Could Psilocybin Therapy Ease the Fear of Dying?

Photo by National Cancer Institute on Unsplash

Physicians are trained to provide treatments that cure illnesses and reduce suffering. But few tools help ease the existential fears that some terminally ill patients experience as they near death, Dr. Daniela Lamas writes in the New York Times. As a pulmonary and critical care physician at Brigham and Women’s Hospital in Boston, Lamas has seen that gap at the bedside. Describing the suffering and terror she witnessed in one patient whose cancer had spread to her bones, Lamas wondered whether she “could have done something more for her than to blunt her consciousness” with calming meds and sedatives.

While not quite ready yet, Lamas is optimistic about the small but growing body of research suggesting that psilocybin, the psychoactive compound in so-called magic mushrooms, can relieve the fear and hopelessness some people experience as they contend with death. By acting on the brain’s serotonin receptors, the drug produces several hours of altered perception and, for some, a lasting change in how they view and understand their own lives. Researchers believe it briefly relaxes the brain’s rigid habitual patterns, leaving patients more receptive to the therapy that accompanies it.

The Food and Drug Administration has finalized its guidance on how psychedelics should be studied and heard from the public on how they should be delivered. The agency could decide whether to approve psilocybin for treatment-resistant depression as soon as early 2027.

That’s good news for lots of people — except her critically ill and dying patients, Lamas writes. Psychedelic trials tend to enroll people who are medically stable, able to complete hours of preparatory therapy and remain available for weeks of follow-up. Moreover, the studies are nearly impossible to blind, because people who take psilocybin can tell that it isn’t a placebo. Patients who expect a life-changing experience or who get extra time with a therapist may feel better for those reasons alone. The drug has risks, too: some people have lasting anxiety after a trip, especially outside of a research setting.

Still, Lamas argues, those concerns are fundamentally different at the end of life. A dying patient seeks less terror and more meaning — something only the patient can judge. This makes rigorous study all the more vital. “If some of the benefit comes from the attention, the sense that someone is trying to help, those are important data,” she writes, urging the regulators and health officials shaping policy to consider whether and how psychedelic treatments can benefit hospitalized patients, too.