I am currently based at the University of Oxford's Department of Psychiatry and Wellcome Centre for Ethics and Humanities, where in October 2020 I began begin a three-year project in empirical ethics, funded by the Wellcome Trust, to articulate a bioethical framework for psychedelic-assisted psychotherapy. This newly (re-)discovered treatment modality challenges a host of the core concepts of medical ethics in novel ways, and it is crucial that potential ethical hazards are properly understood and accommodated before the mainstreaming of psychedelic therapy. For early movers, this means litigation risk minimisation. For the industry in the long term, this means well-established norms in practice and policy to optimise patient outcomes without jeopardising ethical values.
The recent revivification of interest in the therapeutic use of psychedelics has had a particular... more The recent revivification of interest in the therapeutic use of psychedelics has had a particular focus on mood disorders and addiction, although there is good reason to think these drugs may be effective more widely. After outlining pertinent aspects of psilocybin and obsessive-compulsive disorder (OCD), the current review summarizes the evidence supporting the use of the psychedelic compound psilocybin in its, as well as a range of potential therapeutic mechanisms that reflect the action of psilocybin on brain function. The positive preliminary results, as well as the psychological and physiological safety of psilocybin when administered under clinical supervision, support the development of large-scale randomized controlled trials to properly determine efficacy.
Cheryl Abbate’s recent paper in this journal (Abbate, 2016), makes the case that many non-human a... more Cheryl Abbate’s recent paper in this journal (Abbate, 2016), makes the case that many non-human animals are ‘political’ in the Aristotelian sense (Politics, Nicomachean Ethics). Moreover, Abbate rejects the claim that anthrôpos (Homo sapiens) is the most political of animals. While the aim to deflate often over-exaggerated distinctions between us and other animals is laudable, in the following I suggest that Abbate’s evidence from cognitive ethology, and her application of evolutionary principles, fall short of demonstrating other animals to be as political as anthrôpos.
Just as psychedelic-assisted psychotherapy (PAP) represents a clinical innovation that may need t... more 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 mee...
The ethical value—and to some scholars, necessity—of providing trial patients with post-trial acc... more The ethical value—and to some scholars, necessity—of providing trial patients with post-trial access (PTA) to an investigational drug has been subject to significant attention in the field of research ethics. Although no consensus has emerged, it seems clear that, in some trial contexts, various factors make PTA particularly appropriate. We outline the atypical aspects of psychedelic clinical trials that support the case for introducing the provision of PTA within research in this field, including the broader legal status of psychedelics, the nature of the researcher-therapist/participant relationship, and the extended time-frame of the full therapeutic process. As is increasingly understood, the efficacy of psychedelic-assisted psychotherapy is driven as much by extrapharmacological elements and the cultural therapeutic container as by the drug itself. As such, we also advocate for a refocusing of attention from post-trial access to a broader concept encompassing other elements of ...
Just as psychedelic-assisted psychotherapy (PAP) represents a clinical innovation that may need t... more Just as psychedelic-assisted psychotherapy (PAP) represents a clinical innovation that may need to be accommodated with corresponding theoretical and methodological innovations, there is increasing 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 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 'peak' or 'mystical' experiences that frequently arise during PAP, and the longer-term shifts to outlooks, values and priorities that can follow, the processes of decision-making that are normatively expected of decisionally competent 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 as we standardly deploy it as a legitimising process for clinical intervention. The role of understanding in supporting two functions of informed consent-avoiding unauthorised 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 ethical preparation of prospective patients are considered.
Peterson et al. (2023) present a range of ethical issues that arise when considering the use of p... more Peterson et al. (2023) present a range of ethical issues that arise when considering the use of psychedelic substances within medicine. But psychedelics are, by their nature, boundary-dissolving, and we suggest that progress in the Ethics of Psychedelic Medicine is best made within a broaderranging Psychedelic Bioethics, which encompasses not just medicine, but wider society, including the breadth of cultural containers and settings in which these compounds are used.
The recent revivification of interest in the therapeutic use of psychedelics has had a particular... more The recent revivification of interest in the therapeutic use of psychedelics has had a particular focus on mood disorders and addiction, although there is good reason to think these drugs may be effective more widely. After outlining pertinent aspects of psilocybin and obsessive-compulsive disorder (OCD), the current review summarizes the evidence supporting the use of the psychedelic compound psilocybin in its, as well as a range of potential therapeutic mechanisms that reflect the action of psilocybin on brain function. The positive preliminary results, as well as the psychological and physiological safety of psilocybin when administered under clinical supervision, support the development of large-scale randomized controlled trials to properly determine efficacy.
Cheryl Abbate’s recent paper in this journal (Abbate, 2016), makes the case that many non-human a... more Cheryl Abbate’s recent paper in this journal (Abbate, 2016), makes the case that many non-human animals are ‘political’ in the Aristotelian sense (Politics, Nicomachean Ethics). Moreover, Abbate rejects the claim that anthrôpos (Homo sapiens) is the most political of animals. While the aim to deflate often over-exaggerated distinctions between us and other animals is laudable, in the following I suggest that Abbate’s evidence from cognitive ethology, and her application of evolutionary principles, fall short of demonstrating other animals to be as political as anthrôpos.
Just as psychedelic-assisted psychotherapy (PAP) represents a clinical innovation that may need t... more 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 mee...
The ethical value—and to some scholars, necessity—of providing trial patients with post-trial acc... more The ethical value—and to some scholars, necessity—of providing trial patients with post-trial access (PTA) to an investigational drug has been subject to significant attention in the field of research ethics. Although no consensus has emerged, it seems clear that, in some trial contexts, various factors make PTA particularly appropriate. We outline the atypical aspects of psychedelic clinical trials that support the case for introducing the provision of PTA within research in this field, including the broader legal status of psychedelics, the nature of the researcher-therapist/participant relationship, and the extended time-frame of the full therapeutic process. As is increasingly understood, the efficacy of psychedelic-assisted psychotherapy is driven as much by extrapharmacological elements and the cultural therapeutic container as by the drug itself. As such, we also advocate for a refocusing of attention from post-trial access to a broader concept encompassing other elements of ...
Just as psychedelic-assisted psychotherapy (PAP) represents a clinical innovation that may need t... more Just as psychedelic-assisted psychotherapy (PAP) represents a clinical innovation that may need to be accommodated with corresponding theoretical and methodological innovations, there is increasing 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 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 'peak' or 'mystical' experiences that frequently arise during PAP, and the longer-term shifts to outlooks, values and priorities that can follow, the processes of decision-making that are normatively expected of decisionally competent 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 as we standardly deploy it as a legitimising process for clinical intervention. The role of understanding in supporting two functions of informed consent-avoiding unauthorised 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 ethical preparation of prospective patients are considered.
Peterson et al. (2023) present a range of ethical issues that arise when considering the use of p... more Peterson et al. (2023) present a range of ethical issues that arise when considering the use of psychedelic substances within medicine. But psychedelics are, by their nature, boundary-dissolving, and we suggest that progress in the Ethics of Psychedelic Medicine is best made within a broaderranging Psychedelic Bioethics, which encompasses not just medicine, but wider society, including the breadth of cultural containers and settings in which these compounds are used.
Uploads
Drafts by Eddie Jacobs
Papers by Eddie Jacobs