Healthcare policy impacts many areas because health is a function of numerous intersecting variables, commonly referred to as health determinants (Longest, 2009). These variables include human biology and behavior, social and physical environments, policies and interventions, and quality health services ( Healthy People, 2019). Health policies are established at federal, state, and local levels and generally impact a group of individuals or a type of organization (Longest, 2009). Because health policies can affect several areas, it is critical that leaders carefully evaluate potential consequences and ethical dilemmas. The primary goal of health policy, from the perspective of the government, is to enhance health or aid its pursuit. This is important to keep in mind as we dive deeper into the ethical impact of healthcare policy and the role of ethics surrounding hallucinogenic drugs and their respective policies.
Longest (2009) recommends that policymaking should be guided by four philosophical principles: respect for autonomy, justice, beneficence, and nonmaleficence. The Patient Self-Determination Act of 1990 gave individuals the ability to make decisions about their medical care: freedom of choice and the right to the integrity of body and mind. Opposite of this is Paternalism, where someone else determines what is best for people (Longest, 2009). The principle of justice posits that all people should have equal access to the benefits of health services. Beneficence is reflected in policies that provide tangible benefits and seek to do good. Nonmaleficence is strongly linked with medical ethics and “do no harm.” This principle is evident in policies ensuring the safety and quality of medical products and care.
All of the principles described above are related to the topic of psychedelic medicine, but autonomy seems to stand out the most. The current scheduling of psychedelics limits extensive research, as I discussed in my first post. Preliminary clinical trials have demonstrated efficacy in the treatment of certain mental health disorders. The primary goal of health policy is to enhance health and aid its pursuit. Limiting research into drugs that could help those who are suffering is in direct opposition to the primary goal of health policy and the autonomy of individuals. As a health professional, I also understand the responsibility we have to “do no harm.” Thus, beneficence and nonmaleficence also play a large role if a change to the classification of these drugs is to occur.
In 1968, American Psychologist Charles Tart stated, “despite our professional status, we have no real control over who will and will not use psychedelics” (Tart, 1968, pp.456). He further discusses how we do very little as a culture to provide guiding information to influence how they are used. Knowing that individuals are autonomous and have the right to pursue health according to their values and beliefs, we can lean into viewing this as an opportunity to guide individuals who choose this route. The risk to participants in drug trials may be justified if the trial has significant clinical or social value. Peterson, Tagliazucchi, and Weijer (2019) state that appropriate questions to pose would be: is the trial’s research question relevant to answering an insistent clinical hypothesis, and does it address a significant scientific or social problem? With the opiate crisis remaining an issue, and individuals with treatment-resistant mental health disorders, alternative treatments are necessary. Allowing more clinical trials may help to discover other efficacious treatment for this significant social problem. Hallucinogens do not produce neurotoxic effects, have a low-risk of dependence, and do not produce withdrawal (Johnson, Richards, & Griffiths, 2008). Strategies for safety in trials include psychiatric screening, use of monitors/facilitating staff, development of a therapeutic relationship, a comfortable, relaxing environment, education on a range of possible experiences, and the availability of medical staff to treat any acute or adverse reactions (Johnson, Richards, & Griffiths, 2008).
The overarching goal is to improve the efficacy of treatment for individuals who are suffering. Harmful effects can be minimized in a controlled clinical environment. Individuals have a right to medical care that may benefit them, regardless of the judgments, opinions, and false perceptions of others. Policymakers resistant to change should explore any limiting beliefs they may have about hallucinogens. If we can remain focused on helping others and adhere to strict ethical principles, then change in this arena is possible.
References
Healthy People 2020. (2019, April 1). https: //www.cdc.gov/nchs/healthy_people/hp2020.htm
Johnson, M. W., Richards, W. A., & Griffiths, R. R. (2008). Human hallucinogen research: Guidelines for safety. Journal of Psychopharmacology, 22(6), 603-620. doi:http://dx.doi.org.ezproxy1.lib.asu.edu/10.1177/0269881108093587
Longest, B. B. (2009). Health Policymaking in the United States (5th ed.). Chicago, IL: Health Administration Press.
Peterson, A., Tagliazucchi, E., & Weijer, C. (2019, August 6). The ethics of psychedelic research in disorders of consciousness. Neuroscience of Consciousness, 5(1). https://doi.org/10.1093/nc/niz013
Tart, C. T. (1968). Ethics and psychedelic drugs. American Psychologist, 23(6), 455-456. doi:http://dx.doi.org.ezproxy1.lib.asu.edu/10.1037/h0037712
