Compassionate use of psychedelics

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.

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Notes

  1. 1.

    In this paper, we will use “compassionate use” and “unproven treatment”, as well as “compassionate” and “unproven” interchangeably.

  2. 2.

    By “physicalism” we mean the view that everything is physical. “Naturalism” is a notoriously ambiguous term, but at minimum, it refers to the view that supernatural entities like gods, spirits, and magical spells do not exist.

  3. 3.

    We thank an anonymous reviewer of this journal for their clarifying remarks on this point.

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Greif, A., Šurkala, M. Compassionate use of psychedelics. Med Health Care and Philos 23, 485–496 (2020). https://doi.org/10.1007/s11019-020-09958-z

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Keywords

  • Ethics
  • Compassionate use
  • Psychedelic
  • Uncertainty
  • Epistemic harm
  • Naturalism