Psychedelics, Transformative Experience, and Modality An Analysis of Valid and Substantially Informed Consent in Psychedelic-assisted Therapy

The article examines how transformative experiences, as defined by philosopher L.A. Paul, challenge informed consent for psychedelic-assisted therapy (PAT). Paul's concept describes experiences that fundamentally change a person's perspective and cannot be fully understood beforehand. The author argues PAT is a special kind of transformative experience because its effects are particularly ineffable. Two versions of informed consent are distinguished: valid consent and substantially informed consent. The author contends that whether valid consent is possible depends on whether transformative experiences are causally necessary for PAT's therapeutic effects. Regardless of that causal question, the author argues substantially informed consent for PAT is impossible because patients cannot meet the materiality conditions required for truly informed consent.

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Abstract

Paul’s concepts of “Transformative Experiences” (TE) has sparked extensive discussion on multiple epistemological and ethical issues within philosophy. In particular, Paul’s work has inspired significant work on the possibility of informed consent with regard to medical interventions that may induce said TEs. One such intervention, namely Psychedelic-assisted Therapy (PAT), has been discussed at length in the psychiatric ethics literature and has posed a unique challenge to widely accepted notions of autonomy and informed consent. In the following article, I describe in detail Paul’s concept of TEs and make clear why PAT deserves to be viewed as a special kind of TE due to its distinctive ineffability. I then distinguish between two different philosophical and legal versions of informed consent, including “valid consent” and “substantially informed consent” and show that whether one can provide “valid consent” for PAT depends on whether TEs are causally necessary for PAT’s therapeutic effects. I argue that regardless of this causal question, “substantially informed consent” with regard to PAT is not possible due to a failure to meet the conditions of materiality necessary for informed consent.