Transformative experience and informed consent to psychedelic-assisted psychotherapy

Abstract

Just as psychedelic-assisted psychotherapy (PAP) represents a clinical innovation that may need to be accommodated with corresponding theoretical and methodological innovations, there is growing awareness that the tools, normative frameworks, and standard practices of our clinical ethics may also need to be adapted, renewed, or replaced to accommodate its unusual features. Drawing on L. A. Paul's work on “Transformative Experience,” I argue that the acute and long-term effects that are repeatedly reported following the administration of psychedelic drugs, including in clinical contexts, are epistemically inaccessible at the point of deciding to take them. By virtue of both the so-called “mystical” experiences that frequently arise during PAP, and the long-term shifts to outlooks, values, and priorities that can follow treatment, the processes of decision-making that are normatively expected of patients run aground. If this framing is correct, then prospective patients cannot meet the requirement of understanding that is one of the principal analytic components of informed consent. The role of understanding in supporting two functions of informed consent—avoiding unauthorized trespass against patients and supporting values-aligned decision-making—is explored, and I argue that, while the normative standard for the first function may be met by extant suggestions for enhancing the consenting process for PAP, the latter function remains unattainable. In light of this, the consequences for the ethical preparation of prospective patients are considered.

Informed Consent to Psychedelic-Assisted Psychotherapy: Ethical Considerations

“…However, Jacobs argues that owing to the particular effects of psychedelics-namely, mystical and ego-dissolution experiences which can occur acutely after administration and longer-term shifts in identity and values-the typical standards for informed consent may not be feasible. 14 Issues of capacity and consent during the psychedelic experience have received less attention. Individuals using psychedelics often experience profound acute changes to their sensorium along with alterations in mood, detachment from the body, and distortions of their sense of self, time, and reality.…”

Transformative Experience

“…Chan, 2023). 9 For example, it has already been applied in religious studies (e.g., Blanchard & Paul, 2021;Chan, 2019;De Cruz, 2018), education studies (e.g., Paul & Quiggin, 2020;Yacek, 2020;Yacek & Gary, 2020), psychology (e.g., Brouwer & Carhart-Harris, 2021;Forstmann et al, 2020;Yudkin et al, 2022), medical ethics (e.g., Egerton & Capitelli-McMahon, 2023;Hofmann, 2023;Jacobs, 2023;Letheby & Mattu, 2022;McQueen, 2017;Peterson et al, 2022;Walsh, 2020), and other areas of philosophy besides decision theory (e.g., Akhlaghi, 2023;Aumann, 2022;Carel et al, 2016;Carel & Kidd, 2020). Since it is not possible to cover all of these topics, I will focus on work that applies the concept of transformative experiences to illness, medical treatment, and the ethical issues involved.…”

“…Villiger, 2024aVilliger, , 2024b. Jacobs (2023) and Egerton and Capitelli-McMahon (2023) are skeptical. In contrast, Smith and Sisti (2021) argue that informed consent to psychedelic-assisted therapy is possible under an enhanced informed consent process.…”

“…Informed consent is questioned not only in interventions that may lead to (more serious) illness, but in transformative interventions more generally. Most prominently, psychedelic‐assisted therapy is argued to have the potential to be both epistemically and personally transformative (Jacobs, 2023; Smith & Sisti, 2021). This is due to the ineffability of a psychedelic experience and its power to shift one's values and personality.…”

Informed Consent to Psychedelic Treatment—A Work in Progress

“…However, obtaining meaningful informed consent to psychedelic treatment will be challenging, given the unique effects of the drugs—including what are often described as the ineffable elements of the psychedelic experience, such as ego dissolution . Although some commentators have suggested that informed consent to psychedelic treatment, in the usual sense of that term, is simply unattainable, a growing consensus has coalesced around the notion that with proper attention to content and presentation, clinicians will be able to obtain meaningful and valid consent from patients…”