Psychedelic ethics in practice: The case of ketamine-assisted psychotherapy in Norway

As ketamine-assisted psychotherapy (KAP) moves into clinical practice, ethical challenges arise around access, consent, and therapeutic integrity. Interviews with 16 physicians and clinical psychologists in Norway, conducted before the country's August 2025 approval of ketamine reimbursement for treatment-resistant depression, revealed three key themes: access to care was inequitable due to cost, geography, and restrictions on public communication; informed consent was complicated by ketamine's unpredictable effects, requiring flexibility and experiential familiarity; and therapeutic integrity depended on maintaining psychotherapy alongside ketamine, with risks of fragmented care and unrealistic expectations. The principlist framework helped structure these issues but could not fully capture systemic factors like funding and biomedical consent norms.

Study at a glance

Abstract

Psychedelic therapies are moving from the margins of medicine into clinical practice, bringing unresolved ethical questions to the forefront. Among them, ketamine-assisted psychotherapy (KAP) has gained the widest medical acceptance, particularly for treatment-resistant depression (TRD). In August 2025, this development reached a new stage as Norway became the first country to approve reimbursement of generic ketamine for TRD. This study uses a principlist framework to examine ethical challenges related to administering KAP during the formative period preceding this policy shift, when provision was largely private. Sixteen physicians and clinical psychologists in Norway were interviewed about ethical challenges in practice. Data were analyzed abductively through thematic analysis, using Beauchamp and Childress' principlist bioethics as a framework. Findings are structured around three themes: (1) Access to care , where injustice stemmed from cost, geography, and limits on public communication; (2) Informed consent , where the unpredictability of ketamine's effects complicated autonomy, leading practitioners to rely on flexibility and experiential familiarity; and (3) Therapeutic integrity , where beneficence and non-maleficence depended on sustaining psychotherapy, with risks of fragmented care, unrealistic expectations, and ketamine treated as a stand-alone cure. While principlist ethics acted as a useful scaffold, systemic factors such as funding structures and biomedical norms of consent shaped KAP in ways the framework could not fully capture. For KAP to develop into ethically robust psychiatric care in Norway and beyond, it must balance expanded access with the therapeutic depth that grounds the practice, supported by refinement of consent processes.