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

Psychedelics are experiencing a renaissance in mental healthcare. In recent years, more and more early phase trials on psychedelic-assisted therapy have been conducted, with promising results overall. However, ethical analyses of this rediscovered form of treatment remain rare. The present paper contributes to the ethical inquiry of psychedelic-assisted therapy by analysing the ethical implications of its therapeutic mechanisms proposed by the relaxed beliefs under psychedelics (REBUS) hypothesis. In short, the REBUS hypothesis states that psychedelics make rigid beliefs revisable by increasing (...) the influence of bottom-up input. Put differently, patients become highly suggestible and sensitive to context during a psychedelic session, amplifying therapeutic influence and effects. Due to that, patients are more vulnerable in psychedelic-assisted therapy than in other therapeutic interventions; they lose control during a psychedelic session and become dependent on the therapeutic setting (including the therapist). This enhanced vulnerability is ethically relevant and has been exploited by some therapists in the past. Therefore, patients in current research settings and starting mainstream medical settings need to be well informed about psychedelics’ mechanisms and their implications to give valid informed consent to treatment. Furthermore, other security measures are warranted to protect patients from the vulnerability coming with psychedelic-assisted therapy. (shrink)

Since its publication in 2014, L. A. Paul's book Transformative Experience has sparked many discussions in philosophy and beyond. Her main argument is that experiences we have not had before can transform us epistemically (i.e., we learn something we could not learn without the experience) and personally (i.e., our point of view changes radically). This has implications for decision theory in particular, but also for other fields. The present paper provides an overview of how transformative experiences are thought to challenge (...) rational choice and how authors have responded to this challenge (with a focus on the epistemic transformation). Furthermore, it also shows how the concept of transformative experience has been fruitful beyond the decision-theoretical context, with a particular focus on illness, medical treatment, and the ethical issues involved. Finally, the paper presents open questions in the literature on transformative experiences. (shrink)

A psychedelic renaissance is currently taking place in mental healthcare. The number of psychedelic-assisted therapy trials is growing steadily, and some countries already grant psychiatrists special permission to use psychedelics in non-research contexts under certain conditions. These clinical advances must be accompanied by ethical inquiry. One pressing ethical question involves whether patients can even give informed consent to psychedelic-assisted therapy: the treatment’s transformative nature seems to block its assessment, suggesting that patients are unable to understand what undergoing psychedelic-assisted therapy actually (...) means for them and whether it aligns with their values. The present paper argues that patients often have sufficient knowledge to give informed consent because they know that they want to change their negative status quo and that psychedelic-assisted therapy offers an effective way to do so. Accordingly, patients can understand what the transformative nature of psychedelic-assisted therapy means for them and a make a value-aligned choice even if they are unable to anticipate the manifestation of a psychedelic experience. (shrink)

According to L. A. Paul (2014), transformative experiences pose a challenge for decision theory, as their subjective value is not epistemically accessible. However, several authors propose that the subjective values of options are often irrelevant to their ranking; in many cases, all we need for rational transformative decision-making are the known non-subjective values. This stance is in conflict with Paul’s argument that the subjective value can always swamp the non-subjective value. The approach presented in this paper takes Paul’s argument into (...) account and shows how potential swamping can be controlled given that one desires the transformative outcome: If one knows from previous decisions that desired transformative outcomes are associated with positive subjective value and if, in addition, testimony confirms this association for the current decision situation, one can infer that a desired outcome’s expected subjective value has a positive valence. Accordingly, one can rationally choose the desired transformative option if its non-subjective value is no lower than the overall value of any other option. (shrink)

In recent years, an old challenge to informed consent has been rediscovered: the challenge of ignorance. Several authors argue that due to the presence of irreducible ignorance in certain treatments, giving informed consent to these treatments is not possible. The present paper examines in what ways ignorance is believed to prevent informed consent and which treatments are affected by that. At this, it becomes clear that if the challenge of ignorance truly holds, it poses a major problem to informed consent. (...) The paper argues, however, that from both an empirical and a theoretical point of view, it is not convincing that ignorance prevents informed consent. Still, it seems important that the presence of irreducible ignorance is openly discussed during the informed consent process. (shrink)

According to Paul (Transformative experience, 1st edn, Oxford University Press, 2014), transformative experiences pose a challenge to decision theory since their value cannot be anticipated. Building on Pettigrew’s (in: Lambert, Schwenkler (eds) Becoming someone new: essays on transformative experience, choice, and change, Oxford University Press, pp 100–121, 2020) redescription, this paper presents a new approach to how and when transformative decisions can nevertheless be made rationally. Thanks to fundamental higher-order facts that apply to any kind of experience, an agent always (...) at least knows the general shape of the utility space. This in combination with the knowledge about the non-transformative alternative in the choice set can enable rational decision-making despite the presence of a transformative experience. For example, this paper’s approach provides novel arguments for why gender transition (cf. McKinnon in Res Philosophica 92(2):419–440, 2015) or staying childfree (cf. Barnes in Philos Phenomenol Res 91(3):775–786, 2015) can be rational. (shrink)

According to L. A. Paul, the subjective value of an outcome is normally assessed by running a cognitive model of what it would be like if that outcome were to occur. However, cognitive models, along with the expectations in which they result, are unreliable for application to transformative experiences because we cannot know what it would be like for an outcome to occur if we have never experienced it before. This paper argues that despite their unreliability, expectations are still important (...) in the case of chosen and unchosen transformative experiences because expectations about an outcome can systematically influence the very experience of that outcome. More precisely, empirical research shows that affective experiences tend to assimilate to affective expectations. In turn, more positive affective experiences lead, ceteris paribus, to higher subjective value. Therefore, rational agents confronting transformative outcomes should form or cultivate positive/optimistic affective expectations since, all else being equal, that maximizes subjective value. (shrink)

Classic serotonergic psychedelics are experiencing a clinical revival, which has also revived ethical debates about psychedelic-assisted therapy. A particular issue here is how to prepare and protect patients from the vulnerability that the psychedelic state creates. This article first examines how this vulnerability manifests itself, revealing that it results from an impairment of autonomy: psychedelics diminish decision-making capacity, reduce controllability, and limit resistance to external influences. It then analyzes the strengths and weaknesses of five safety measures proposed in the literature, (...) what aspect of the patient’s vulnerability they seek to reduce, and how they can be optimized. The analysis shows that while preparatory sessions, advance directives, and specific training and oversight are useful, starting with a lower dosage and no therapy is less so. Finally, the article presents a safety measure that has been overlooked in the literature but could be highly effective and feasible: bringing a close person to the psychedelic session. (shrink)

This Open-Access-book examines the phenomenon of discrimination using a descriptive approach. Discrimination is omnipresent, whether it is people who discriminate against other people or, more recently, also machines that discriminate against people. The first part of the analysis employs decision theory on discrimination, leading to two fundamental subtypes: taste-based discrimination and statistical discrimination. The second part links taste-based discrimination to social identity theory, demonstrates that not all taste-based discrimination is ultimately statistical discrimination, and reveals the evolutionary origins of our tastes. (...) The third part surveys how people get their beliefs for statistical discrimination and thereby shows that they often deviate from Bayesianism: they have inherent prior beliefs and do not exclusively update their beliefs according to Bayes’ law. Additionally, the analysis of belief formation highlights the importance of the learning environment. The last part reassembles the previously dissected aspects of discrimination, presents a new descriptive model of discrimination, and lists five implications for a normative theory of discrimination. (shrink)

The end of a long-term romantic relationship ranks among the most stressful and momentous events in life. Thus, the decision of whether to break up with someone whom one has been with for many years should generally be made very carefully. Unfortunately, decision theory is often thought to be unable to provide rational guidance in such high-stake life choices due to the outcomes’ presumed transformative character. The present paper shows how agents can rationally decide whether to leave their romantic partner (...) even if the decision is transformative. It does so by using a novel five-level account of transformative decision-making, which can also be used for other key life choices, and which is the first to integrate in a systematic way several approaches for making (certain types of) transformative decisions that have been proposed in recent years. (shrink)

Ignorance is said to be the most widely accepted explanation of what makes choices hard (Chang 2017). But despite its apparent popularity, the debate on hard choices has been dominated by tetrachotomist (e.g., “parity”) and vagueness views. In fact, there is no elaborate ignorance account of hard choices. This article closes this research gap. In so doing, it connects the debate on hard choices with that on transformative experiences (Paul 2014). More precisely, an option’s transformative character can prevent us from (...) epistemically accessing its expected value, promoting ignorance of how to rank the options. Methods of achieving an advance assessment of transformative experiences such as fine-graining, consulting testimony, and using higher-order facts can sometimes evade this epistemic blockade, but not always. Therefore, in cases where these methods fail, a choice can be hard because of our ignorance. The prominent hard choice between two careers could be such a case. (shrink)

Psychedelics are experiencing a renaissance in clinical research. In recent years, an increasing number of studies on psychedelic-assisted treatment have been conducted. So far, the results are promising, suggesting that this new (or rather, rediscovered) form of therapy has great potential. One particular reason for that appears to be the synergistic combination of the pharmacological and psychotherapeutic interventions in psychedelic-assisted treatment. But how exactly do these two interventions complement each other? This paper provides the first account of the interaction between (...) pharmacological and psychological effects in psychedelic-assisted treatment. Building on the relaxed beliefs under psychedelics (REBUS) hypothesis of Carhart-Harris and Friston and the contextual model of Wampold, it argues that psychedelics amplify the common factors and thereby the remedial effects of psychotherapy. More precisely, psychedelics are assumed to attenuate the precision of high-level predictions, making them more revisable by bottom-up input. Psychotherapy constitutes an important source of such input. At best, it signalizes a safe and supportive environment (cf. setting) and induces remedial expectations (cf. set). During treatment, these signals should become incorporated when high-level predictions are revised: a process that is hypothesized to occur as a matter of course in psychotherapy but to get reinforced and accelerated under psychedelics. Ultimately, these revisions should lead to a relief of symptoms. (shrink)

Stereotypes are often described as being generally inaccurate and irrational. However, for years, a minority of social psychologists has been proclaiming that stereotype accuracy is among the most robust findings in the field. This same minority also opposes the majority by questioning the power of self-fulfilling prophecies and thereby the construction of social reality. The present paper examines this long-standing debate from the perspective of predictive processing, an increasingly influential cognitive science theory. In this theory, stereotype accuracy and self-fulfilling prophecies (...) are two sides of the same coin, namely prediction error minimisation, pointing to a new middle course between the two existing views. On the one hand, predictive processing indicates that depicting stereotypes as generally inaccurate runs counter to their actual purpose of making the social world predictable, which supports the minority view. On the other hand, predictive processing supposes that expectations, including stereotypes, permanently affect perception and behaviour and thereby co-construct social reality, which supports the majority view. Therefore, from a predictive processing perspective, stereotypes are largely rational and not per se inaccurate, and self-fulfilling prophecies are omnipresent and greatly affect social reality. This new middle course appears to fit the empirical data better than the two existing views. (shrink)

In the standard volunteer’s dilemma (VoD), a single prosocial act (i.e., volunteering) yields the optimal overall outcome. Whereas the volunteer’s outcome is certain, the defector’s outcome depends on what others do. This research addressed the confounding of prosocial responses with uncertainty avoidance in the standard VoD. In Experiment 1, participants (N = 102) considered 18 hypothetical one-shot two-person VoD scenarios with certain, risky, and uncertain outcomes when volunteering. In Experiment 2, participants (N = 496) considered three hypothetical one-shot two-person VoD (...) scenarios; a certain VoD and two uncertain VoDs of which one had a lower expected collective outcome of volunteering than the certain VoD and the other a higher one. Results suggest that volunteering does not reflect a desire to avoid uncertainty but to maximize expected collective outcomes, reinforcing the assumption that the high volunteering rates we see in a standard VoD are due to social/moral preferences and social projection. (shrink)

The presence of unusual features in psychedelic treatments has led to the argument that these treatments are exceptional within medicine and should therefore also be treated as exceptional when ana...