Ethical Issues Regarding Nonsubjective Psychedelics as Standard of Care.

Psychedelics partly achieve their therapeutic effects through the subjective experiences they produce and how individuals interpret those experiences. Because these subjective effects can be disturbing for people with certain mental illnesses, researchers are developing 'nonsubjective' psychedelics that cause similar biological changes without the characteristic subjective effects. The authors broadly support creating such substances for scientific and clinical reasons but argue they should be reserved only for cases where subjective effects are specifically contraindicated. Classic psychedelics that produce subjective experiences should remain the default standard of care, as withholding typically positive, meaningful, and therapeutic experiences from most patients raises ethical concerns.

Study at a glance

Abstract

Evidence suggests that psychedelics bring about their therapeutic outcomes in part through the subjective or qualitative effects they engender and how the individual interprets the resulting experiences. However, psychedelics are contraindicated for individuals who have been diagnosed with certain mental illnesses, on the grounds that these subjective effects may be disturbing or otherwise counter-therapeutic. Substantial resources are therefore currently being devoted to creating psychedelic substances that produce many of the same biological changes as psychedelics, but without their characteristic subjective effects. In this article, we consider ethical issues arising from the prospect of such potential "nonsubjective" psychedelics. We are broadly supportive of efforts to produce such substances for both scientific and clinical reasons. However, we argue that such nonsubjective psychedelics should be reserved for those special cases in which the subjective effects of psychedelics are specifically contraindicated, whereas classic psychedelics that affect subjective experience should be considered the default and standard of care. After reviewing evidence regarding the subjective effects of psychedelics, we raise a number of ethical concerns around the prospect of withholding such typically positive, meaningful, and therapeutic experiences from most patients.