified in cases of extreme suffering, and psychedelic states may not represent a false reality, thus not problematic by Nozick's standards.
Journal of Medical Ethics
May 30, 2023
Scott Hoener, Aaron Wolfgang, David A. Nissan et al.
6 citations
Psychedelic-assisted therapies, particularly with MDMA and psilocybin, show rapid, durable, and cost-effective results for conditions like PTSD and major depression in clinical trials. Researchers are now interested in applying these treatments to active-duty US military personnel with treatment-resistant mental health issues, though psychedelics remain unapproved for general use. Unique ethical concerns arise for service members, including informed consent, confidentiality, deployability, and unanticipated psychological risks. The authors argue that MDMA-assisted therapy is a promising option that warrants accelerated investigation for military use, while cautioning that military-specific uncertainties must be carefully addressed.
Journal of Medical Ethics
March 10, 2026
Chiara Caporuscio
The transformative potential of psychedelic experiences raises ethical concerns about informed consent in psychedelic-assisted therapy, because an altered state of consciousness might shift a person's values in ways they cannot foresee. This argument, however, overemphasizes the power of the psychedelic experience itself. In most cases, the altered state is only the start; lasting change requires a sober, authentic agential process afterward. This two-step view of transformation alleviates the pressure on informed consent, suggesting that consent before the experience can still be valid.