An emerging thought leader in psychedelic research, Eddie Jacobs is a Neuroethicist at the University of Oxford and an honorary research associate at King’s College London – exploring the clinical, ethical, and policy dimensions of psychedelic-assisted psychotherapy.
Eddie graduated from the University of Oxford’s prominent Politics, Philosophy and Economics degree program, before completing a master’s degree in Cognitive Neuroscience. His foray into the professional psychedelic space began at the Beckley Foundation, which left him captivated by the clinical potential of psychedelic-assisted psychotherapy, but also contemplative of ethical dilemmas.
Before he embarks on a three-year project to assert a bioethical framework for psychedelic-assisted psychotherapy, we had the good fortune to connect and discuss his upcoming research.
– Eddie, thank you very much for taking the time to speak with MAPS Canada. At a high level, please can you tell us about your research into the ethics of psychedelic psychotherapy?
My aim over the course of the project is to map out the ethical terrain of psychedelic psychotherapy, highlighting the main challenges, and offering some potential ways to meet those challenges. Against the backdrop of regular healthcare, the experience of psychedelic psychotherapy, its mechanisms of action, and its downstream consequences, are all pretty unusual. So it’s not surprising that it seems to throw a curveball at almost every principle or tenet of medical ethics.
For example, the first part of my research focuses in on the curious ‘side-effects’ of psychedelic psychotherapy, though ‘side-effect’ is a short-hand that isn’t really fit for purpose. Consider the fact that patients sometimes report that these changes – to their aesthetic appreciation, to their attitudes and values, general disposition, and religious beliefs – are more important to them than the treatment effect. These really are quite radical shifts to the core of someone’s identity, so it’s worth pausing to consider the significance of inducing these changes in the context of healthcare.
There’s quite a lot for the more philosophically-inclined to get their teeth into there: questions about authenticity, autonomy, and self-development. But I’m principally interested in the cash value of these considerations on the ground. How should our knowledge of these changes feed into practice? Are our normal methods of informed consent enough to sufficiently protect and empower patients? What do these changes mean for a practitioner’s duty of care over their patients, once the treatment is finished?
– It sounds like your research may ask more questions than it answers. Why is now such a crucial time for the conversation on ethics in psychedelic psychotherapy?
Licensed psychedelic psychotherapy is just around the corner! I don’t think anyone reading the MAPS website will be in doubt about the clinical potential of psychedelic psychotherapy, but the clinical potential is only part of the story. Not only do we want to have our ethical house in order before there is widespread uptake of psychedelic psychotherapy, but getting the ethics right will also facilitate widespread uptake.
Suppose we forge ahead without deep, critical ethical engagement, and we overlook something that we could have fixed, that leaves patients feeling let down, violated, or otherwise not properly considered. Not only would that amount to a failure of a physician’s duty of care, it would cost the psychedelic psychotherapy movement itself: maybe the loss of the public goodwill that has been so hard to build, maybe a series of litigation actions that make treatment providers, insurers, and decision-makers in other jurisdictions considerably less enthusiastic about facilitating psychedelic psychotherapy, ultimately meaning that many other people who could benefit would miss out.
Maybe that sounds pessimistic, or even catastrophizing. When I mention the subject of my research, sometimes people assume I’m seeking to answer the question ‘is it ethical to do psychedelic psychotherapy?’ My answer to that question is an emphatic yes – anything that can alleviate such suffering so profoundly in so many is surely OK to do.
I share the enthusiasm of psychedelic researchers on this matter. But I’m aiming to make sure that this optimism doesn’t blind us to potential challenges or hazards along the way. The best way to do that is to be pessimistic: go looking for potential problems, and then think about how to manage or accommodate them.
– A sensible and undeniably necessary approach. What do you perceive will be the potential ethical challenges and hazards on the frontline?
There are lots of ethical questions related to psychedelic psychotherapy that could be considered in theoretical or philosophical terms, that wouldn’t require you to get up from the armchair. But providing practical considerations and guidance, of the sort that will be useful for therapists and policy makers, demands that you engage meaningfully with the experiences and perspectives of the people at the coalface of the work: primarily the patients, but also their loved ones and the therapists themselves.
As such, I need to speak to a range of patients who have undergone psychedelic psychotherapy in clinical trials: those who experienced non-clinical changes like those I described earlier, and those who didn’t. Those who underwent psychedelic psychotherapy for different conditions. And importantly, both those for whom the therapy was successful, and those who did not get the treatment outcome they were hoping for.
“These really are quite radical shifts to the core of someone’s identity…There’s quite a lot for the more philosophically-inclined to get their teeth into there: questions about authenticity, autonomy, and self-development.”
Without conversations with patients, I would only be able to generate half the picture at most. That’s why I’m hugely grateful to Robin Carhart-Harris at the Imperial Centre for Psychedelic Research, and Matthew Johnson at the Johns Hopkins Psychedelic Research Center, who are supporting my research by allowing me to reach out to patients from their previous trials.
I am hoping their recognition of the value of the research is shared among the community of psychedelic researchers and therapists, as I’ll also be running focus groups to interview practitioners at conferences across the next couple of years. Psychedelic conferences are not only rare, but tend to be packed with hard-to-resist presentations. So my hope is that I can lure enough therapists away for an hour to get a good grasp of their perspectives, too.
– For a new field of psychotherapy do we need an entirely new ethical framework?
Ask me again in three years! At the beginning of this project, I’d say that the problem space for a bioethics of psychedelic psychotherapy looks similar to the problem space for a theory of psychedelic therapy: As a mode of healing, psychedelic psychotherapy has clear similarities, but also clear discontinuities, when compared to orthodox psychotherapeutic approaches. With the pace that research is currently expanding at, hopefully we’ll soon have a better idea of how best to understand psychedelic psychotherapy. Can we absorb it into current frameworks, with a few important amendments? Or will we get more explanatory leverage by adopting new theoretical models?
The question about a bioethics of psychedelic psychotherapy is the same: do we already have the conceptual resources we need in medical ethics, or do its unique features require novel approaches? I’ll have to get back to you on that.
– And we will hold you to it! Was it challenging to obtain funding to study psychedelic psychotherapy?
I had to knock on a lot of doors to secure the funding to support this research. It was quite a demoralizing process, but that’s something everyone in the field experiences. Of course, there aren’t any funders who give out money easily in any field, but you do get the sense that researchers wanting to investigate psychedelics are facing additional challenges because of the taboo, and general eyebrow-raising nature of the research.
That said, I am absolutely thrilled that the project has secured funding from the Wellcome Trust. Wellcome are deeply committed to funding high-impact biomedical research, so their support is a powerful endorsement of the value and promise of psychedelic psychotherapy, as well as an affirmation of the importance of getting the ethics right.
– What are your hopes for the upcoming DPhil?
I’m less concerned about finding definitive answers to the ethical questions that psychedelic psychotherapy raises, but I’m hoping to stimulate conversation, and to bring the issues to the forefront of discussions about how we go forward.
I’m hoping that, by grounding the ethical discussion in the experiences and perceptions of those who have undergone psychedelic psychotherapy, I can go some way to articulating and promoting ethically robust practices, in advance of psychedelic medicine becoming a firmly established element in mental health treatment. Ideally, this will be of some value to practising therapists, but also to those developing the training for therapists, and for those setting clinical guidance
– I’m sure it will be seminal. Eddie, thank you again for taking the time to speak with MAPS Canada. Studies into the ethics of psychedelic psychotherapy are crucial to establish and legitimise the treatment, we wish you all the best with your research.
Follow Eddie on Twitter @EddieTalksDrugs.