Is it okay to give psychedelics to someone in a vegetative state?: 5 Questions for journalist Jonathan Moens

Moens discusses his recent National Geographic piece on the potential of treating severe brain injuries with psychedelics, and its thorny ethics.

For years, psychedelics have been studied as potentially helpful in the treatment of mental health conditions including depression, anxiety, and PTSD. Researchers are now turning their attention to whether the drugs might be useful in the treatment of other brain-related conditions, including brain damage. Some researchers, like those at Stanford and Johns Hopkins, are looking into if psychedelics can improve quality of life and functioning in people with mild to moderate disability, but others will soon be investigating psychedelics’ use in more severe cases. National Geographic recently published a piece that looks into new research in this area and follows the story of a couple named David and Sarah (both are pseudonyms). Sarah was hit by a car and suffered severe brain damage; after the accident, she was minimally responsive. Her husband David, desperate to revive her consciousness, put a tincture of distilled psilocybin into Sarah’s feeding tube. The Microdose spoke with the author of the piece, the Rome-based journalist Jonathan Moens, about his reporting and the ethics of dosing someone with a severe brain injury. (Moens’s piece was supported by a The Ferriss-UC Berkeley Psychedelic Journalism Fellowship.)

How did you come across this story?

I came across a proposal that was published back in 2019 by Robin Carhart-Harris and Gregory Scott about how psychedelics could help people with disorders of consciousness. It was really interesting - it outlined a hypothesis of how complexity in the brain could be boosted, and how that increase is associated with greater awareness and consciousness. The interesting part to me was that this measure could increase and help people awaken – but also, what are the ethics around all this? My mind was blown and I was thinking, is this actually going to happen, and if so, who is going to authorize it? What kind of scientists are willing to take on the risks, and what kinds of patients are willing to do this?

The turning point was when I read an interview with Olivia Gosseries, a researcher at University of Liège, describing how her lab was interested in doing this research using psilocybin on people who have disorders of consciousness, like comas or vegetative states. They had a PhD student working on it, and after establishing a relationship with that student, I realized this research could take a really long time; the clinical trials are probably going to take at least another year. But what I found out from them is that there was this couple, who I call David and Sarah, who lived in Colorado and who didn’t have the time to wait until the trials would happen. They were willing to try it out and had reached out to the scientists.

Your previous reporting has probed the balance between bureaucratic red tape and safety in psychedelic studies. Where’s the line here — is it ethical to give psychedelics to someone like Sarah, who cannot grant consent?

There are some clear questions outlined by the academic community. The first is the potential of a bad trip — if people are minimally conscious or in a vegetative state, they still have some form of conscious awareness. So if they have psychedelics, and the theory Carhart-Harris and Scott laid out proves to be correct, those drugs could raise their levels of awareness, and that could lead to a terrifying trip, or suicidal thoughts that are out of their control. 

The second thing is consent. Sarah is not able to communicate in a consistent way; her diagnosis is somewhere between minimally conscious and vegetative, which means she can’t consistently answer questions, blink or move her eyes on demand, or move fingers. So she obviously couldn’t consent in any way that we legally define consent. 

Another question Carthart-Harris mentions: if you become lucid enough to become aware of your predicament, but not lucid enough to benefit from it in a meaningful way, you might end up being super aware of your horrible state — which could be an unpleasant limbo. 

In this case, David chose to give his wife Sarah psilocybin. Making a decision like that for a loved one must have been difficult; from your conversations with him, did you get a sense for how he was thinking about making that decision?

The first thing I want to note about David was that he was an incredibly intelligent man and desperately in love with his wife. He had thought through all the things a sensible, reasonable person might have thought. He tried a range of options, including supplements and transcranial direct-current stimulation; he consulted with top experts in the field of consciousness.

He asked himself the question, “Would she have wanted this?” and I think he asked that probably every single day while he was trying this. It’s also the reason he stopped giving Sarah psilocybin — he thought she wouldn’t want to do it again. His philosophy throughout was that she would’ve wanted him to try anything to get her to a state of lucidity or awareness, even if there were a slim chance, and once he’d exhausted those options, she’d have wanted to be left alone. That’s why he’s now proceeding with end-of-life treatment. 

Sarah’s brain activity was measured during her trip, and she was assessed for responsiveness. How would researchers define “success” in giving psychedelics to people with minimal consciousness or in vegetative states? 

Success depends on your perspective. In Sarah’s case, David wanted her to come to a higher consciousness level or communicate. He didn't expect her to fully awaken, but he wanted her to be able to communicate, or have a higher quality of life. He wanted to be able to do activities with her, to joke about things — to show her humanity again.

From scientists’ perspective, they’re using more standard measurements. The neuroscientist Olivia Gosseries was unofficially involved with this case; she taught David how to administer some standard surveys to establish scientifically whether Sarah showed improvement. Those results showed that Sarah continued to score low, but if they had seen a significant increase in those values, they would’ve seen that as success. Sarah also wore a helmet that took measures of brain complexity. They did see a significant increase in real time, but what that actually translates to in terms of consciousness is still to be determined.

Clinical trials with people in vegetative states or with minimal states of consciousness are slated to begin in the next few years at the University of Liège and Imperial College London. What might Sarah’s case tell us about this new area of research? 

One thing I wish I had emphasized more in the piece is that Sarah is just one person. Just because that treatment didn’t work for her doesn't mean it wouldn't work for others. But I do think it opens the question of who it could work for. If clinical trials show that it does work for others, then how do we identify those people, and why are they responsive when others aren’t? 

This interview has been edited and condensed for clarity and length.