With great power comes great vulnerability: an ethical analysis of psychedelics’ therapeutic mechanisms proposed by the REBUS hypothesis
Daniel Villiger, Manuel Trachsel
Journal of Medical Ethics April 12, 2023 DOI: 10.1136/jme-2022-108816 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Theoretical or philosophical paper Peer reviewed |
|---|---|
| Topics | Psychedelic-assisted therapy |
| Keywords | Psychedelic treatment Psychedelic medicine Psychedelic healing Psychedelic interventions Patient vulnerability Patient suggestibility Therapeutic dependence Patient risk Dependency Medical ethics Ethical considerations Safeguards Informed consent Patient safety Ethical treatment Belief flexibility Cognitive flexibility Openness Mind flexibility Belief change |
| Citations | 40 |
| Key points | Argues that the REBUS hypothesis implies patients in psychedelic-assisted therapy are more vulnerable than in other therapeutic interventions, requiring enhanced informed consent and security measures. |
Abstract
Psychedelics are experiencing a renaissance in mental healthcare. In recent years, more and more early phase trials on psychedelic-assisted therapy have been conducted, with promising results overall. However, ethical analyses of this rediscovered form of treatment remain rare. The present paper contributes to the ethical inquiry of psychedelic-assisted therapy by analysing the ethical implications of its therapeutic mechanisms proposed by the relaxed beliefs under psychedelics (REBUS) hypothesis. In short, the REBUS hypothesis states that psychedelics make rigid beliefs revisable by increasing the influence of bottom-up input. Put differently, patients become highly suggestible and sensitive to context during a psychedelic session, amplifying therapeutic influence and effects. Due to that, patients are more vulnerable in psychedelic-assisted therapy than in other therapeutic interventions; they lose control during a psychedelic session and become dependent on the therapeutic setting (including the therapist). This enhanced vulnerability is ethically relevant and has been exploited by some therapists in the past. Therefore, patients in current research settings and starting mainstream medical settings need to be well informed about psychedelics’ mechanisms and their implications to give valid informed consent to treatment. Furthermore, other security measures are warranted to protect patients from the vulnerability coming with psychedelic-assisted therapy