Volume 24, Issue 7, July 2024, Page 6-12.

When used clinically, psychedelics may appear unusual or even unique when compared to more familiar or long-standing medical interventions, prompting some to suggest that the ethical issues raised may likewise be exceptional. If that is correct, then perhaps psychedelics should be treated differently from other medical substances: for example, by being subjected to different ethical or evidentiary standards. Alternatively, it may be that psychedelics have more in common with various existing medical interventions than first meets the eye. We argue in (...) favor of the latter position, drawing on parallels from earlier debates around genetic exceptionalism in bioethics. We suggest there are risks to adopting a stance of “psychedelic ethical exceptionalism,” and propose that consistent ethical rules and evidentiary standards should be applied across all relevant areas of clinical medicine. Importantly, this does not preclude the possibility that changes to existing standards should be made; but if so, this should not be justified by appealing to the alleged uniqueness of psychedelics. (shrink)

ABSTRACT:Psychedelics, including psilocybin, and other consciousness-altering compounds such as 3,4-methylenedioxymethamphetamine (MDMA), currently are being scientifically investigated for their potential therapeutic uses, with a primary focus on measurable outcomes: for example, alleviation of symptoms or increases in self-reported well-being. Accordingly, much recent discussion about the possible value of these substances has turned on estimates of the magnitude and duration of persisting positive effects in comparison to harms. However, many have described the value of a psychedelic experience with little or no reference (...) to such therapeutic benefits, instead seeming to find the experience valuable in its own right. How can we make sense of such testimony? Could a psychedelic experience be valuable even if there were no persisting beneficial effects? If so, how? Using the concept of psychological richness, combined with insights from the philosophy of aesthetics and the enhancement literature, this essay explores potential sources of value in the acute subjective experience, apart from the value derived from persisting beneficial effects. (shrink)

In his paper ‘Ethical problems with kindness in healthcare’, Jesudason sets out an interesting examination of the concept of kindness, arguing that it poses significant ethical challenges due to its discretionary nature. I suggest that kindness, a concept difficult to define, may still have a role to play in healthcare. Different treatments of kindness show us that it need not be discretionary, and that kind care can be provided to all. Finally, curiosity may also have a role to play in (...) medicine to help promote inclusiveness. (shrink)

Psychedelics such as psilocybin reliably produce significantly altered states of consciousness with a variety of subjectively experienced effects. These include certain changes to perception, cognition, and affect,1 which we refer to here as the acute subjective effects of psychedelics. In recent years, psychedelics such as psilocybin have also shown considerable promise as therapeutic agents when combined with talk therapy, for example, in the treatment of major depression or substance use disorder.2 However, it is currently unclear whether the aforementioned acute subjective (...) effects are necessary to bring about the observed therapeutic effects of psilocybin and other psychedelics. This uncertainty has sparked a lively—though still largely hypothetical—debate on whether psychedelics without subjective effects (“nonsubjective psychedelics” or “non-hallucinogenic psychedelics”) could still have the same therapeutic impact, or whether the acute subjective effects are in fact necessary for this impact to be fully realized.3,4,5. (shrink)

A prominent critique of cognitive or athletic enhancement claims that certain performance‐improving drugs or technologies may ‘cheapen’ resulting achievements. Considerably less attention has been paid to the impact of enhancement on the value of moral achievements. Would the use of moral enhancement (bio)technologies, rather than (solely) ‘traditional’ means of moral development like schooling and socialization, cheapen the ‘achievement’ of morally improving oneself? We argue that, to the extent that the ‘cheapened achievement’ objection succeeds in the domains of cognitive or athletic (...) enhancement, it could plausibly also succeed in the domain of moral enhancement—but only regarding certain forms. Specifically, although the value of moral self‐improvement may be diminished by some of the more speculative and impractical forms of moral enhancement proposed in the literature, this worry has less force when applied to more plausibly viable forms of moral enhancement: forms in which drugs or technologies play an adjunctive or facilitative, rather than a determinative, role in moral improvement. We illustrate this idea with three examples from recent literature: the possible use of psychedelic drugs in certain moral‐learning contexts, ‘Socratic Al’ (a proposed Al‐driven moral enhancer) and empathy enhancement through virtual reality (VR). We argue that if one assumes that these technologies work roughly as advertised, the ‘cheapened achievement’ objection loses much of its bite. The takeaway lesson is that moral enhancement in its most promising and practical forms ultimately evades a leading critique of cognitive and athletic enhancement. We end by reflecting on the potential upshot of our analysis for enhancement debates more widely. (shrink)

Virtues commonly associated with physicians and other healthcare professionals include empathy, respect, kindness, compassion, trustworthiness, and many more. Building upon the work of Bortolloti, Murphy-Hollies, and others, I suggest that curiosity as a virtue has an integral role to play in healthcare, namely, in helping to make those who are invisible, visible. Practicing the virtue of curiosity enables one to engage with and explore the experiences of patients and contributes toward building a physician–patient relationship of trust. As the perspectives and (...) experiences of patients can be too often dismissed or lost within medical settings, curiosity can allow physicians to deeply know their patients, and thus provide better care. However, caution must be exercised so as to not to venture into inappropriate curiosity, where questions are asked for improper reasons or to help satisfy the personal interest of physicians. Finally, I sketch out two cases—on chronic pain and on vaccine hesitancy—to illustrate where curiosity can play a valuable role. (shrink)

Epigenetic research has brought several important technological achievements, including identifying epigenetic clocks and signatures, and developing epigenetic editing. The potential military applications of such technologies we discuss are stratifying soldiers’ health, exposure to trauma using epigenetic testing, information about biological clocks, confirming child soldiers’ minor status using epigenetic clocks, and inducing epigenetic modifications in soldiers. These uses could become a reality. This article presents a comprehensive literature review, and analysis by interdisciplinary experts of the scientific, legal, ethical, and societal issues (...) surrounding epigenetics and the military. Notwithstanding the potential benefit from these applications, our findings indicate that the current lack of scientific validation for epigenetic technologies suggests a careful scientific review and the establishment of a robust governance framework before consideration for use in the military. In this article, we highlight general concerns about the application of epigenetic technologies in the military context, especially discrimination and data privacy issues if soldiers are used as research subjects. We also highlight the potential of epigenetic clocks to support child soldiers’ rights and ethical questions about using epigenetic engineering for soldiers’ enhancement and conclude with considerations for an ethical framework for epigenetic applications in the military, defense, and security contexts. (shrink)