Clarifying the ethical landscape of psychedelic-assisted psychotherapy

Informed consent for psychedelic-assisted psychotherapy (PAP) is possible and need not be especially difficult if reasonable approaches are used. A central but overlooked risk in PAP is the patient's heightened susceptibility to environmental influence during the session, termed epistemic vulnerability. This vulnerability should be disclosed as part of informed consent in all cases. The paper argues that a nondirective therapeutic approach—where patients manage their own experience—is more ethically supportable than other approaches, partly because it prioritizes autonomous transformation. Analogous concerns from regular psychotherapy are addressed through a process view of consent, which can help navigate the complexities of ongoing consent in PAP.

Study at a glance

Abstract

This paper attempts to integrate ongoing conversations about the nature and ethics of psychedelic-assisted psychotherapy (PAP) in order to clarify some outstanding ethical questions. First, I address a debate about whether informed consent is possible for “transformative” therapies like PAP, and I conclude that reasonable approaches to informed consent should not be considered especially difficult for PAP. Next, I argue that a focus on potential barriers to information about PAP has obscured a more central risk for the therapy – that posed by a PAP patient’s radical susceptibility to environmental influence, or what I call epistemic vulnerability. After expanding on this concept, I conclude that warnings about epistemic vulnerability should be a part of informed consent to PAP in all cases. Finally, I discuss more broadly the complexities of informed consent in PAP, drawing on analogous concerns for regular psychotherapy that may be addressed by a “process view” of consent. I propose that a “nondirective” approach to PAP may be more ethically supportable than other approaches, in part because of the theoretical benefit to patients from managing their own experience, prioritizing the potential for autonomous transformation.