BMC medical ethicsOct 14, 2026

Feeling Safe: Understanding Vulnerability in (Es)Ketamine Treatment

Psychedelic Science Weekly Brief ↗PubMed ↗DOI ↗OA ↗

Updated Oct 16, 2026

Abstract

Acute consciousness-altering treatments like (es)ketamine may reduce patients' capacity for self-advocacy and self-regulation.

Feeling safe is essential for patients to consent to and remain in treatment.
Factors influencing patients' feelings of safety include the treatment setting, clinician attitudes, and patient perceptions.
The study differentiates between clinical safety, felt safety, and ethical protection.
A framework of induced, layered vulnerability is used to analyze the relationships among these concepts.

Simplified

Treatments with acute consciousness-altering effects, such as (es)ketamine, place patients in a state of heightened vulnerability with reduced capacity for self-advocacy and self-regulation. Since feeling safe is a precondition for consenting to begin, and remaining in, treatment, this raises distinct ethical demands on care. Which features of the setting enable patients to feel safe, and how patients' and clinicians' understandings of the treatment relate to these requirements, remains unclear. This study identifies patient-, clinician- and setting-related factors shaping the experience of safety during (es)ketamine treatment and derives ethically grounded recommendations, distinguishing clinical safety, felt safety and ethical protection and analyzing their relations through a framework of induced, layered vulnerability.

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Feeling Safe: Understanding Vulnerability in (Es)Ketamine Treatment

Abstract

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