Last year saw the 20th anniversary edition of JECP, and in the introduction to the philosophy section of that landmark edition, we posed the question: apart from ethics, what is the role of philosophy 'at the bedside'? The purpose of this question was not to downplay the significance of ethics to clinical practice. Rather, we raised it as part of a broader argument to the effect that ethical questions -about what we should do in any given situation -are embedded within whole understandings of the situation, inseparable from our beliefs about what is the case (metaphysics), what it is that we feel we can claim to know (epistemology), as well as the meaning we ascribe to different aspects of the situation or to our perception of it. Philosophy concerns fundamental questions: it is a discipline requiring us to examine the underlying assumptions we bring with us to our thinking about practical problems. Traditional academic philosophers divide their discipline into distinct areas that typically include logic: questions about meaning, truth and validity; ontology: questions about the nature of reality, what exists; epistemology: concerning knowledge; and ethics: how we should live and practice, the nature of value. Any credible attempt to analyse clinical reasoning will require us to think carefully about these types of question and the relationships between them, as they influence our thinking about specific situations and problems. So, the answers to the question we posed, about the role of philosophy at the bedside, are numerous and diverse, and that diversity is illustrated in the contributions to this thematic edition.

Background Psychiatrists depend on their patients for clinical information and are obligated to regard them as trustworthy, except in special circumstances. Nevertheless, some critics of psychiatry have argued that psychiatrists frequently perpetrate epistemic injustice against patients. Epistemic injustice is a moral wrong that involves unfairly discriminating against a person with respect to their ability to know things because of personal characteristics like gender or psychiatric diagnosis. Methods We review the concept of epistemic injustice and several claims that psychiatric practice is epistemically unjust. Results While acknowledging the risk of epistemic injustice in psychiatry and other medical fields, we argue that most concerns that psychiatric practice is epistemically unjust are unfounded. Conclusions The concept of epistemic injustice does not add significantly to existing standards of good clinical practice, and that it could produce changes in practice that would be deleterious. Psychiatrists should resist calls for changes to clinical practice based on this type of criticism.

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Psychedelic research is proceeding rapidly, despite ongoing legal and regulatory barriers and lingering questions about study design, such as the difficulty of ensuring adequate blinding, the relative overrepresentation in studies of participants who have previously used psychedelics, and the importance of personal experience with psychedelics for those who provide psychedelic-assisted therapy. Here we wish to explore a distinct concern: whether personal use of psychedelics by researchers could threaten the objectivity and ethical conduct of psychedelic research itself. In 2020, Anderson et al. suggested that psychedelic use could lead even “conservative individuals to become wildly enthusiastic about the potentials of psychedelics to heal and transform”. Recent popular press criticisms of psychedelic science, in particular critiques of the MAPS Phase II and Phase III MDMA-Assisted Therapy trials for PTSD, have also raised questions about whether personal use of psychedelic drugs by psychedelic therapists could compromise scientific objectivity, lead to the exploitation of research subjects, or promote biased reporting of results. Here, we elaborate on and attempt to delimit these concerns, with the goal of informing policy related to psychedelic research and the eventual clinical use of psychedelics. In particular, we explore whether the possibility that psychedelic use can directly and positively affect investigators’ enthusiasm about psychedelics themselves raises concerns about bias and scientific integrity. We then discuss several practical strategies to reduce perceived conflict of interest.