Hastings Center News

Bioethics Chats: I. Glenn Cohen

I. Glenn Cohen, JD, is the James A. Attwood and Leslie Williams Professor of Law and Deputy Dean, and Faculty Director of the Petrie-Flom Center for Health Law Policy, Biotechnology & Bioethics at Harvard. He is a Hastings Center Fellow who has worked with The Hastings Center on various projects. He is one of the world’s leading experts on the intersection of bioethics and the law. Last year, he became an elected member of the National Academy of Medicine. Glenn talked with Vardit Ravitsky about his most recent research on the ethical use of psychedelics and some surprising things he’s learned, including that interest in psychedelics is actually bipartisan. The conversation has been edited for clarity.

Vardit: Tell us about your work on ethical and legal issues surrounding the use of psychedelics.

Glenn: We look at clinical use, including informed consent and FDA approval, but also use in religious institutions and communities and recreational use.

Vardit: What are some high-level lessons that you’ve learned?

Glenn: Use of psychedelics involves a heterogeneous community and range of experiences. There are some who emphasize a psychotherapeutic experience, others who view this much more like traditional drug therapy.

The second lesson I’ve learned is how interesting the politics are. A wide range of people is involved: hippies, veterans, Indigenous populations who have long traditions and histories with these substances, religious communities, people who view themselves as suffering from very debilitating PTSD or major depressive disorder, and other people who are seeking spiritual enlightenment. Part of what’s delighted me is that, in America, where everything seems incredibly partisan and divided along party lines, interest in psychedelics–and how best they can be incorporated into society, or whether they should be–is bipartisan. I meet just as many people on the Republican side as the Democratic side who are interested in these issues and in thinking about how policy should respond.

Vardit: So, this topic does not polarize America?

Glenn: It’s polarizing, but not along traditional party lines. There’s a strong interest among Silicon Valley types, but there are also people in the military and ex-military who are really desperate for therapies in a space where nothing else has worked for them, and many of them strongly believe that this is what they’re looking for. So, I think it is divisive but in a way that’s not typical. There are people who want to run drug companies and big pharma, and others who want to grow mushrooms in their backyards. How to put all of these pieces together is very interesting.

Vardit: The Hastings Center Report recently published a paper that explores whether therapists and trainees in the field of psychedelic-assisted therapy should be required to undergo this therapy themselves.  What are your thoughts on that?

Glenn: I overall agree with the paper that any requirement that this be mandated as part of a training program is just not going to work. But maybe it ought to be permissible, subject to more data collection, to see whether it helps.

Vardit: I’d like to zoom out a little bit from the specific topic of psychedelics and ask you, when you look at the field of bioethics today, what keeps you up at night? What are the top three biggest topics, greatest challenges?

Glenn: Number one is everything to do with reproductive autonomy and reproductive rights. And this is a little bit of a U.S.-centric answer. But I think we’re really in a very different reality, not just concerning abortion, but also questions about embryo personhood.

The second challenge is the integration of artificial intelligence, especially large language models, into medicine. In a very quick period, we’ve gone from stepping into the portal of AI to having it built into many of the tools we use. It’s a question of living in a data environment, an environment where it’s always on. And we’re going to be going further with ambient listening sensors, collecting different data streams of patients. This is exciting, interesting, difficult, and moving really, really fast.

Vardit: Reproductive rights and AI, we totally agree that these are two major challenges. Let’s see if we agree on the third.

Glenn: I think the third one is climate change. This is a bioethics topic. The recent fires in Los Angeles, among other places, are reminders that so much of our existence is reliant on the environment in which we live, and I think bioethics has a lot to contribute to this conversation. It has begun doing so, but it hasn’t been as forceful as in other areas.

Vardit: No surprise that I agree as well. Let me ask you something more personal, Glenn. You work a lot. Some people look at your publications record and your cv and cannot believe that you’re just one person. What do you do for fun?

Glenn: I am kind of a nerdy poet type. So, novels, theater, movies, travel, working out, a little bit of music. But also video games. During the pandemic I returned to my 12-year-old self’s love of video games. So, I play a lot of video games in my spare time.

Vardit: As a mom of teenagers, I have to ask, what’s your favorite video game?

Glenn: I just finished Baldur’s Gate 3, which is a very interesting role-playing game. I tend to be attracted to games that have strong narrative structure, but often I’m playing one serious game and then one game that I can pick up for five or six minutes at a time. My five-or-six minutes-at-a-time game is Balatro.

Vardit: We’ve known each other for years, and I didn’t know this about you! Very cool. To end our conversation, what advice do you have for junior bioethicists?

Glenn: I have three pieces of advice. First, don’t be a prima donna. Bioethics is an incredibly collaborative field. If you’re known as a prima donna or difficult to work with, it’ll be hard to find great collaborators.

Second, still speaking about collaborators, in writing as in life, you should date before you get married. That is, if you’re thinking about writing with someone, write something small, easy, tractable, before you agree to write a 400-page manuscript. Get to know them and see if you are aligned.

The third piece of advice is that you need to have a major and you should have a minor. But you should try to pick up some basic competencies with other skills. My major is law; my minor is philosophy. But I like to think that I can understand, and maybe sometimes even participate in, qualitative research, empirical research. So, look for those opportunities when they present themselves.

Vardit: Thank you so much, Glenn. I always learn new things when I chat with you!