Protecting patient autonomy in psychedelic-assisted psychotherapy: a nursing ethics perspective

Psychedelic-assisted psychotherapy (PAP) has re-emerged over the past decade as a promising therapeutic approach for a range of mental health conditions, including treatment-resistant depression, post-traumatic stress disorder, anxiety associated with life-threatening illness, and substance use disorders. Substances such as psilocybin, MDMA, ketamine, and LSD are being studied and, in some contexts, clinically applied under controlled conditions. While early evidence suggests significant therapeutic potential, PAP also raises complex ethical challenges, particularly concerning the protection of patient autonomy. The altered states of consciousness induced by psychedelics can heighten suggestibility, emotional vulnerability, and dependency on therapists, thereby complicating traditional models of informed consent, voluntariness, and decision-making capacity. Nurses, as patient advocates and ethical practitioners, occupy a critical position in safeguarding autonomy throughout PAP processes. This article critically examines the ethical principle of autonomy within the context of psychedelicassisted psychotherapy from a nursing ethics perspective. Drawing on contemporary ethical frameworks and empirical literature from the last decade, the article explores informed consent, power dynamics, relational autonomy, cultural considerations, risk mitigation, and professional accountability. Eight figures and three tables are integrated to enhance conceptual clarity. Overall, the article argues that nurses play an indispensable role in upholding patient autonomy through ethical vigilance, therapeutic presence, advocacy, and adherence to professional standards in emerging psychedelic therapies.