Death is one of the only things we can be sure about in life, yet it remains one of the most misunderstood and anxiety-inducing aspects of the human condition. For many facing the end of their lives, the fear of death, the pain of saying goodbye, and the uncertainty of what comes next can lead to intense emotional turmoil, often making the final chapter of life one of deep, profound distress.
Although current medical interventions in end-of-life care can help with alleviating physical discomfort, they rarely touch the deeper emotional pain and existential suffering that many patients must endure.
Psychedelic therapy has shown great promise in helping patients navigate the complex psychological challenges associated with the dying process. However, since these substances remain federally illegal, they are not widely accessible to terminally ill patients, raising important questions about how we prioritize patient care and medical ethics in the face of evolving science.
Why should those who are already facing the most difficult journey of their lives be denied access to a therapy that could help them find solace, meaning, and acceptance as they finally face death? As more evidence supports the use of psychedelic-assisted therapy in end-of-life care, so too does the urgency to reexamine and update our current healthcare and legal systems to better serve those in their final days.
The role of psychedelics in end-of-life care
Psychedelic-assisted therapy involves administering controlled doses of psychedelic substances under the supervision of trained therapists, typically in conjunction with therapy sessions. Previous findings have found that this form of treatment can significantly reduce symptoms of adverse mental health outcomes like anxiety and depression.
Yet this potential is not confined to mental health treatment alone; there is mounting evidence to suggest that it can also help patients address the unique emotional challenges that come with facing death.
“Psychedelics, such as psilocybin and MDMA, have shown promise in end-of-life care by helping patients manage anxiety, depression, and existential distress associated with terminal illnesses,” explains Kristie Tse, psychotherapist and founder of Uncover Mental Health Counseling. “In clinical experiences, these substances have facilitated significant emotional breakthroughs, enabling individuals to face their fears about death with greater clarity. Both traditional psychedelics and newer options like ketamine present unique treatment possibilities, offering patients insights into their deepest emotions.”
This efficacy, particularly in psilocybin, is believed to be related to its interaction with serotonin receptors in the brain, especially the 5-HT2A receptor, which is responsible for regulating mood and perception.
“Psilocybin has an impact on serotonin receptors in the brain that causes changes in perception and insights that assist patients in dealing with their fears and feelings in a new way. Research has shown that one dose of psilocybin is capable of reducing anxiety and depression levels by a significant margin and improving the patient’s quality of life as they near their final days,” adds Dr. Bryan Bruno, Medical Director at Mid City TMS.
Take the 2016 Johns Hopkins study, for example, which found that psilocybin-assisted psychotherapy significantly reduced the fear of death in cancer patients and higher ratings of acceptance1. Another 2022 study examining over 3,000 adults revealed that participants who had used psychedelics were more likely to report feelings of profound peace, reduced anxiety, and a greater acceptance of their mortality, similar to the psychological relief found in near-death experiences2.
Psychedelics have also been explored for their ability to reduce chronic pain and improve quality of life, which could greatly benefit those who are also dealing with physical suffering in their final days. The serotonin receptors activated by these substances can also alter the subjective experience of pain, helping to reduce its mental intensity so it feels less overwhelming.
What we’re seeing from this growing body of research is that psychedelics could offer something truly valuable to those at the end of life. They don’t just ease physical discomfort or anxiety – they help patients confront and process the deeper existential questions that arise as death approaches.
Quality of life vs. quality of death
The process of dying is no easy one. It’s physically and emotionally draining, often robbing individuals of their sense of self and agency. For many, being able to maintain dignity and a sense of control during this time is just as important as managing physical pain.
Unfortunately, the standard methods of pain management have side effects like sedation and cognitive impairment, which can sometimes dull a patient’s senses and make it difficult for them to stay present. But what can be done to ensure that patients don’t have to choose between comfort and clarity?
“Some individuals want to maintain full awareness as they’re dying, so they decline medication. Similarly, individuals with chronic pain often find it challenging to experience total relief from their pain, and there have been countless discussions about the importance of delivering effective pain management at the end of life,” says Elreacy Dock, thanatologist, death educator, certified grief educator, and behavioral health consultant. “Since psychedelic therapy has the potential to address a variety of symptoms simultaneously, it can also reduce the need to use multiple medications. However, limited access and acceptability often prevent the use of psychedelic therapy in end-of-life settings, and this has merited ongoing advocacy from individuals with terminal illnesses and their loved ones or caregivers.”
A growing momentum of psychedelics for terminally ill patients
In recent years, the fight for access to psychedelic therapy in end-of-life care has gained momentum, largely due to the efforts of terminally ill patients, their doctors, and advocates who recognize its potential beyond the treatments currently available.
Thomas Hartle, a Canadian man in his early 50s, was diagnosed with stage 4 colon cancer. Facing the stark reality of his diagnosis, he was overcome with anxiety and existential dread. After learning about the potential of psilocybin therapy, Hartle applied for and was granted a legal exemption to use the otherwise illegal substance in 2020, making him the first in his country to legally take mushrooms. Three other Canadians were also granted an exemption that year.
Thanks to his therapy sessions, Hartle was able to experience what he described as a profound sense of peace and acceptance, allowing him to confront his morality without the overwhelming fear that had previously taken over his thoughts.
“I find myself much more living in the moment, rather than thinking about what might happen or what could be around the corner,” Hartle expressed in an interview.
Although Hartle never expected to become an inspiration or advocate, his experience with psilocybin has made him a notable instance in the conversation about psychedelic use in end-of-life care. Despite his recent passing, the legacy of Thomas Hartle lives on, continuing to shape the conversation about end-of-life care.
Legal barriers in the U.S.
In Seattle, Dr. Sunil Aggarwal, a palliative care physician at the Advanced Integrative Medical Science Institute, has become a major advocate for the integration of psychedelics into palliative care, particularly for those with terminal illnesses. Dr. Aggarwal requested a permit from the Washington state government and the DEA to use psilocybin for his terminally ill cancer patients. The DEA denied the request, insisting that they had no power to wave the federal law of the Controlled Substances Act just for him – The only way he could legally use the drug was through a federal research permit, which he could not access at the time.
Understanding that his patients didn’t have much time left, Dr. Aggarwal decided to sue the United States Ninth Circuit Court of Appeals. He argued that under the government’s Right to Try Act (RTT), special cases could be granted. Under the RTT, terminally ill patients are allowed to try investigational drugs. And while psilocybin is considered an investigational drug, its classification as a Schedule I substance complicates legal approval. Once again, Dr. Aggarwal’s lengthy legal battle was met with rejection. The DEA continues to deny access, emphasizing that federal law does not allow exceptions for psilocybin, even for terminal patients.
Currently, no one in the U.S. has successfully accessed psilocybin for therapeutic use under the RTT Act. Terminally ill patients have incredibly limited, if not completely nonexistent, opportunities to benefit from psilocybin outside of clinical trials or research studies. Until federal law adapts to accommodate these needs, patients will continue to be denied access to what could be a vital component of compassionate end-of-life care.
The future of psychedelics for terminally ill patients
As more research and legislation go into psychedelic-assisted therapy, perhaps one day, it could become an option in mainstream palliative care. The landscape is slowly changing, with growing support from both the medical community and the public for the use of psychedelics in treating the psychological distress that often accompanies terminal illness.
Oregon led the way in 2020 by passing Measure 109, the first state-level initiative in the U.S. to legalize psilocybin for therapeutic use. The legislation established a legal framework that allows adults over 21 access to psilocybin therapy so long as it’s administered in a regulated and licensed environment. Therefore, terminally ill patients in Oregon now have a legal pathway to explore psilocybin-assisted therapy as a part of their end-of-life care.
Since the state’s first center opened up in 2023, twenty-eight more centers have opened their doors, with over 300 licensed facilitators who are trained to administer psilocybin in a controlled environment.
Colorado, who passed a similar measure in 2022, is still in the works of developing their own program, with centers anticipated to be operational by 2025. This makes Oregon the only place in the U.S. where such therapy is currently accessible.
Nevertheless, as long as the federal illegality of psilocybin continues to limit access across the country, the misalignment between state and federal laws leaves many patients without this promising treatment option. So far, Oergon’s program has successfully shown that psilocybin can safely and effectively be used in a controlled environment to treat a wide range of mental health conditions, including the psychological distress that often comes with terminal illnesses. As more states consider similar legislation, there is hope that one day, broader changes could be made at the federal level, making this therapy accessible to all who need it.
But, as Elreacy Dock advises, “For individuals who are interested in exploring psychedelics as part of their end-of-life care plan, it’s crucial to work with professionals who are knowledgeable about the medical and legal landscape surrounding psychedelics since it is rapidly evolving.”
While Oregon’s progress is promising, the national conversation about psychedelics is still in its early stages. Limited legal options mean that most terminal patients interested in psilocybin therapy might explore less reliable and unregulated options, where the risks are significantly higher and can reduce the likelihood of successful treatment.
Navigating the end of life is an incredibly personal process, and patients should have the right to approach their final days with peace and dignity without being overwhelmed by the crushing fear and anxiety that often accompany this final stage of existence. Existing federal limitations go beyond restricting access – they also undermine the ability of healthcare professionals to offer the care and support that can make a meaningful difference in a person’s last days. Those facing the end of their life deserve the autonomy to pursue a treatment path that reflects their final needs as fellow human beings, confident that their choice will be supported by experts committed to helping them find peace facing their own mortality.
References
- Griffiths, Roland R, et al. “Psilocybin Produces Substantial and Sustained Decreases in Depression and Anxiety in Patients with Life-Threatening Cancer: A Randomized Double-Blind Trial.” Journal of Psychopharmacology, vol. 30, no. 12, 30 Nov. 2016, pp. 1181–1197, https://doi.org/10.1177/0269881116675513. ↩︎
- Sweeney, Mary M., et al. “Comparison of Psychedelic and Near-Death or Other Non-Ordinary Experiences in Changing Attitudes about Death and Dying.” PLOS ONE, vol. 17, no. 8, 24 Aug. 2022, p. e0271926, https://doi.org/10.1371/journal.pone.0271926. ↩︎
