Compassionate use of psychedelics
This paper (2020) reviews the safety and efficacy of psilocybin- and MDMA-assisted therapies and argues that it can be rational for some patients to try compassionate psychedelic therapy, notwithstanding the uncertainty of outcomes, as the expected value of psychotherapy can outweigh the expected value of routine care, palliative care, or no care at all. They also address the epistemic risk carried by the notion that psychedelics are philosophically deceptive given that the subjective effects may often feel more real than normal consciousness, but the authors argue that it is not known how classical psychedelics influence one’s beliefs or whether they make one metaphysically irrational, and assert that metaphysics should be ignored in medicine as much as possible. While acknowledging that there are suboptimal uses of psychedelics, the authors see no ethical barriers for their compassionate use in palliative care.
Authors
- Greif, A.
- Šurkala, M.
Published
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.
Research Summary of 'Compassionate use of psychedelics'
Introduction
Psychedelics—here focused on psilocybin and MDMA—are psychoactive substances that produce marked changes in perception, affect and cognition. After decades of prohibition following mid‑20th century research, recent clinical studies have rekindled interest in therapeutic applications, with psilocybin and MDMA attracting attention for cancer‑related distress, depression, addiction and post‑traumatic stress disorder (PTSD). Both substances remain investigational and have been granted breakthrough therapy designations, but are not yet approved medicines; nevertheless, regulatory mechanisms such as compassionate use / expanded access allow seriously ill patients who have exhausted proven options to request investigational therapies outside clinical trials. Greif and Šurkala set out to consider whether compassionate psychedelic therapy (PT) can be ethically permissible. Rather than addressing all procedural issues of conducting PT, the paper focuses on a fundamental question: can compassionate PT ever be ethical? To answer this, the authors review available evidence on safety and efficacy for psilocybin and MDMA, advance a beneficence‑based defence of compassionate use, and respond to a specific philosophical objection—that PT causes epistemic harm by foisting metaphysical delusions—arguing that the objection is unsubstantiated given current evidence and conceptual issues.
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Study Details
- Study Typemeta
- Journal
- Compounds
- Topics
- APA Citation
Greif, A., & Šurkala, M. (2020). Compassionate use of psychedelics. Medicine, Health Care and Philosophy, 23(3), 485-496. https://doi.org/10.1007/s11019-020-09958-z
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Bouso, J. C., Révész, D., Ona, G. et al. · Scientific Reports (2023)
Ponomarenko, P., Seragnoli, F., Calder, A. et al. · Journal of Psychopharmacology (2023)
Rudin, D., Areesanan, A., Liechti, M. E. et al. · Frontiers in Psychiatry (2023)
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