artwork by Daiara Tukano
by Daiara Tukano and Maria Fernanda Gebara
Last June, we had the honor of speaking at “Law and Policy of Psychedelic Medicine,” the 2024 Annual Conference hosted by the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School. You can watch our panel here. Speakers from around the world discussed the legal and ethical aspects of psychedelic use.
In two posts, based on the Conference discussions, we aim first (Part I) to highlight the ethical considerations surrounding the use of Indigenous medicines and second (Part II), to consider paths forward to true ethical engagement.
Part I: Ethical Considerations
Indigenous ethics: sacred medicines, ancestral wisdom
For many Indigenous groups, ethical responsibility begins with those who plant, harvest, and prepare medicine. If integrity is lacking in this process, it is believed to directly affect the recipient. Thus, trust in the source is crucial, as medicines can carry the intentions of their maker. While this may be dismissed as superstition in a biomedical context, it remains a vital protocol for many Indigenous peoples. In some traditions, harvesting medicinal plants for healing or magical purposes must be done alone, while “apologizing to the plant spirit and asking for her help,” as Ludmila Škrabáková writes. Shamans are rare, and access to medicines like ayahuasca was traditionally restricted. Knowledge was passed down within families, reserved for community healers with unique diagnostic and treatment methods. In cultures like the Tukano, for example, ayahuasca is used for consultation and study, rather than direct healing, guiding healers toward other medicinal plants.
When the pharmaceutical industry proposes developing an ayahuasca pill or a product based on its “recipe,” Indigenous peoples face challenges in understanding this commercialization. This contrast became evident at the 2022 Indigenous Ayahuasca Conference, during a panel on ayahuasca commercialization, where Indigenous leader Moisés Ashaninka made a poignant comparison: “Kamarampi (ayahuasca) is one of our ancestors, like our grandfather. Would you sell your grandfather?” This perspective highlights the profound difference between a cosmological view of respect and spiritual connection to plants, and the Western approach of commodifying ayahuasca. It raises the question of whether psychedelic ethics should extend beyond humanity, aiming to protect all beings. Plants not only possesses beneficial properties but also carries the vital force endowed by nature to all living beings.
In Indigenous healing practices, the process involves a deep understanding of the patient’s condition, their emotions, and using ayahuasca to determine what is needed for their healing. This holistic approach contrasts sharply with the idea of reducing ayahuasca to a standardized product. The current psychedelic research and practice in this sense obscures, reconfigures, and erases the methods, knowledge, and rituals of traditional healers and healing systems regarding sacred medicines. When sacred medicines become mobile and are studied in laboratories, as with ayahuasca, they are conceivably dislocated from the knowledge and rituals of the groups who have used them for millennia. Hence, medicinal knowledge is seen as not necessarily located within entities such as plants, but rather in the therapeutic transformation/s that emerge from healing “encounters and their traces.”
The different ethical paradigms
In 2017, a group of Indigenous leaders founded the Indigenous Ayahuasca Conference to address the complex challenges posed by the globalization of ayahuasca and other Indigenous medicines. Their primary goal is to develop a Code of Ethics that effectively responds to the multifaceted issues associated with this global spread, acknowledging the diverse layers and levels at which these problems exist.
First, we are dealing with a scientific paradigm — specifically, medical science, encompassing health and mental health. Amazonian shamans and Indigenous peoples are exceptional scientists, engaged in observation, inquiry, and experimentation. The discovery of ayahuasca is not only a gift from nature but also a result of dedicated research. Ignoring Indigenous peoples’ scientific contributions risks decontextualizing this traditional medicine and losing important aspects of its value.
We must also address the justice paradigm — how laws, rights, and ethics are shaped around Indigenous medicines and knowledge. “Lex et Iustitia”(Latin for “Law and Justice”) is elegantly inscribed on Harvard Law School’s shield, yet its practical application is complex. Indigenous peoples were among the last to gain democratic and civic rights. In Brazil, they were deemed incapable and placed under state guardianship until 1979; constitutional rights were recognized only in 1988, and international rights in the 1990s. Despite this progress, countries like the United States, which position themselves as human rights champions, have not signed agreements protecting Indigenous rights over their medicines and knowledge, effectively denying the legitimacy of Indigenous practices.
Ayahuasca is legally used in religious contexts in Brazil, the United States, and other countries, but remains illegal for Indigenous traditional practices. While some countries, like Brazil, recognize the cultural heritage and genetic patrimony linked to these medicines and emphasize the importance of consultation protocols, others, such as the United States, impose standardized criteria through the Food and Drug Administration (FDA). This can criminalize traditional uses, disregarding the cultural and spiritual significance and violating Indigenous rights.
There is also considerable cultural ignorance regarding ayahuasca. This ignorance is often rooted in a cultural paradigm characterized by a dominant Anglo-European perspective that undervalues Indigenous practices. It is the reason why it took four centuries since ayahuasca was first taxonomically identified for it to capture Western interest. This raises concerns about similar biases in the current psychedelic field. For instance, vomiting during ayahuasca use is often labeled an “adverse effect” by prominent authors (e.g., in Ayelet Waldman’s talk at the pre-event of the Conference) and in biomedical research, whereas Indigenous peoples see it as integral to healing both body and spirit. Moreover, psychedelic ethics have largely been shaped by researchers from the Global North. It is crucial to include decolonial perspectives from the Global South — where these medicinal traditions originate — in the regulation, decriminalization, and legalization of Indigenous medicines to ensure a more inclusive and non-colonizing approach.
A pluralistic approach is essential to address the ways in which the global economic system and dominant epistemologies perpetuate social exclusion and cultural appropriation in the field of psychedelics and sciences in general. This must include Indigenous voices and discussions on gender, race, and intersectional factors. Importantly, these dialogues should originate from the territories where Indigenous medicines have been integral for millennia, long before modern industry and biomedicine intervened.
Next is Part II: Towards ethical integration.
Daiara Tukano is a Tukano Indigenous artist, activist, human rights defender, and educator.
Maria Fernanda Gebara is a mother, writer, lawyer/anthropologist, and lecturer from Brazil.