Should patients be able to choose their own treatments?
Patient Autonomy: Insights from 'Awakenings', 'A Beautiful Mind', and 'The Psychedelic Drug Trial'.
Start Exploring
Navigation
The Debate
Awakenings (1990)
A Beautiful Mind (2001)
The Psychedelic Drug Trial (2021)
Key takeaways
The Debate on Patient Autonomy in Neuropharmacology...
The Ethical Question
This raises the question of how to best respect autonomy whilst ensuring that patients receive the most appropriate care regarding their condition.
The debate of patient autonomy is significant in neuropharmacology. As medications often have negative side effects, it could be argued that it is important to prioritise patient autonomy, allowing individuals to control their treatment options and consider the impact of these side effects in the context of their own lives. However it is important to acknowledge that people with severe disorders may lack the necessary cognitive insight to be able to make informed decisions.
The Movies
The Movies
(Letterboxd.com, 2021)
(Goldsman and Nasar, 2002)
(Amazon.co.uk, 2025)
Awakenings (1990)
Plot Relevance L-DOPA Discussion The Big Picture
A Beautiful Mind (2001)
The character of Nash begins by following his doctor's reccommendations, taking anti-psychotic medications to manage his schizophrenia.
More Info
Nash is depicted taking haloperidol, a commonly used typical anti-psychotic medication.
However, whilst haloperidol helps Nash to manage his symptoms, it also induces significant side effects
More Info
Nash ultimately chooses to stop taking medication, despite medical advice.
More Info
The Psychedelic Drug Trial (2021)
The Trial Psilocybin Escitalopram Discussion The Big Picture
Key Takeaways
While respecting patient autonomy is vital, the ability to make fully informed decisions may be compromised due to the disorder itself. These films illustrate the tensions between efficacy, side effects, and quality of life. Patients should have a say in their treatment options, but this autonomy must be supported by comprehensive education about potential risks, alternatives, and long-term impacts. Medical professionals play a crucial role in guiding patients through these complex decisions, ensuring that choices are made in a balanced, well-informed manner.
References
Awakenings (1990)
The film Awakenings is a good example to use to discuss this question as it explores a real-life scenario in which patients were able to recover from a catatonic state, but only temporarily.
Read More
A Beautiful Mind (2001)
A Beautiful Mind is an ideal example to explore the impact of patient autonomy. It highlights the realistic struggle that individuals with schizophrenia face in balancing medication and side effects within the context of their own lives.
Read More
The Psychedelic Drug Trial (2021)
The Psychedelic Drug Trial is an incredibly captivating documentary which intertwines the raw vulnerability of participants suffering from long-term depression with the experimentation of non-conventional treatments.
Read More
Dr. Malcolm Sayer works with catatonic patients affected by encephalitis lethargica. After learning about L-DOPA, effective in Parkinson’s disease (PD), Sayer administers it to Leonard, who “awakens” completely. The L-DOPA effects prove temporary, and Leonard begins to deteriorate, returning to catatonia. Catatonia is defined as ‘a state in which someone is awake but does not seem to respond to other people and their environment’ (Royal College of Psychiatrists, 2022).
The ability of a patient to be released from a catatonic state could be forever life-changing and have lasting impacts on those who experience it. However, knowing that the patient will return to the same or worse state is what questions the ethics of this. With desperation clouding the patient's mind, how can we be sure that they understand the risks and side effects involved with taking the drug? The outcome after the drug could positively or negatively impact the patient’s well-being and quality of life. Some patients may appreciate the small time they had, while others become forever frustrated at the fact that the treatment was only temporary with the patients’ hopes and lives seemingly trapped by circumstances beyond their control.
L-DOPA remains one of the most effective treatments for PD, improving motor function. However, it can cause side effects such as dyskinesia, mood changes, and hallucinations (ELM 5). L-DOPA is used for PD as it is able to increase dopamine levels, it is effective within the central nervous system due to its ability to cross the blood-brain barrier (ELM 5)
In Awakenings, the treatment challenges the idea of whether a patient can make a fully informed decision if they are desperate for a cure or improvement.
The eventual decline of the patients after their brief recovery is emotionally heavy, highlighting the struggles of living with a debilitating condition, and deepening empathy for individuals with neurological disorders, as it shows the humanity of patients often treated as lost causes. The central issue was whether patients if informed of the potential benefits and risks, should have the right to choose this treatment, even if it only offered temporary relief. This reflects a common issue in neurodegenerative disorder treatments.
In this context, the question isn’t whether the drug itself is beneficial but if the temporary relief outweighs the possible long-term side effects. Ultimately, if the patient understands the risks and side effects of the treatment, even if it could be highly damaging, they should have the right to choose their own treatment. This is highly relevant for debilitating conditions when it could be the patient's only chance to take control of their life again, while temporary, they should not be denied this chance.
A double-blind trial was used to separate the participants into two therapeutic groupsThe first therapeutic group used psilocybin, a psychedelic drug derived from the Psilocybe mushroom genusThe second group used escitalopram, a conventional SSRI anti-depressant
Psilocybin is the inert pro-drug of its pharmacologically active compound psilocin (Nichols, 2016), which is synthesised upon alkaline phosphatase-dependent dephosphorylation (Nichols, 2020).Psilocin is responsible for the psychomimetic effects observed after ingesting magic mushrooms, ranging from sensory disturbances to complete hallucinations whilst also possessing the ability to induce profound changes in perception and mood. Unlike psychomotor drugs, psilocybin lacks dependency and doesn't cause memory impairment, making it a promising alternativeThis also begins to reveal an alternative avenue for conventional drugs, such as SSRIs, with even more severe ramifications
In contrast, escitalopram is a conventional SSRI which provides improvements to mood regulation and stability underlying the treatment of depression. It primarily works by blocking SERT and increasing the concentration of serotonin within the synaptic cleft. Despite its ability to alleviate some of the mood-related symptoms of depression, it also comes with some serious side effects, including insomnia, discontinuation syndrome, increased aggression and suicide ideation (ELM 14).Additionally, the onset of conventional anti-depressants is delayed with more moderate improvements when compared to non-conventional drugs, such as psilocybin
This documentary tackles the debate of using non-conventional psychedelics as an alternative to conventional anti-depressants. After only two sessions of psilocybin, positive therapeutic outcomes were seen in the form of deep emotional breakthroughs and sustained symptom reliefAs a collective, we thought this was extremely impactful in highlighting the increased sense of self connection and reduced relapse accounted by participants such as Matt and Joe. Watching them describe their journeys after psilocybin therapy was both incredibly touching and heartbreakingIt made us feel frustrated that potentially life-changing treatments like psilocybin are still facing many legal barriers despite their ability to offer rapid relief from depressive symptoms. The experiences of Matt and Joe made the hope for psilocybin treatment feel personal and urgent. It made us question the reliance on conventional strategies, such as escitalopram, which ultimately produce very gradual and muted changesThe holistic nature of non-conventional treatments therefore has the potential to revolutionise mental health treatment
If patients are given the option to choose alternative treatments it may provide them with a feeling of empowerment and autonomy that could further improve their overall sense of well-being.The rapid onset of psychedelics could also assist in motivating patients to remain engaged with their therapy as the positive effects are seen earlier than with traditional medications. In this circumstance, we feel that treatment should be chosen by the individual rather than medical professionals as it is deeply personal
- This aligns with current clinical practises where anti-psychotic medications, such as chlorpromazine and haloperidol, are commonly prescribed to treat schizophrenia
- Research has shown haloperidol is able to effectively alleviate psychotic symptoms which is reflected in the film, as Nash's hallucinations and delusions subside
(Adams et al., 2013)(ELM 17)
Side Effects: Sedation, motor impairments, and emotional blunting
These side effects are consistent with clinically observed side effects of haloperidol, which can induce symptoms such as muscle rigidity, due to its actions on the D2 receptors in the motor pathway
We see how these physical and emotional effects undermine Nash's ability to function. As a mathematician, his mental ability is essential, not only for his work but also for his sense of self worth. The cognitive dulling he experiences makes it difficult for him to reach his personal achievements and the emotional blunting diminishes his ability to connect with his wife Alicia. For Nash, these effects are profoundly disabling, impacting both his professional and personal life.
Our group felt sympathetic towards psychiatric patients and the choices they have to make between symptom management and quality of life. Seeing the impacts of medication in Nash's life underscored how detrimental side effects can be (ELM 17)
- We found that this choice was the point that demonstrated the value of patient autonomy.
- In the context of Nash's life, his choice in stopping medication to eliminate the side effects was crucial for his wellbeing
The progression of the film highlights the importance of considering the unique circumstances of each patient and reinforces the argument that patient autonomy should be a priority
1. Adams, C.E., Bergman, H., Irving, C.B. and Lawrie, S. (2013). Haloperidol versus placebo for schizophrenia. Cochrane Database of Systematic Reviews. doi:https://doi.org/10.1002/14651858.cd003082.pub3. 2. Amazon.co.uk. (2025). AWAKENINGS MOVIE POSTER PRINT APPROX SIZE 12X8 INCHES : Amazon.co.uk: Home & Kitchen. [online] Available at: https://www.amazon.co.uk/AWAKENINGS-POSTER-APPROX-12X8-INCHES/dp/6030018981 [Accessed 2 Apr. 2025]. 3. ELM 5: Neurodegenerative disorders 1 4. ELM 6: Neurodegenerative disorders 2 5. ELM 14: Mood disorders 1 6. ELM 17: Anti-psychotics 2 7. Goldsman, A. and Nasar, S. (2002). A Beautiful Mind. [online] IMDb. Available at: https://www.imdb.com/title/tt0268978/. 8. Letterboxd.com. (2021). The Psychedelic Drug Trial (2021). [online] Available at: https://letterboxd.com/film/the-psychedelic-drug-trial/ [Accessed 2 Apr. 2025]. 9. Nichols, D.E. (2016). Psychedelics. Pharmacological Reviews, 68(2), pp.264–355. doi:https://doi.org/10.1124/pr.115.011478.
10. Nichols, D.E. (2020). Psilocybin: from ancient magic to modern medicine. The Journal of Antibiotics, 73(10), pp.679–686. doi:https://doi.org/10.1038/s41429-020-0311-8.
11. Royal College of Psychiatrists (2022). Catatonia | Royal College of Psychiatrists. [online] www.rcpsych.ac.uk. Available at: https://www.rcpsych.ac.uk/mental-health/mental-illnesses-and-mental-health-problems/catatonia.
Should patients be able to choose their own treatments?
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Transcript
Should patients be able to choose their own treatments?
Patient Autonomy: Insights from 'Awakenings', 'A Beautiful Mind', and 'The Psychedelic Drug Trial'.
Start Exploring
Navigation
The Debate
Awakenings (1990)
A Beautiful Mind (2001)
The Psychedelic Drug Trial (2021)
Key takeaways
The Debate on Patient Autonomy in Neuropharmacology...
The Ethical Question
This raises the question of how to best respect autonomy whilst ensuring that patients receive the most appropriate care regarding their condition.
The debate of patient autonomy is significant in neuropharmacology. As medications often have negative side effects, it could be argued that it is important to prioritise patient autonomy, allowing individuals to control their treatment options and consider the impact of these side effects in the context of their own lives. However it is important to acknowledge that people with severe disorders may lack the necessary cognitive insight to be able to make informed decisions.
The Movies
The Movies
(Letterboxd.com, 2021)
(Goldsman and Nasar, 2002)
(Amazon.co.uk, 2025)
Awakenings (1990)
Plot Relevance L-DOPA Discussion The Big Picture
A Beautiful Mind (2001)
The character of Nash begins by following his doctor's reccommendations, taking anti-psychotic medications to manage his schizophrenia.
More Info
Nash is depicted taking haloperidol, a commonly used typical anti-psychotic medication.
However, whilst haloperidol helps Nash to manage his symptoms, it also induces significant side effects
More Info
Nash ultimately chooses to stop taking medication, despite medical advice.
More Info
The Psychedelic Drug Trial (2021)
The Trial Psilocybin Escitalopram Discussion The Big Picture
Key Takeaways
While respecting patient autonomy is vital, the ability to make fully informed decisions may be compromised due to the disorder itself. These films illustrate the tensions between efficacy, side effects, and quality of life. Patients should have a say in their treatment options, but this autonomy must be supported by comprehensive education about potential risks, alternatives, and long-term impacts. Medical professionals play a crucial role in guiding patients through these complex decisions, ensuring that choices are made in a balanced, well-informed manner.
References
Awakenings (1990)
The film Awakenings is a good example to use to discuss this question as it explores a real-life scenario in which patients were able to recover from a catatonic state, but only temporarily.
Read More
A Beautiful Mind (2001)
A Beautiful Mind is an ideal example to explore the impact of patient autonomy. It highlights the realistic struggle that individuals with schizophrenia face in balancing medication and side effects within the context of their own lives.
Read More
The Psychedelic Drug Trial (2021)
The Psychedelic Drug Trial is an incredibly captivating documentary which intertwines the raw vulnerability of participants suffering from long-term depression with the experimentation of non-conventional treatments.
Read More
Dr. Malcolm Sayer works with catatonic patients affected by encephalitis lethargica. After learning about L-DOPA, effective in Parkinson’s disease (PD), Sayer administers it to Leonard, who “awakens” completely. The L-DOPA effects prove temporary, and Leonard begins to deteriorate, returning to catatonia. Catatonia is defined as ‘a state in which someone is awake but does not seem to respond to other people and their environment’ (Royal College of Psychiatrists, 2022).
The ability of a patient to be released from a catatonic state could be forever life-changing and have lasting impacts on those who experience it. However, knowing that the patient will return to the same or worse state is what questions the ethics of this. With desperation clouding the patient's mind, how can we be sure that they understand the risks and side effects involved with taking the drug? The outcome after the drug could positively or negatively impact the patient’s well-being and quality of life. Some patients may appreciate the small time they had, while others become forever frustrated at the fact that the treatment was only temporary with the patients’ hopes and lives seemingly trapped by circumstances beyond their control.
L-DOPA remains one of the most effective treatments for PD, improving motor function. However, it can cause side effects such as dyskinesia, mood changes, and hallucinations (ELM 5). L-DOPA is used for PD as it is able to increase dopamine levels, it is effective within the central nervous system due to its ability to cross the blood-brain barrier (ELM 5) In Awakenings, the treatment challenges the idea of whether a patient can make a fully informed decision if they are desperate for a cure or improvement.
The eventual decline of the patients after their brief recovery is emotionally heavy, highlighting the struggles of living with a debilitating condition, and deepening empathy for individuals with neurological disorders, as it shows the humanity of patients often treated as lost causes. The central issue was whether patients if informed of the potential benefits and risks, should have the right to choose this treatment, even if it only offered temporary relief. This reflects a common issue in neurodegenerative disorder treatments.
In this context, the question isn’t whether the drug itself is beneficial but if the temporary relief outweighs the possible long-term side effects. Ultimately, if the patient understands the risks and side effects of the treatment, even if it could be highly damaging, they should have the right to choose their own treatment. This is highly relevant for debilitating conditions when it could be the patient's only chance to take control of their life again, while temporary, they should not be denied this chance.
A double-blind trial was used to separate the participants into two therapeutic groupsThe first therapeutic group used psilocybin, a psychedelic drug derived from the Psilocybe mushroom genusThe second group used escitalopram, a conventional SSRI anti-depressant
Psilocybin is the inert pro-drug of its pharmacologically active compound psilocin (Nichols, 2016), which is synthesised upon alkaline phosphatase-dependent dephosphorylation (Nichols, 2020).Psilocin is responsible for the psychomimetic effects observed after ingesting magic mushrooms, ranging from sensory disturbances to complete hallucinations whilst also possessing the ability to induce profound changes in perception and mood. Unlike psychomotor drugs, psilocybin lacks dependency and doesn't cause memory impairment, making it a promising alternativeThis also begins to reveal an alternative avenue for conventional drugs, such as SSRIs, with even more severe ramifications
In contrast, escitalopram is a conventional SSRI which provides improvements to mood regulation and stability underlying the treatment of depression. It primarily works by blocking SERT and increasing the concentration of serotonin within the synaptic cleft. Despite its ability to alleviate some of the mood-related symptoms of depression, it also comes with some serious side effects, including insomnia, discontinuation syndrome, increased aggression and suicide ideation (ELM 14).Additionally, the onset of conventional anti-depressants is delayed with more moderate improvements when compared to non-conventional drugs, such as psilocybin
This documentary tackles the debate of using non-conventional psychedelics as an alternative to conventional anti-depressants. After only two sessions of psilocybin, positive therapeutic outcomes were seen in the form of deep emotional breakthroughs and sustained symptom reliefAs a collective, we thought this was extremely impactful in highlighting the increased sense of self connection and reduced relapse accounted by participants such as Matt and Joe. Watching them describe their journeys after psilocybin therapy was both incredibly touching and heartbreakingIt made us feel frustrated that potentially life-changing treatments like psilocybin are still facing many legal barriers despite their ability to offer rapid relief from depressive symptoms. The experiences of Matt and Joe made the hope for psilocybin treatment feel personal and urgent. It made us question the reliance on conventional strategies, such as escitalopram, which ultimately produce very gradual and muted changesThe holistic nature of non-conventional treatments therefore has the potential to revolutionise mental health treatment
If patients are given the option to choose alternative treatments it may provide them with a feeling of empowerment and autonomy that could further improve their overall sense of well-being.The rapid onset of psychedelics could also assist in motivating patients to remain engaged with their therapy as the positive effects are seen earlier than with traditional medications. In this circumstance, we feel that treatment should be chosen by the individual rather than medical professionals as it is deeply personal
(Adams et al., 2013)(ELM 17)
Side Effects: Sedation, motor impairments, and emotional blunting
These side effects are consistent with clinically observed side effects of haloperidol, which can induce symptoms such as muscle rigidity, due to its actions on the D2 receptors in the motor pathway
We see how these physical and emotional effects undermine Nash's ability to function. As a mathematician, his mental ability is essential, not only for his work but also for his sense of self worth. The cognitive dulling he experiences makes it difficult for him to reach his personal achievements and the emotional blunting diminishes his ability to connect with his wife Alicia. For Nash, these effects are profoundly disabling, impacting both his professional and personal life.
Our group felt sympathetic towards psychiatric patients and the choices they have to make between symptom management and quality of life. Seeing the impacts of medication in Nash's life underscored how detrimental side effects can be (ELM 17)
- We found that this choice was the point that demonstrated the value of patient autonomy.
- In the context of Nash's life, his choice in stopping medication to eliminate the side effects was crucial for his wellbeing
The progression of the film highlights the importance of considering the unique circumstances of each patient and reinforces the argument that patient autonomy should be a priority1. Adams, C.E., Bergman, H., Irving, C.B. and Lawrie, S. (2013). Haloperidol versus placebo for schizophrenia. Cochrane Database of Systematic Reviews. doi:https://doi.org/10.1002/14651858.cd003082.pub3. 2. Amazon.co.uk. (2025). AWAKENINGS MOVIE POSTER PRINT APPROX SIZE 12X8 INCHES : Amazon.co.uk: Home & Kitchen. [online] Available at: https://www.amazon.co.uk/AWAKENINGS-POSTER-APPROX-12X8-INCHES/dp/6030018981 [Accessed 2 Apr. 2025]. 3. ELM 5: Neurodegenerative disorders 1 4. ELM 6: Neurodegenerative disorders 2 5. ELM 14: Mood disorders 1 6. ELM 17: Anti-psychotics 2 7. Goldsman, A. and Nasar, S. (2002). A Beautiful Mind. [online] IMDb. Available at: https://www.imdb.com/title/tt0268978/. 8. Letterboxd.com. (2021). The Psychedelic Drug Trial (2021). [online] Available at: https://letterboxd.com/film/the-psychedelic-drug-trial/ [Accessed 2 Apr. 2025]. 9. Nichols, D.E. (2016). Psychedelics. Pharmacological Reviews, 68(2), pp.264–355. doi:https://doi.org/10.1124/pr.115.011478. 10. Nichols, D.E. (2020). Psilocybin: from ancient magic to modern medicine. The Journal of Antibiotics, 73(10), pp.679–686. doi:https://doi.org/10.1038/s41429-020-0311-8. 11. Royal College of Psychiatrists (2022). Catatonia | Royal College of Psychiatrists. [online] www.rcpsych.ac.uk. Available at: https://www.rcpsych.ac.uk/mental-health/mental-illnesses-and-mental-health-problems/catatonia.