The practice of psychopharmacology has profoundly influenced the evolution of clinical psychiatry from the first use of chlorpromazine in 1952 for treatment of psychosis. Since then, a flurry of psychotropic medications have been introduced into the field, driven by the hypothesis that interventions in brain physiology can treat disorders defined by symptoms of mood, thought, or behavior. Because many of these symptoms are perceived and expressed through the lens of subjective experience, it is not surprising that the discussion of psychopharmacological treatment generates multiple ethical considerations. Weighing the risks and benefits of treatment and nontreatment, for example, against a backdrop of patient and societal values generates multiple tensions that the ethical practitioner must consider. A medically ill patient who is at high risk of adverse treatment effects is one salient example, as is the case of a healthy, functioning individual seeking cognitive enhancement.