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Peer-reviewedCC BYThe oncologist

Aspirational autonomy and psychedelic-assisted therapy in advanced cancer: ethical lessons from clinical cases.

  • Keenan Wills Davis1,2
  • Michelle C Bach2,3,4
  • JoEllen Schimmels5
  • Ali John Zarrabi2,3,6,7
7 affiliations
  1. 1Emory University School of Medicine, Emory University, Atlanta, GA 30322, United States.
  2. 2Emory Center for Psychedelics and Spirituality, Emory University, Atlanta, GA 30322, United States.
  3. 3Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Emory University, Atlanta, GA 30322, United States.
  4. 4Emory Center for Ethics, Emory University, Atlanta, GA 30322, United States.
  5. 5Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA 30322, United States.
  6. 6Division of Palliative Medicine, Emory University School of Medicine, Emory University, Atlanta, GA 30322, United States.
  7. 7Department of Family and Preventive Medicine, Emory University School of Medicine, Emory University, Atlanta, GA 30322, United States.
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Abstract

Psychedelic-assisted therapy (PAT) is increasingly discussed as a potential intervention for anxiety, depression, and existential distress among patients with advanced cancer. Yet the ethical challenges of PAT for patients approaching the end of life remain underdeveloped, particularly for oncologists who may be asked to counsel patients or consider referral to clinical trials. This article uses 3 deidentified clinical vignettes from a clinical trial of psilocybin-assisted therapy in a palliative oncology context to examine what it means for PAT to "work." We argue that PAT should not be evaluated only by symptom reduction or the production of mystical experiences, but also by whether it helps patients move toward valued forms of self-understanding, connection, courage, acceptance, or reconciliation. Drawing on the concept of "aspirational autonomy," we propose that meaningful consent to PAT need not depend on full foreknowledge of an unpredictable experience. Rather, consent may be understood as a patient's endorsement of a supported process of moral and existential aspiration. We then identify practical ethical challenges for oncology, including expectation management, therapeutic ambiguity, somatic amplification, limited time for integration, and family dynamics. We conclude by offering candidate-selection considerations for oncologists, emphasizing aspirational clarity, cognitive and psychological stability, temporal feasibility, relational support, and realistic expectations.

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Cite

BibTeXRIS
BibTeX
@article{davis2026aspirational,
  title = {{Aspirational autonomy and psychedelic-assisted therapy in advanced cancer: ethical lessons from clinical cases.}},
  author = {Keenan Wills Davis and Michelle C Bach and JoEllen Schimmels and Ali John Zarrabi},
  journal = {The oncologist},
  year = {2026},
  month = oct,
  doi = {10.1093/oncolo/oyag402},
  url = {https://europepmc.org/article/MED/42879734},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Aspirational autonomy and psychedelic-assisted therapy in advanced cancer: ethical lessons from clinical cases.
AU  - Keenan Wills Davis
AU  - Michelle C Bach
AU  - JoEllen Schimmels
AU  - Ali John Zarrabi
PY  - 2026
DA  - 2026/10/01
JO  - The oncologist
DO  - 10.1093/oncolo/oyag402
UR  - https://europepmc.org/article/MED/42879734
AB  - Psychedelic-assisted therapy (PAT) is increasingly discussed as a potential intervention for anxiety, depression, and existential distress among patients with advanced cancer. Yet the ethical challenges of PAT for patients approaching the end of life remain underdeveloped, particularly for oncologists who may be asked to counsel patients or consider referral to clinical trials. This article uses 3 deidentified clinical vignettes from a clinical trial of psilocybin-assisted therapy in a palliative oncology context to examine what it means for PAT to "work." We argue that PAT should not be evaluated only by symptom reduction or the production of mystical experiences, but also by whether it helps patients move toward valued forms of self-understanding, connection, courage, acceptance, or reconciliation. Drawing on the concept of "aspirational autonomy," we propose that meaningful consent to PAT need not depend on full foreknowledge of an unpredictable experience. Rather, consent may be understood as a patient's endorsement of a supported process of moral and existential aspiration. We then identify practical ethical challenges for oncology, including expectation management, therapeutic ambiguity, somatic amplification, limited time for integration, and family dynamics. We conclude by offering candidate-selection considerations for oncologists, emphasizing aspirational clarity, cognitive and psychological stability, temporal feasibility, relational support, and realistic expectations.
SN  - 1083-7159
SN  - 1549-490X
ER  -