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Cited by 146Psychedelics and Drug StudiesEthics in Clinical ResearchEthics and bioethics in healthcare

Ethics and ego dissolution: the case of psilocybin

Open access
Smith, William R, Sisti, Dominic·2021·Journal of Medical Ethics
DOI 10.1136/medethics-2020-106070PMC PMC9202314
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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.

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  • Psychedelic-assisted therapy has been shown to enhance perceptions and ability to find meaning in one's life and lead to positive alterations of the self, despite being artificially induced.

    “Psychedelic-assisted therapy has been shown to enhance perceptions and ability to find meaning in one's life (Smith and Sisti 2020), while leading to positive alterations of the self (Baggott et al. 2016), despite being artificially induced.”

    From Authenticity and Love Drugs: Insights from Psychedelic Therapy (2026) · cites this paper as Smith and Sisti 2020

    In “Personality Change and Neurobiology of Psilocybin-Assisted Psychotherapy” (page unavailable), Smith and Sisti report that most subjects in several studies ranked psilocybin treatment among the most meaningful events of their lives and describe changed perceptions of connection. This supports the claim about meaningful experiences, but does not establish an enhanced ability to find meaning in life. The separate claim about positive alterations of the self is cited to Baggott et al., not to Smith and Sisti. (LLM, conf=0.82)

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  • Psychedelic experiences in clinical settings are often characterized as highly meaningful.

    “Psychedelic experiences in clinical settings are often characterized as highly meaningful.”

    From Authenticity and Love Drugs: Insights from Psychedelic Therapy (2026) · cites this paper as Smith and Sisti 2020

  • Psilocybin treatment has been described as one of the most meaningful experiences in the lives of participants of several studies.

    “psilocybin treatment has been described as one of the most meaningful experiences (Griffiths et al. 2008;Smith and Sisti 2020) in the lives of participants of several studies.”

    From Authenticity and Love Drugs: Insights from Psychedelic Therapy (2026) · cites this paper as Smith and Sisti 2020

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Research works printed but not linked: 42

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Authors
Smith, W. R., & Sisti, D.
Affiliations
University of Pennsylvania (US)
Corresponding author
Smith, William R
ORCID
Venue
Journal of Medical Ethics
Publisher
BMJ
Published
2020-05-27
Volume
47
Issue
12
Pages
807-814
ISSN
  • 0306-6800 (ISSN-L)
  • 1473-4257
DOI
10.1136/medethics-2020-106070
PMC
PMC9202314
OpenAlex
W3029961383
Cited by
146
References
19
Citations by year
2026: 19 · 2025: 31 · 2024: 52 · 2023: 17 · 2022: 18 · 2021: 9
FWCI
4.15
Type
journal article
Language
en
Open access
Locations
  • Journal of Medical Ethics (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • The Thomas Scattergood Behavioral Health Foundation
  • National Institute of Mental Health (R25MH119043-01)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Psychedelics and Drug Studies
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics in Clinical Research
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
Keywords
psilocybin, psychedelics, informed consent, ego dissolution, treatment risks, personality change, worldview change, psychotherapy, substance use disorders

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