Academic reflects on bioethical issues in medicalization of psychedelics

Australian researcher cites need to explore ethical issues regarding the use of psychedelics as medicine.

Riccardo Miceli McMillan says bioethicists should pay attention because psychedelics “induce noteworthy changes in human cognition”. Danylana/Getty Images


Many agree that psychedelics hold a lot of promise in treating an array of mental and physical conditions.

Recent years have seen a revival in interest about these mind-altering substances, and research into medical uses is rapidly advancing.

However, the exploration of ethical issues regarding the use of psychedelics in medicine appears to be lagging behind.

It’s a matter that has caught the attention of Riccardo Miceli McMillan, an academic based in Australia.

McMillan is currently pursuing two graduate degrees in the philosophy of medicine and bioethics.

He believes that a discussion on the ethical use of medical advances in the field of psychedelics is warranted.

As McMillan stated in notes to CannCentral that the absence of such conversation is “surprising to say the least”.

“The lack of apparent bioethics interest in the challenges of psychedelic medicalization struck me as a gross injustice that required immediate addressing,” McMillan said.

And so what the Australian academic did was write a paper outlining a number of bioethical concerns regarding the use of psychedelics in medicine.

On September 15, 2021, the Journal of Psychedelic Studies published online his paper titled “Global bioethical challenges of medicalising psychedelics”.

In his work, McMillan noted that it is undisputed that psychedelic substances “induce noteworthy changes in human cognition”.

“As such, it is imperative that bioethicists play a role in guiding the use of these compounds,” he wrote.

In approaching the subject, McMillan employed frameworks developed by German philosopher Martin Heidegger and Swedish intellectual Fredrik Svenaeus.

McMillan explained to CannCentral that Heidegger’s critique of modern technology is valuable.

“In particular, Heidegger argued that modern technologies ‘Enframed’ our understanding of the world, such that these technologies only allow us to understand the world as a resource, and in doing so, erase other ways of understanding the world,” McMillan said.

McMillan went on to say that the “process of turning psychedelic compounds into modern medical technologies risks ‘Enframing’ psychedelic states of consciousness, ecological sources of psychedelic compounds, and cultural contexts of psychedelic practices”.

“That is to say that medicalization risks limiting humanity’s understanding of psychedelic states of consciousness, ecological sources of psychedelic compounds, and cultural contexts of psychedelic practices by transforming them only into medical resources and erasing other ways of understanding them,” the academic stated.

He believes that this could lead to unwanted results.

“I warn that this shift in understanding is, and will continue to have, detrimental consequences such as decreased therapeutic efficacy, endangerment of ecosystems, and perpetuation of cultural injustices,” McMillan said.

Moreover, McMillan suggested that the solution does not lie in rejecting the use of psychedelics in medicine.

Rather, it’s to “ensure that the diverse array of ways in which psychedelics are understood is protected”.

“In particular, I suggest that traditional, non-reductionist ways of understanding psychedelics need to be preserved and integrated with medical ways of understanding psychedelics,” McMillan explained.

In his paper, McMillan noted that as hallucinogenic compounds “undergo the process becoming medical technologies … psychedelic experiences are likely to become reduced to neurochemical resources”.

“That is to say that psychedelic experiences (and their utility for human goals) are at risk of being explained at purely a neurochemical level of analysis,” he wrote.

To illustrate, McMillan pointed out that so-called “mystical-like” experiences and the therapeutic effects these bring about could “become understood purely with reference to disruptions of neural networks or alterations in neurotransmitters”.

“In losing other non-reductionist modes of revealing psychedelic experiences, I argue that the effectiveness of psychedelic-assisted psychotherapy will be diminished,” he stated.

McMillan asked what other “potential applications” may be “concealed” if non-therapeutic ways of understanding psychedelic experiences are lost.

“Research demonstrates that psychedelics can engender profound, life altering experiences,” he noted in the paper.

Additionally, “In understanding these experiences only as therapeutic resources, is the power of such experiences being held hostage by the medical model?”

McMillan argued that “preserving different ways of understanding psychedelic experiences will elucidate other ways in which we should, at least consider, using psychedelics in society”.

He cited as an example that “shamanic modes of revealing psychedelic experiences might suggest that these experiences represent connections with the divine”.

Meanwhile, the so-called psychonautic approach may posit that these experiences “represent a form of deep self-knowledge”.

As well, “recreational modes of revealing psychedelic experiences might suggest that these experiences represent intrinsically pleasurable states”.

Follow Carlito Pablo on Twitter at @carlitopablo

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