Ethics and ego dissolution: the case of psilocybin

Recent early-phase trials suggest psychedelics offer novel benefits for treating mental health and substance use disorders, producing experiences unlike other treatments, such as feelings of unity, loss of self-importance, and encountering deep reality or God. Focusing on psilocybin, the authors argue these unique features pose novel risks that require an enhanced informed consent process—more comprehensive than typical for psychiatric medications. They highlight key issues for consent, suggest discussion prompts, and respond to objections, concluding with ethical considerations as psychedelics move from controlled research into mainstream clinical psychiatry.

Study at a glance

Abstract

Despite the fact that psychedelics were proscribed from medical research half a century ago, recent, early-phase trials on psychedelics have suggested that they bring novel benefits to patients in the treatment of several mental and substance use disorders. When beneficial, the psychedelic experience is characterized by features unlike those of other psychiatric and medical treatments. These include senses of losing self-importance, ineffable knowledge, feelings of unity and connection with others and encountering ‘deep’ reality or God. In addition to symptom relief, psychedelic experiences often lead to significant changes in a patient’s personality and worldview. Focusing on the case of psilocybin, we argue that the peculiar features of psychedelics pose certain novel risks, which warrant an enhanced informed consent process–one that is more comprehensive than what may be typical for other psychiatric medications. We highlight key issues that should be focused on during the consent process and suggest discussion prompts for enhanced consent in psychedelic psychiatry. Finally, we respond to potential objections before concluding with a discussion of ethical considerations that will arise as psychedelics proceed from highly controlled research environments into mainstream clinical psychiatry.