Seminário Ética

Smith, W. R., & Sisti, D. (2021).
Ethics and ego dissolution: the case of

psilocybin. Journal of medical ethics, 47(12), 807-814.
 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.
 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.
 Three components of the therapeutic process, mechanism and side effect profile of
psilocybin will be novel and potentially unexpected for patients, and require special
attention in enhanced consent:
1. shifts in values and personality

2. rare mental health side effects (severe anxiety, psychosis and trauma re-
exposure)
3. the possible use of therapeutic touch during therapy.
 Presumably, if therapists are to employ touch at all, they should do so only if it is

therapeutic and requested by the patient. Nevertheless, challenges arise when patients
change their minds about whether they would or would not like therapeutic touch during
the psychedelic experience.
 Changes in preferences are particularly challenging because the psychedelic state may
undermine patients’ decision-making capacity. Moreover, decision-making capacity may
be difficult to assess since it often involves a variety of questions about patient
preferences and rationale that may be both impractical and counter-therapeutic to ask
to a patient in the midst of anxiety that might warrant therapeutic touch during the
psychedelic experience.
 Three scenarios that merit distinct considerations.
1st. A patient may consent to therapeutic touch during the consent process but later,
when confronting anxiety during the psychedelic experience, reject it. In such a case, therapists
must not touch a patient against their will; here, the duty to respect autonomy holds despite the
fact that the psychedelic state may sometimes undermine the patient’s decision-making
capacity.
2nd. A patient initially declines therapeutic touch but has become agitated and, further,
is now a safety risk to themselves or others. In such a case, redirection, or even restraint, may
be required. We do not anticipate this case arising frequently in psychedelic psychotherapy, but
importantly, both the nature and justification of such intervention is different from that of
therapeutic touch and should not be confused with it.
3rd. When patients initially decline therapeutic touch during the consent process but
when experiencing distress in the psychedelic state, they change their mind and ask to be
touched. In such cases, it may be ethically appropriate to provide the patient with therapeutic
touch despite their initial declination and the fact that the patient may be technically
incapacitated. Here therapists will have to exercise their judgment carefully, but ideally, in such
cases, a second therapist should provide immediate consultation to assess the shift in the
patient’s decision and the appropriateness of such touch.
Importante destacar: O processo de consentimento esclarecido deve ser mais

detalhado no caso dos psicodélicos, dado que podem produzir as alterações
acima mencionadas em intervalos de tempo relativamente curtos (uma ou
poucas sessões), difíceis de serem compreendidas por quem nunca teve uma
experiência psicodélica e, por vezes, incompatível com seu sistema de crenças
e valores, o que gera situações éticas mais complexas do que com os
medicamentos tradicionais. Explicar ao paciente sobre a ampla gama de
experiências que podem ser vivenciadas não é apenas parte da sessão
preparatória, mas também parte do consentimento esclarecido “reforçado”.
Brennan, W., Jackson, M. A., MacLean, K., & Ponterotto, J. G. (2021). A
qualitative exploration of relational ethical challenges and practices in
psychedelic healing. Journal of Humanistic Psychology, 00221678211045265.
Neste estudo qualitativo de desenho fenomenológico, 23 terapeutas (12 com algum

tipo de formação em psicoterapia, e todos com treinamento ou mentoria de pelo
menos 1 ano, em contextos underground, em psicodélicos) que administraram MDMA
e psilocibina a pelo menos 10 pacientes na vida, em contextos “underground” (não
legalizados), foram recrutados anonimamente e entrevistados com relação aos
desafios éticos vivenciados em sua prática. Dentre eles, a maior intensidade das
manifestações transferenciais e contratransferenciais (incuindo a necessidade de
reconhecimento e manejo de estados regressivos e a maior sensibilidade dos
pacientes a sensações e estados emocionais do terapeuta), a necessidade de maior
flexibilidade em relação a terapias de fala tradicionais, a tendência a ampliação dos
vínculos para além do tratamento, a maior vulnerabilidade dos pacientes e o uso do
toque são os principais desafios encontrados. A necessidade de supervisão constante,
a atenção as próprias questões e a importância do trabalho pessoal, incluindo as
próprias experiências psicodélicas, o reconhecimento dos limites em seu treinamento
e capacidades, o aumento da percepção sobre a adequação e momento certo do
toque, bem como a adoção de consentimento em dois estágios são estratégias
utilizadas pelos participantes para a manutenção de sua prática dentro de limites
éticos aceitáveis.

Seminário Ética

Uploaded by

Copyright:

Available Formats

Seminário Ética

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Seminário Ética

Uploaded by

Copyright:

Available Formats

Smith, W. R., & Sisti, D. (2021).

Ethics and ego dissolution: the case of

 The psychedelic experience is characterized by features unlike those of other

1. shifts in values and personality

 Presumably, if therapists are to employ touch at all, they should do so only if it is

 Three scenarios that merit distinct considerations.

Importante destacar: O processo de consentimento esclarecido deve ser mais

Neste estudo qualitativo de desenho fenomenológico, 23 terapeutas (12 com algum

You might also like