Compassionate use of psychedelics

The paper argues that compassionate psychedelic psychotherapy using psilocybin and MDMA can be morally permissible. When given under supportive conditions with psychotherapy, these therapies show promising results, but their controversial nature requires ethical justification. The authors review safety and efficacy and claim that it can be rational for some patients to try psychedelic therapy despite uncertainty, because the expected value can outweigh that of routine care, palliative care, or no care. They respond to the objection that psychedelic psychotherapy is epistemically harmful, arguing that this objection is unsubstantiated, mainly because no experimental evidence suggests such harm occurs.

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Abstract

In the present paper, we discuss the ethics of compassionate psychedelic psychotherapy and argue that it can be morally permissible. When talking about psychedelics, we mean specifically two substances: psilocybin and MDMA. When administered under supportive conditions and in conjunction with psychotherapy, therapies assisted by these substances show promising results. However, given the publicly controversial nature of psychedelics, compassionate psychedelic psychotherapy calls for ethical justification. We thus review the safety and efficacy of psilocybin- and MDMA-assisted therapies and claim that it can be rational for some patients to try psychedelic therapy. We think it can be rational despite the uncertainty of outcomes associated with compassionate use as an unproven treatment regime, as the expected value of psychedelic psychotherapy can be assessed and can outweigh the expected value of routine care, palliative care, or no care at all. Furthermore, we respond to the objection that psychedelic psychotherapy is morally impermissible because it is epistemically harmful. We argue that given the current level of understanding of psychedelics, this objection is unsubstantiated for a number of reasons, but mainly because there is no experimental evidence to suggest that epistemic harm actually takes place.