This commentary (2021) argues that psychedelic-using communities ought to be included in bioethical discussions that guide normative elements of psychedelic medicalisation. At present, there is no bioethics literature involving these communities. It is argued that psychedelic-using communities have a degree of epistemic expertise regarding psychedelics and that these communities are uniquely and heavily affected by psychedelic medicalisation.

Abstract

“Psychedelic compounds are regaining widespread interest due to emerging evidence surrounding their therapeutic effects. The controversial nature of these compounds highlights the need for extensive bioethical input to guide the process of medicalisation. To date, there is no bioethics literature that consults the voices of psychedelic-using communities in order to help guide normative considerations of psychedelic medicalisation. In this paper, I argue that psychedelic-using communities ought to be included in bioethical discussions that guide normative elements of psychedelic medicalisation. I argue this by presenting two points. First, psychedelic-using communities hold a degree of epistemic expertise regarding psychedelics by virtue of their embodied experiences with these compounds. Therefore, these communities are able to identify normative considerations that communities without embodied experiences would overlook. Second, psychedelic-using communities are uniquely and heavily affected by psychedelic medicalisation. Therefore, the needs of these communities ought to be considered when evaluating and implementing normative changes that alter psychedelic usage in society. The counterargument that psychedelic-using communities should not guide normative considerations of psychedelic medicalisation is presented by highlighting empirical data that suggest groups of the public with embodied experiences regarding a topic are less able to engage in deliberative reasoning on the said topic than the lay public. However, I propose that even if this is the case, psychedelic-using communities are owed consultation by agents of psychedelic medicalisation in order to undo and cease perpetuating epistemic injustice against these communities.”

Authors: Riccardo M. McMillan

Summary

INTRODUCTION

Psychedelics are regaining widespread interest as research demonstrates the potentially therapeutic applications of these compounds. However, the therapeutic use of these compounds remains controversial.

Despite an emerging bioethics literature on psychedelics, there is a paucity of research that consults psychedelic-using communities to evaluate the suggestions these communities may have regarding the future of psychedelic medicalisation. This raises concerns regarding potential epistemic harms committed against psychedelic-using communities.

In the following I will argue that psychedelic-using communities should guide normative considerations for psychedelic medicalisation. This is because these communities have a degree of epistemic expertise regarding psychedelics and are uniquely affected by the medicalisation of psychedelics.

In this paper I argue that psychedelic-using communities should not be involved in guiding normative considerations for psychedelic medicalisation, however, I also argue that even if this limitation could not be overcome, psychedelic-using communities are still owed consultation by agents of psychedelic medicalisation.

THE ROLE OF PUBLIC OPINION IN BIOETHICS

Public opinion can be used to guide normative considerations in bioethics in three ways: to identify and characterise ethical issues, to provide data to support justifications from moral theories that rely on certain empirical realities, and to guide policy makers on how to implement certain normative changes.

Despite the aforementioned uses, there are also normative challenges when consulting public opinion in bioethics, including concerns regarding who should be consulted, how public opinion should be collected, and if public opinion should even be collected at all.

TUNING IN TO PSYCHEDELIC-USING COMMUNITIES

I propose that psychedelic-using communities should guide normative considerations for psychedelic medicalisation. This is because these communities hold a degree of epistemic expertise regarding psychedelics, and because these communities are uniquely affected by the medicalisation of psychedelics.

Epistemic expertise of psychedelic-using communities

Epistemology refers to the philosophical investigation of knowledge. Three types of knowledge are distinguished by epistemologists: knowledge that, knowledge how, and knowledge by acquaintance.

Psychedelic experiences are argued to provide users with knowledge of their previously unconscious mental states, self- knowledge into one’s thought patterns, and knowledge on how to skilfully navigate altered states of consciousness.

Psychedelic-using communities have gained knowledge regarding psychedelics and how they interact with human experience. This knowledge is evidently respected in some aspects of psychedelic medicalisation. Respecting the knowledge of those with lived-experience of a particular phenomenon is perhaps self- evident when one is seeking to replicate the said phenomenon. Similarly, psychedelic-using communities are authorities on the potential normative challenges faced by increasing psychedelic use in society.

Psychedelic-using communities as ‘being affected’

One of the normative challenges of public consultation in bioethics involves deciding which parts of the public to consult. Groups classified as being affected should be consulted due to their epistemic expertise and because normative changes regarding said matter will often have a more significant impact on them.

Psychedelic-using communities should be represented in discussions regarding normative aspects of medicalisation of psychedelics, as their experiences and attitudes will have a substantial impact on the process of medicalisation. This is important for ‘moral pragmatics’ when regulators seek to implement policies that alter how psychedelics are used in society.

THE EPISTEMIC SHORTCOMINGS OF ‘BEING AFFECTED’

Those who are being affected are less likely to include perspectives that go beyond their own personal experience when making normative decisions, and are therefore less likely to engage in deliberative reasoning. This could be used to argue that psychedelic-using communities are too epistemologically ‘self-centred’ to guide normative considerations of psychedelic medicalisation.

Ignoring the fact that the medicalisation movement may have impaired deliberative reasoning, I suggest that psychedelic-using communities are owed consultation by the medicalisation movement.

Epistemic injustice towards psychedelic- using communities has arguably led to testimonial injustice, whereby the testimony of psychedelic- using communities regarding psychedelic experiences is treated as untrustworthy, purely due to the social prejudices against the perceived identity of the speaker in the mind of the listener.

The testimonial injustice against psychedelic-using communities should be a cause of great concern for agents of psychedelic medicalisation. These communities have a degree of expertise regarding psychedelic compounds, and their history of advocating for the potential therapeutic effects of psychedelic compounds should be considered.

CONCLUSION

Psychedelic-using communities should play a role in guiding normative considerations for the medicalisation of psychedelic compounds, as they will be uniquely and heavily affected by medically focussed normative frameworks that inevitably emerge to regulate psychedelic usage in society. I argued that psychedelic-using communities are still owed consultation, due to the epistemic injustice committed against them. While these voices have certain epistemic limitations, they also have certain epistemic advantages, which have been continuously ignored.