Miceli McMillan Riccardo
University of Queensland, Brisbane, Queensland, Australia
University of Sydney, Sydney, New South Wales, Australia.
J Med Ethics. 2021 Oct;47(10):701-705. doi: 10.1136/medethics-2020-106619. Epub 2020 Nov 4.
The recent renaissance in research on psychedelic-assisted psychotherapy is showing great promise for the treatment of many psychiatric conditions. Interestingly, therapeutic outcomes for patients undergoing these treatments are predicted by the occurrence of a mystical experience-an experience characterised in part by a sense of profound meaning. This has led to hypotheses that psychedelic-assisted psychotherapy is therapeutic because it enhances perception of meaning, and consequently leads to a meaning response (a therapeutic mechanism that has been well described in the philosophical literature on the placebo effect). The putative mechanism of action of psychedelics as meaning enhancers raises normative ethical questions as to whether it can be justified to pharmacologically increase the perception of meaning in order to heal patients. Using the perspectives of hedonistic moral theories, this paper argues that if psychedelics operate as meaning enhancers, psychedelic-assisted psychotherapy can be ethically justified. An anti-hedonistic objection is presented by applying Robert Nozick's Experience Machine thought experiment to the case of psychedelic-assisted psychotherapy. However, it is argued that this objection falls short for two reasons. First, even if pleasure and pain are not the only consequences which have moral value they are not morally irrelevant, therefore, therapeutic meaning enhancement can still be justified in cases of extreme suffering. Second, it is possible that psychedelic states of consciousness do not represent a false reality, hence their therapeutic meaning enhancement is not problematic according to Nozick's standards.
近期对迷幻剂辅助心理治疗的研究复兴，为许多精神疾病的治疗带来了巨大希望。有趣的是，接受这些治疗的患者的治疗效果可由神秘体验的发生来预测——这种体验部分特征是具有深刻的意义感。这引发了一些假说，即迷幻剂辅助心理治疗具有治疗作用是因为它增强了对意义的感知，从而引发意义反应（这是安慰剂效应哲学文献中已充分描述的一种治疗机制）。迷幻剂作为意义增强剂的假定作用机制引发了规范性伦理问题，即从药理学角度增加意义感知以治愈患者是否合理。本文从享乐主义道德理论的视角出发，认为如果迷幻剂起到意义增强剂的作用，那么迷幻剂辅助心理治疗在伦理上是合理的。通过将罗伯特·诺齐克的体验机思想实验应用于迷幻剂辅助心理治疗的案例，提出了一种反享乐主义的反对意见。然而，有人认为这种反对意见存在两个不足之处。首先，即使快乐和痛苦并非具有道德价值的唯一后果，但它们并非在道德上无关紧要，因此，在极端痛苦的情况下，治疗性的意义增强仍然是合理的。其次，迷幻意识状态有可能并不代表虚假的现实，因此，根据诺齐克的标准，其治疗性的意义增强并无问题。
