{"id":4253,"date":"2021-12-22T13:24:15","date_gmt":"2021-12-22T12:24:15","guid":{"rendered":"https:\/\/blogs.bmj.com\/medical-ethics\/?p=4253"},"modified":"2021-12-22T13:24:15","modified_gmt":"2021-12-22T12:24:15","slug":"respecting-autonomy-in-altered-states-navigating-ethical-quandaries-in-psychedelic-therapy","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/medical-ethics\/2021\/12\/22\/respecting-autonomy-in-altered-states-navigating-ethical-quandaries-in-psychedelic-therapy\/","title":{"rendered":"Respecting autonomy in altered states: Navigating ethical quandaries in psychedelic therapy"},"content":{"rendered":"

By Hannah McLane, Courtney Hutchison, Daniel Wikler, Timothy Howell, & Emma Knighton.<\/p>\n

Research into psychedelic-assisted therapy has grown in the past ten years as non-profits<\/a>, academic institutions<\/a>, pharmaceutical<\/a> companies, and even venture capitalists<\/a> race to develop protocols for using MDMA, psilocybin, ketamine, and other psychedelic substances to treat mental illness. Already, dozens of ketamine clinics across the country administer the medication off-label for depression, and MDMA- and psilocybin-assisted therapy are expected to be approved by the FDA in the coming years<\/a>.<\/p>\n

The use of psychedelics to catalyze psychotherapy represents a paradigm shift in medicine, charting new territory in how to ethically work with patients in altered states of consciousness. A recent string of allegations<\/a> against clinicians\u2014even against a clinician from an FDA clinical trial<\/a>\u2013for inappropriate touching of patients during psychedelic sessions has underscored the urgent need for clearer ethical guidelines within this burgeoning field. Given that therapeutic touch (e.g., holding a patient\u2019s hand) is a common aspect<\/a> of psychedelic-assisted therapy, navigating consent for touch\u2014and how it might shift while patients are under the influence of psychedelics\u2014represents an important ethical testing ground.<\/p>\n

Many protocols for psychedelic-assisted therapy cite<\/a> the use of \u201cnurturing touch\u201d as an \u201cimportant catalyst to healing\u201d. Because psychedelic experiences can include intense affect states and bring up past trauma, touch helps patients manage anxiety or provide a reparative experience<\/a> of support and care. To deprive a patient of touch in situations where touch is clinically indicated could replicate past experiences of neglect, but of equal importance, unwanted touch could retraumatize patients.<\/p>\n

\"\"<\/a>
Touch in a ketamine-assisted psychotherapy session. Copyright SoundMind Center.<\/figcaption><\/figure>\n

Though certain lines in clinical ethics are clear (e.g., prohibitions on sexual contact), more challenging issues arise for patients and clinicians alike when previously established patient preferences (e.g., those discussed during informed consent) shift during the session. For example, prior to the medicated session, patients may provide consent to, or specifically decline, having their hand held, only to make an opposite request while under the influence of the medicine. This presents clinicians with a quandary\u2014which request should they abide by?<\/p>\n

Though some organizations conducting psychedelic research have moved toward codifying ethics<\/a> around touch, scant<\/a> empirical work has been done in the field, and what exists highlights the need for clearer frameworks<\/a>. These discussions, however, have been limited by a dichotomous view of the self (sober vs. under the influence) that fails to recognize the complexity and nuance of psychological growth and healing during psychedelic sessions.<\/p>\n

The mechanism of change in psychedelic-assisted therapy depends on the individual under the influence being, at times, in better touch with their feelings and needs\u2014perhaps more attuned, more integrated, and more rational than the self mired in mental illness. Thus, requiring their choices during intake (e.g., allowing or barring therapeutic touch) to override those made subsequently during session may not only preclude opportunities for healing, but also fail to respect patient autonomy. Psychedelic-assisted sessions frequently generate intense thoughts and emotions\u2014even regression to childlike states\u2014rendering patients uniquely vulnerable. For clinicians, this may lead to a conflict within their fiduciary responsibilities\u2014honoring their patients\u2019 autonomy vs. making good faith efforts to do no harm and promote healing.<\/p>\n

One approach to this dilemma is to develop a view of the self as fluidly shifting, where capacity to consent is evaluated by clinicians in partnership with patients both before and during medicated sessions. The literature on trauma-informed practice provides some guidelines for navigating this process, such as trigger mapping to enhance clinician and patient understanding of potentially retraumatizing actions. A further avenue to explore draws upon the ethical literature on advanced directives and Ulysses contracts<\/a>\u2014a mechanism for committing a future self to desired action used previously in the mental health literature.<\/p>\n

Though assessing patient capacity for autonomy is central to these issues, ensuring the capacity of clinicians for ethical practice is also vitally important. The recent allegations of abuse highlight the need to identify clinicians who would use their position to do harm. However, even among the best-intentioned clinicians, the intensity of psychedelic-assisted sessions have been noted to catalyze strong feelings<\/a> in clinicians, which can in turn increase the risk of boundary violations. This issue can become compounded if dynamics of power, oppression, and privilege<\/a> go unacknowledged by the clinician, especially when working with marginalized patient populations. Thus, clinicians\u2019 capacity to recognize and manage their own feelings, thoughts, and responses must also be a vital part of ethical discussions and guidelines.<\/p>\n

To steer this new frontier in psychiatry toward safe, patient-clinician collaborative practice, further work is needed to synthesize rigorous ethical literature with emerging work on trauma, consciousness, and consent.<\/p>\n

 <\/p>\n

Authors<\/strong>: Hannah McLane, Courtney Hutchison, Daniel Wikler, Timothy Howell, & Emma Knighton<\/p>\n

Affiliations: <\/strong><\/p>\n

Hannah McLane, MD MA MPH, SoundMind Center<\/p>\n

Courtney Hutchison, LSW MSS MPH, Rutgers University School of Social Work\u00a0& SoundMind Center<\/p>\n

Daniel Wikler, PhD, Harvard\u00a0T.H. Chan\u00a0School of Public Health<\/p>\n

Timothy Howell, MD\u00a0MA,\u00a0University of Wisconsin School of Medicine and Public Health<\/p>\n

Emma Knighton, MA LMHC,\u00a0American Psychedelic Practitioners Association<\/p>\n

Competing interests<\/strong>: None.<\/p>\n

Social media accounts of post authors: <\/strong>Twitter: @HannahMcLaneMD; Instagram: soundmind.institute; Facebook: https:\/\/www.facebook.com\/soundmindphl<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

By Hannah McLane, Courtney Hutchison, Daniel Wikler, Timothy Howell, & Emma Knighton. Research into psychedelic-assisted therapy has grown in the past ten years as non-profits, academic institutions, pharmaceutical companies, and even venture capitalists race to develop protocols for using MDMA, psilocybin, ketamine, and other psychedelic substances to treat mental illness. Already, dozens of ketamine clinics […]<\/p>\n

Read More…<\/a><\/p>\n","protected":false},"author":354,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[968,8053,8083,8057],"tags":[],"class_list":["post-4253","post","type-post","status-publish","format-standard","hentry","category-clinical-ethics","category-consent","category-drug-policy","category-medical-ethics"],"yoast_head":"\nRespecting autonomy in altered states: Navigating ethical quandaries in psychedelic therapy - Journal of Medical Ethics blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/medical-ethics\/2021\/12\/22\/respecting-autonomy-in-altered-states-navigating-ethical-quandaries-in-psychedelic-therapy\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Respecting autonomy in altered states: Navigating ethical quandaries in psychedelic therapy - Journal of Medical Ethics blog\" \/>\n<meta property=\"og:description\" content=\"By Hannah McLane, Courtney Hutchison, Daniel Wikler, Timothy Howell, & Emma Knighton. Research into psychedelic-assisted therapy has grown in the past ten years as non-profits, academic institutions, pharmaceutical companies, and even venture capitalists race to develop protocols for using MDMA, psilocybin, ketamine, and other psychedelic substances to treat mental illness. Already, dozens of ketamine clinics [...]Read More...\" \/>\n<meta property=\"og:url\" content=\"https:\/\/blogs.bmj.com\/medical-ethics\/2021\/12\/22\/respecting-autonomy-in-altered-states-navigating-ethical-quandaries-in-psychedelic-therapy\/\" \/>\n<meta property=\"og:site_name\" content=\"Journal of Medical Ethics blog\" \/>\n<meta property=\"article:published_time\" content=\"2021-12-22T12:24:15+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/blogs.bmj.com\/medical-ethics\/files\/2021\/12\/Hannah_Steve_Patient.png\" \/>\n<meta name=\"author\" content=\"Hazem Zohny\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Hazem Zohny\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"4 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2021\\\/12\\\/22\\\/respecting-autonomy-in-altered-states-navigating-ethical-quandaries-in-psychedelic-therapy\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2021\\\/12\\\/22\\\/respecting-autonomy-in-altered-states-navigating-ethical-quandaries-in-psychedelic-therapy\\\/\"},\"author\":{\"name\":\"Hazem Zohny\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/#\\\/schema\\\/person\\\/e73152f6aa4e164c7d625d77cf4fed35\"},\"headline\":\"Respecting autonomy in altered states: Navigating ethical quandaries in psychedelic therapy\",\"datePublished\":\"2021-12-22T12:24:15+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2021\\\/12\\\/22\\\/respecting-autonomy-in-altered-states-navigating-ethical-quandaries-in-psychedelic-therapy\\\/\"},\"wordCount\":882,\"commentCount\":0,\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/#organization\"},\"image\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2021\\\/12\\\/22\\\/respecting-autonomy-in-altered-states-navigating-ethical-quandaries-in-psychedelic-therapy\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/files\\\/2021\\\/12\\\/Hannah_Steve_Patient.png\",\"articleSection\":[\"clinical ethics\",\"consent\",\"Drug policy\",\"Medical ethics\"],\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2021\\\/12\\\/22\\\/respecting-autonomy-in-altered-states-navigating-ethical-quandaries-in-psychedelic-therapy\\\/#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2021\\\/12\\\/22\\\/respecting-autonomy-in-altered-states-navigating-ethical-quandaries-in-psychedelic-therapy\\\/\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2021\\\/12\\\/22\\\/respecting-autonomy-in-altered-states-navigating-ethical-quandaries-in-psychedelic-therapy\\\/\",\"name\":\"Respecting autonomy in altered states: Navigating ethical quandaries in psychedelic therapy - Journal of Medical Ethics blog\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2021\\\/12\\\/22\\\/respecting-autonomy-in-altered-states-navigating-ethical-quandaries-in-psychedelic-therapy\\\/#primaryimage\"},\"image\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2021\\\/12\\\/22\\\/respecting-autonomy-in-altered-states-navigating-ethical-quandaries-in-psychedelic-therapy\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/files\\\/2021\\\/12\\\/Hannah_Steve_Patient.png\",\"datePublished\":\"2021-12-22T12:24:15+00:00\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2021\\\/12\\\/22\\\/respecting-autonomy-in-altered-states-navigating-ethical-quandaries-in-psychedelic-therapy\\\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2021\\\/12\\\/22\\\/respecting-autonomy-in-altered-states-navigating-ethical-quandaries-in-psychedelic-therapy\\\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2021\\\/12\\\/22\\\/respecting-autonomy-in-altered-states-navigating-ethical-quandaries-in-psychedelic-therapy\\\/#primaryimage\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/files\\\/2021\\\/12\\\/Hannah_Steve_Patient.png\",\"contentUrl\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/files\\\/2021\\\/12\\\/Hannah_Steve_Patient.png\",\"width\":877,\"height\":846,\"caption\":\"Touch in a ketamine-assisted psychotherapy session. Copyright SoundMind Center.\"},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2021\\\/12\\\/22\\\/respecting-autonomy-in-altered-states-navigating-ethical-quandaries-in-psychedelic-therapy\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Respecting autonomy in altered states: Navigating ethical quandaries in psychedelic therapy\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/#website\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/\",\"name\":\"Journal of Medical Ethics blog\",\"description\":\"A blog to discuss the ethics of medicine in its many guises and formats.\",\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/#organization\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"},{\"@type\":\"Organization\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/#organization\",\"name\":\"Journal of Medical Ethics blog\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/\",\"logo\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/#\\\/schema\\\/logo\\\/image\\\/\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/files\\\/2026\\\/04\\\/jme-logo.png\",\"contentUrl\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/files\\\/2026\\\/04\\\/jme-logo.png\",\"width\":200,\"height\":50,\"caption\":\"Journal of Medical Ethics blog\"},\"image\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/#\\\/schema\\\/logo\\\/image\\\/\"}},{\"@type\":\"Person\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/#\\\/schema\\\/person\\\/e73152f6aa4e164c7d625d77cf4fed35\",\"name\":\"Hazem Zohny\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/4d1bd322d5ff8e6f31a624003143903d0ba7346af8cdb1fd6b5e95924b92ece1?s=96&d=mm&r=g\",\"url\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/4d1bd322d5ff8e6f31a624003143903d0ba7346af8cdb1fd6b5e95924b92ece1?s=96&d=mm&r=g\",\"contentUrl\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/4d1bd322d5ff8e6f31a624003143903d0ba7346af8cdb1fd6b5e95924b92ece1?s=96&d=mm&r=g\",\"caption\":\"Hazem Zohny\"},\"sameAs\":[\"https:\\\/\\\/www.practicalethics.ox.ac.uk\\\/people\\\/dr-hazem-zohny\"],\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/author\\\/zohnyh\\\/\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Respecting autonomy in altered states: Navigating ethical quandaries in psychedelic therapy - Journal of Medical Ethics blog","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/blogs.bmj.com\/medical-ethics\/2021\/12\/22\/respecting-autonomy-in-altered-states-navigating-ethical-quandaries-in-psychedelic-therapy\/","og_locale":"en_US","og_type":"article","og_title":"Respecting autonomy in altered states: Navigating ethical quandaries in psychedelic therapy - Journal of Medical Ethics blog","og_description":"By Hannah McLane, Courtney Hutchison, Daniel Wikler, Timothy Howell, & Emma Knighton. Research into psychedelic-assisted therapy has grown in the past ten years as non-profits, academic institutions, pharmaceutical companies, and even venture capitalists race to develop protocols for using MDMA, psilocybin, ketamine, and other psychedelic substances to treat mental illness. Already, dozens of ketamine clinics [...]Read More...","og_url":"https:\/\/blogs.bmj.com\/medical-ethics\/2021\/12\/22\/respecting-autonomy-in-altered-states-navigating-ethical-quandaries-in-psychedelic-therapy\/","og_site_name":"Journal of Medical Ethics blog","article_published_time":"2021-12-22T12:24:15+00:00","og_image":[{"url":"https:\/\/blogs.bmj.com\/medical-ethics\/files\/2021\/12\/Hannah_Steve_Patient.png","type":"","width":"","height":""}],"author":"Hazem Zohny","twitter_card":"summary_large_image","twitter_misc":{"Written by":"Hazem Zohny","Est. reading time":"4 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"Article","@id":"https:\/\/blogs.bmj.com\/medical-ethics\/2021\/12\/22\/respecting-autonomy-in-altered-states-navigating-ethical-quandaries-in-psychedelic-therapy\/#article","isPartOf":{"@id":"https:\/\/blogs.bmj.com\/medical-ethics\/2021\/12\/22\/respecting-autonomy-in-altered-states-navigating-ethical-quandaries-in-psychedelic-therapy\/"},"author":{"name":"Hazem Zohny","@id":"https:\/\/blogs.bmj.com\/medical-ethics\/#\/schema\/person\/e73152f6aa4e164c7d625d77cf4fed35"},"headline":"Respecting autonomy in altered states: Navigating ethical quandaries in psychedelic therapy","datePublished":"2021-12-22T12:24:15+00:00","mainEntityOfPage":{"@id":"https:\/\/blogs.bmj.com\/medical-ethics\/2021\/12\/22\/respecting-autonomy-in-altered-states-navigating-ethical-quandaries-in-psychedelic-therapy\/"},"wordCount":882,"commentCount":0,"publisher":{"@id":"https:\/\/blogs.bmj.com\/medical-ethics\/#organization"},"image":{"@id":"https:\/\/blogs.bmj.com\/medical-ethics\/2021\/12\/22\/respecting-autonomy-in-altered-states-navigating-ethical-quandaries-in-psychedelic-therapy\/#primaryimage"},"thumbnailUrl":"https:\/\/blogs.bmj.com\/medical-ethics\/files\/2021\/12\/Hannah_Steve_Patient.png","articleSection":["clinical ethics","consent","Drug policy","Medical ethics"],"inLanguage":"en-US","potentialAction":[{"@type":"CommentAction","name":"Comment","target":["https:\/\/blogs.bmj.com\/medical-ethics\/2021\/12\/22\/respecting-autonomy-in-altered-states-navigating-ethical-quandaries-in-psychedelic-therapy\/#respond"]}]},{"@type":"WebPage","@id":"https:\/\/blogs.bmj.com\/medical-ethics\/2021\/12\/22\/respecting-autonomy-in-altered-states-navigating-ethical-quandaries-in-psychedelic-therapy\/","url":"https:\/\/blogs.bmj.com\/medical-ethics\/2021\/12\/22\/respecting-autonomy-in-altered-states-navigating-ethical-quandaries-in-psychedelic-therapy\/","name":"Respecting autonomy in altered states: Navigating ethical quandaries in psychedelic therapy - Journal of Medical Ethics blog","isPartOf":{"@id":"https:\/\/blogs.bmj.com\/medical-ethics\/#website"},"primaryImageOfPage":{"@id":"https:\/\/blogs.bmj.com\/medical-ethics\/2021\/12\/22\/respecting-autonomy-in-altered-states-navigating-ethical-quandaries-in-psychedelic-therapy\/#primaryimage"},"image":{"@id":"https:\/\/blogs.bmj.com\/medical-ethics\/2021\/12\/22\/respecting-autonomy-in-altered-states-navigating-ethical-quandaries-in-psychedelic-therapy\/#primaryimage"},"thumbnailUrl":"https:\/\/blogs.bmj.com\/medical-ethics\/files\/2021\/12\/Hannah_Steve_Patient.png","datePublished":"2021-12-22T12:24:15+00:00","breadcrumb":{"@id":"https:\/\/blogs.bmj.com\/medical-ethics\/2021\/12\/22\/respecting-autonomy-in-altered-states-navigating-ethical-quandaries-in-psychedelic-therapy\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/blogs.bmj.com\/medical-ethics\/2021\/12\/22\/respecting-autonomy-in-altered-states-navigating-ethical-quandaries-in-psychedelic-therapy\/"]}]},{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/blogs.bmj.com\/medical-ethics\/2021\/12\/22\/respecting-autonomy-in-altered-states-navigating-ethical-quandaries-in-psychedelic-therapy\/#primaryimage","url":"https:\/\/blogs.bmj.com\/medical-ethics\/files\/2021\/12\/Hannah_Steve_Patient.png","contentUrl":"https:\/\/blogs.bmj.com\/medical-ethics\/files\/2021\/12\/Hannah_Steve_Patient.png","width":877,"height":846,"caption":"Touch in a ketamine-assisted psychotherapy session. Copyright SoundMind Center."},{"@type":"BreadcrumbList","@id":"https:\/\/blogs.bmj.com\/medical-ethics\/2021\/12\/22\/respecting-autonomy-in-altered-states-navigating-ethical-quandaries-in-psychedelic-therapy\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/blogs.bmj.com\/medical-ethics\/"},{"@type":"ListItem","position":2,"name":"Respecting autonomy in altered states: Navigating ethical quandaries in psychedelic therapy"}]},{"@type":"WebSite","@id":"https:\/\/blogs.bmj.com\/medical-ethics\/#website","url":"https:\/\/blogs.bmj.com\/medical-ethics\/","name":"Journal of Medical Ethics blog","description":"A blog to discuss the ethics of medicine in its many guises and formats.","publisher":{"@id":"https:\/\/blogs.bmj.com\/medical-ethics\/#organization"},"potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/blogs.bmj.com\/medical-ethics\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"},{"@type":"Organization","@id":"https:\/\/blogs.bmj.com\/medical-ethics\/#organization","name":"Journal of Medical Ethics blog","url":"https:\/\/blogs.bmj.com\/medical-ethics\/","logo":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/blogs.bmj.com\/medical-ethics\/#\/schema\/logo\/image\/","url":"https:\/\/blogs.bmj.com\/medical-ethics\/files\/2026\/04\/jme-logo.png","contentUrl":"https:\/\/blogs.bmj.com\/medical-ethics\/files\/2026\/04\/jme-logo.png","width":200,"height":50,"caption":"Journal of Medical Ethics blog"},"image":{"@id":"https:\/\/blogs.bmj.com\/medical-ethics\/#\/schema\/logo\/image\/"}},{"@type":"Person","@id":"https:\/\/blogs.bmj.com\/medical-ethics\/#\/schema\/person\/e73152f6aa4e164c7d625d77cf4fed35","name":"Hazem Zohny","image":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/secure.gravatar.com\/avatar\/4d1bd322d5ff8e6f31a624003143903d0ba7346af8cdb1fd6b5e95924b92ece1?s=96&d=mm&r=g","url":"https:\/\/secure.gravatar.com\/avatar\/4d1bd322d5ff8e6f31a624003143903d0ba7346af8cdb1fd6b5e95924b92ece1?s=96&d=mm&r=g","contentUrl":"https:\/\/secure.gravatar.com\/avatar\/4d1bd322d5ff8e6f31a624003143903d0ba7346af8cdb1fd6b5e95924b92ece1?s=96&d=mm&r=g","caption":"Hazem Zohny"},"sameAs":["https:\/\/www.practicalethics.ox.ac.uk\/people\/dr-hazem-zohny"],"url":"https:\/\/blogs.bmj.com\/medical-ethics\/author\/zohnyh\/"}]}},"_links":{"self":[{"href":"https:\/\/blogs.bmj.com\/medical-ethics\/wp-json\/wp\/v2\/posts\/4253","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.bmj.com\/medical-ethics\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.bmj.com\/medical-ethics\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.bmj.com\/medical-ethics\/wp-json\/wp\/v2\/users\/354"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.bmj.com\/medical-ethics\/wp-json\/wp\/v2\/comments?post=4253"}],"version-history":[{"count":0,"href":"https:\/\/blogs.bmj.com\/medical-ethics\/wp-json\/wp\/v2\/posts\/4253\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.bmj.com\/medical-ethics\/wp-json\/wp\/v2\/media?parent=4253"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.bmj.com\/medical-ethics\/wp-json\/wp\/v2\/categories?post=4253"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.bmj.com\/medical-ethics\/wp-json\/wp\/v2\/tags?post=4253"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}