Consent Without Continuity: Psychedelic-Assisted Therapy and the Structural Failure of Informed Consent Doctrine
Michael Palmieri
Study at a glance
AI-extracted from the abstract| Characteristics | Theoretical or philosophical paper Longitudinal |
|---|---|
| Interventions | Psychedelic-assisted therapy Psilocybin MDMA |
| Topics | Psychedelic-assisted therapy |
| Key points | Proposes that psychedelic-assisted therapy disrupts the stable-agent assumption underlying informed consent doctrine, requiring a dynamic consent model to address the collapse of continuity between the consenting self and the experiencing self. |
Abstract
American informed consent doctrine rests on an unexamined premise: the stable-agent assumption—that the patient who authorizes a medical intervention and the patient who experiences its consequences share a continuous evaluative framework. Materiality doctrine presupposes this continuity; causation doctrine embeds it; capacity doctrine assumes it. For most of modern medical practice, the assumption held because treatments did not alter the cognitive architecture through which patients assess risk. Psychedelic-assisted therapy disrupts that continuity. Compounds such as psilocybin and MDMA, now administered under state regulatory frameworks in Oregon and Colorado, produce documented and sometimes durable changes in patients’ values, self-concept, and evaluative frameworks—not as incidental side effects but as intended therapeutic outcomes. When a treatment transforms the cognitive architecture through which risk is assessed, the temporal bridge between the consenting self and the experiencing self collapses. This Article proposes a dynamic consent model comprising four components: pre-session identity-impact disclosures with a meta-disclosure acknowledging the structural limits of pre-treatment consent; staged reaffirmation checkpoints across post-treatment intervals; integration-phase consent validation; and longitudinal documentation reforms. Without reconstruction, materiality lacks a stable decisional perspective, causation lacks a stable counterfactual subject, and capacity assessment fails to account for a treatment designed to alter the cognitive framework it purports to assess.
Comparable studies
Other theoretical and historical papers on psychedelic-assisted therapy, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Theorizing that Psychedelic Assisted Therapy May Play a Role in the Treatment of Trauma-Induced Personality Disorders. | 2024 | Theoretical or philosophical paper | |
| Learning to Let Go: A Cognitive-Behavioral Model of How Psychedelic Therapy Promotes Acceptance | 2020 | Theoretical or philosophical paper | |
| Awe: a putative mechanism underlying the effects of classic psychedelic-assisted psychotherapy | 2018 | Theoretical or philosophical paper | |
| Ethical and legal issues in psychedelic harm reduction and integration therapy | 2021 | Theoretical or philosophical paper | |
| Towards psychedelic apprenticeship: Developing a gentle touch for the mediation and validation of psychedelic-induced insights and revelations. | 2022 | Theoretical or philosophical paper |