Should treatment for severe mental illness include medical assistance in dying?

By Anand Kumar and Sally Weinstein

Canada is on the threshold of enacting a law that would make medical assistance in dying (MAiD) accessible to people whose only medical condition is mental illness. If this were to pass, Canada would be one of only a handful of countries to extend that process for patients with serious mental illness.

It will apply to conditions that are primarily within the domain of psychiatry like depression and personality disorders. Political leaders have accused the Trudeau government of promoting a “culture of death;” others see this as a sign of gross underfunding of high demand mental health services.

In the United States, Oregon was the first state to enact the Death With Dignity Act, in 1997. The measure allowed terminally ill adults to end their lives by voluntarily self-administering lethal doses of medication prescribed by a physician for that purpose, with key caveats that included a physician’s diagnosis of terminal illness leading to death within six months. Since then, the District of Columbia and nine additional states have enacted laws that facilitate medication assisted death along the lines of the Oregon model.

Societal expectations regarding MAiD evolved over time. Several European countries have broadened the scope beyond terminal illness and imminent death to include suffering, functional decline and unbearable circumstances with no prospect of improving with treatment, thereby incorporating quality of life metrics into the process.

In a potentially dangerous expansion, countries including Switzerland, the Netherlands, Belgium and Luxembourg currently permit medical assistance in dying for patients characterized as having severe and persistent mental illness (SPMI) — defined as conditions resistant to evidence-based treatments — provided they meet additional criteria that include intolerable suffering with preserved decision-making capacity. By expanding into the realm of mental illness, we change the fundamental nature of the discussion.

Serious mental disorders are in essence brain disorders that are influenced by psychosocial factors. Unlike neurologic diseases, mental disorders cannot be localized to specific regions of the brain. Neuroimaging studies of patients diagnosed with SPMI, including bipolar disorder, the schizophrenia spectrum, anorexia, and post-traumatic disorder, for example, demonstrate that multiple brain regions are involved in the development of these illnesses. These disorders are mediated by impaired brain circuits — interconnected brain regions — rather than any specific part of the brain. The region most consistently involved in these circuits is the prefrontal cortex, which mediates executive functions.

Executive functions include judgment, abstract thinking, planning, integrating information from all brain regions and insight. These domains are therefore compromised in patients with SPMI, with important downstream behavioral consequences that include impaired insight into the nature of their illness and loss of the ability to objectively consider the pros and cons of intervention.

This is not to suggest that all patients with SPMI have minimal insight or are incapable of making rational decisions about their health care. Far from it. But it must be acknowledged that not all diseases, not even all brain disorders, are the same, and some of them do adversely impact cognitive domains germane to consequential decision-making.

There are effective treatments, both pharmacological and psychotherapeutic, that can reduce the burden of disease and improve the quality of life for patients with mental illness. Some of them require long treatment trials using traditional approaches or with newer neuromodulation techniques, such as transcranial magnetic stimulation.

A major compounding factor for patients with SPMI is the lack of adequate access to psychiatric care. Insurance companies frequently use a ‘business model’ approach that maximizes profit; for those with insurance, especially publicly funded insurance that is increasingly privatized, payment is often denied or limited. Denial of care exacerbates the challenges patients face as they navigate our health care system and potentiates the desire for an “exit plan.” Like the current debate in Canada, adequate mental health services and access to care will serve as mitigating factors favoring life in a subgroup of patients.

The notion that there is a right dose and combination of medications for all patients that will eventually result in symptom remission is more folklore than science. We must be intellectually honest and acknowledge that not all forms of SPMI are curable with appropriate therapy and that some patients remain refractory to treatment even after repeated attempts. Patients may also be overwhelmed by long medication trials and experience hopelessness about clinical remission, which is difficult to disentangle from the very symptoms of these illnesses. Perseverance is often a long game in clinical medicine.

An option for this group would be palliative psychiatry. Palliative medicine — that is, the absence of active medical interventions while providing basic sustenance and support — is more widely appreciated in cases of cancer and other near terminal illnesses where the patient makes an informed decision that quality of life, brief as it may be, is more important than measures to extend life, especially when they cause undue discomfort. Palliative approaches in psychiatry are conceptually comparable and include accepting that severe mental illness can be incurable, avoiding direct treatments with challenging side effects and questionable impact, and offering a support system that helps patients live impactful lives until death.

The American Medical Association’s Code of Ethics maintains that assisting in death violates a fundamental code for medical practitioners. The American Psychiatric Association adopted the same position as the AMA in 2016, stating “a psychiatrist should not prescribe or administer any intervention to a non-terminally ill person for the purpose of causing deaths. Suicide prevention is the bedrock of mental health care throughout the country.”

The debate is clearly a difficult one, fraught with emotions; it needs to incorporate not only new scientific information but also the cultural values and principles of the society in which we live. The relationship between patients with mental illness and the practice of medical assistance in dying is a slippery slope that is likely to get even more slippery over time. We will require great caution and a thoughtful national debate as we move forward.

Complete Article HERE!

New survey says Canadians strongly support using psychedelics for patients at end-of-life

An online survey reveals that 79% of Canadians support the use of psilocybin to treat existential distress in patients suffering from an incurable disease. While the production, sale and possession of this active ingredient from hallucinogenic mushrooms is currently prohibited in Canada, a unique access program allows people to obtain an exemption for medical or scientific reasons.

“Studies have already shown that psilocybin, combined with psychotherapy, produces rapid, robust and lasting anxiolytic and antidepressant effects in patients who have advanced cancer,” states lead researcher Michel Dorval, professor at the Université Laval’s Faculty of Pharmacy and researcher at the CHU de Québec-Université Laval Research Center.

“Our results indicate that the social acceptability of this intervention is high in the Canadian population,” he comments. “If we consider only Québec respondents, the acceptability rate is similar to the national average.”

The survey included 1,000 respondents from Québec and 1,800 from Ontario, Alberta and British Columbia.

Psilocybin in healthcare
The study published in Palliative Medicine specifically focused on the social acceptability of the intervention when delivered by healthcare professionals.

While nearly four out of five respondents found psilocybin-assisted therapy a reasonable medical choice for a patient suffering from existential distress at the end-of-life, 84.8% agreed that the public health system should cover the costs of the intervention. Moreover, 63.3% would welcome the legalization of the substance for medical purposes.

In Canada, doctors can apply for the exemption of psilocybin on behalf of their patients if psychotherapy, antidepressants or anxiolytics have failed or if a patient’s condition requires urgent intervention.

“This substance can bring about a profound awareness that leads the patient to view existence from a different perspective. Treatment with psilocybin, combined with psychotherapy, can produce relief for up to six months,” underscores Dorval.

The researchers hope that the survey’s findings may contribute to improving access to therapy in palliative and end-of-life care settings and mobilizing resources.

Support drivers
Survey respondents exposed to palliative care had a higher support rating for psilocybin.

“Having been close to loved ones at the end of life, or having witnessed their distress, could explain this openness to new approaches designed to help people at this stage of their life,” he suggests.

In addition, support was higher among people who previously used psilocybin.

Dorval explains: “There are still many prejudices against psychedelic substances. Familiarity with these substances probably helps better understand their true effects and therapeutic potential.”

Market and research developments
Psilocybin and other psychedelics are gaining popularity in mental health support for their effects on the brain, treatment-resistant depression and addiction.

Last year, a clinical trial on psilocybin treatment found it could clinically and significantly reduce depressive symptoms and functional disability without serious adverse events. Participants received the psychedelic combined with psychological support before, during and after dosing.

Earlier research revealed that psychedelics outperformed antidepressants, as psilocybin activates a different set of serotonin depressors instead of suppressing emotions — common effects of antidepressants.

There have also been several movements to legalize psychedelics for public use to move the “magic mushroom” into the mainstream market.

Meanwhile, the US Food and Drug Administration has issued guidance to the industry as the use of psychedelic drugs for medical conditions gains interest and popularity. The guidance supports the development of treatments based on psychedelics and opens the discussion on the use of the products in clinical trials.

Complete Article HERE!

Terror Management Theory

— How Humans Cope With the Awareness of Their Own Death

By Cynthia Vinney, PhD

Terror Management Theory (TMT) suggests that human beings are uniquely capable of recognizing their own deaths and therefore they must manage the existential anxiety and fear that comes with knowing their time on Earth is limited.

The theory was developed by psychological researchers Jeff Greenberg, Sheldon Solomon, and Tom Pyszczynski, who published the first TMT article in 1986.1 They based TMT on the writings of Ernest Becker, who spoke of the need to protect against the universality of the terror of death.

In this article, we’ll review key concepts of TMT, look at empirical evidence in support of TMT, explore real-life examples of TMT, and discuss how it is used across different fields.

Key Concepts and Principles of Terror Management Theory

Terror Management Theory explains that people protect themselves against mortality salience, or awareness of one’s own death, based on whether their fears are conscious or unconscious.

If they’re conscious, people combat them through proximal defenses by eliminating the threat from their conscious awareness. If they’re unconscious, distal defenses, such as a sense of meaning, like cultural worldviews, or value, like self-esteem, diminish unconscious concerns about death.2

Cultural worldviews and self-esteem are key concepts of TMT. They are both central to protection against mortality salience. David Tzall, PsyD, a licensed psychologist in New York, notes, “TMT suggests that individuals gravitate towards and defend their cultural worldviews more strongly when confronted with thoughts of mortality.”

Through cultural worldviews, people can achieve literal or symbolic immortality. Literal immortality, the idea that we will continue to exist after our death, is usually the domain of religious cultural worldviews. Symbolic immortality is the idea that something greater than oneself continues to exist after their death, such as families, monuments, books, paintings, or anything else that continues to exist after they’re gone.

TMT suggests that individuals gravitate towards and defend their cultural worldviews more strongly when confronted with thoughts of mortality.

Self-esteem plays a significant role in TMT too. “When faced with the awareness of death,” Tzall says, “people often engage in activities or behaviors that boost their self-esteem as a way to manage the anxiety associated with mortality.” In so doing, they provide the sense that they are a valuable participant  in a meaningful universe.3

These have led to two important hypotheses in TMT. First, the mortality salience hypothesis says we have negative reactions to individuals from a different group, called “outgroupers,” who present a threat to our group, and have positive reactions to those who represent our cultural values, referred to as “ingroupers.” Second, the anxiety-buffer hypothesis says strengthening our anxiety-buffer by, for example, boosting self-esteem, should reduce the individual’s anxiety about death.4

Review of Empirical Evidence Supporting Terror Management Theory

There are over 500 studies conducted in countries around the world supporting TMT. For example, one study found that raising self-esteem reduces anxiety in response to images of death.5 Similarly, increasing self-esteem reduces the effects of mortality salience on the defense of one’s worldview. When the researchers provided positive personality feedback instead of neutral feedback, their preference for a US-based author was equivalent to that of the control group, whereas participants who received neutral feedback far exceeded the control group in preference for the author.6

Another study found that worldview threats increase accessibility of death thoughts. When Canadians were exposed to a website that either derogated Canadian values or Australian values, they had far more thoughts about death when they encountered the anti-Canadian information.7

Real-Life Examples Illustrating the Application of Terror Management Theory

There are many ways that terror management theory can be applied to real life. Tzall provides some examples, such as “religion where religious beliefs and practices offer explanations for life’s meaning, purpose, and what happens after death. People will turn to religion to alleviate existential anxiety and find solace in the idea of an afterlife.”

Believing in religion may provide a chance at literal immortality, but beyond that, it can provide a cultural worldview that brings meaning and purpose to life and can alleviate mortality salience.

Likewise, Tzall gives the example of belonging to a nation that “provides a sense of identity and belonging, which can help individuals feel connected to something enduring. People may strive to achieve success, create meaningful relationships, or contribute to society in ways that leave a lasting impact.” There are all sorts of ways that people can find meaning and achieve symbolic immortality, including being part of a nation that will go on after their death.

In addition to feeling like a part of the nation, people will want to put their own stamp on the nation whether through success in industry, meaningful relationships that have a lasting impact, or other options like volunteering, having a family, or writing a book.

Implications of Terror Management Theory across Different Fields

Different fields can use TMT in different ways. For example, the most obvious may be the field of therapy and counseling. As Tzall explains, “TMT sheds light on how individuals’ psychological well-being, self-esteem, and behavior are influenced by thoughts of mortality.” Tzall continues, this “can help therapists understand existential anxiety and develop strategies to address it.”

The theory can similarly be used in marketing and advertising, but the emphasis is different. “TMT can inform advertising strategies that tap into consumers’ desires for symbolic immortality,” Tzall says. In this conception, marketers and advertisers advertise goods or services in a way that communicates their desire for symbolic immortality can be met.

Similarly, political science “can help explain the polarization of political ideologies,” explains Tzall, “and the ways in which leaders appeal to their followers’ existential concerns to gain support.” Through cultural worldviews that appreciate others like them but reject others that are not like them, leaders can exploit their followers and even lead them to rise up against others that do not agree with them, in wars, conflicts, or events like January 6th, where a small group of like-minded citizens stormed Congress.

Significance of Terror Management Theory in Understanding Human Behavior and Beliefs

Though some studies about TMT have failed to be replicated, Terror Management Theory has continued to resonate with many people. And researchers still use it to describe various events.

For example, a group of researchers used TMT to detail the COVID-19 pandemic during its height, explaining that regardless of how deadly the virus is, the risk of dying was highly salient.8 As a result, in response to the pandemic, people responded to the constant fear of death in both proximal and distal ways.

In proximal ways: drinking and eating in excess to arguing that the virus isn’t nearly as lethal as health experts claim. And in distal ways: affirming an individual’s cultural worldview to maximizing one’s self-esteem, in line with the TMT literature. As threats that remind us of our own deaths continue and expand, TMT will continue to be a leading source of understanding human behavior and beliefs.

Complete Article HERE!

Psychedelics gave terminal patients relief from their intense anxiety

— End-of-life cancer patients in a therapy group in Canada used psilocybin to reduce their fears. It helped some find peace.

Valorie Masuda, left, Gail Peekeekoot, center, and Barb Fehlau participate in a grounding ceremony for staff members at Roots to Thrive, a wellness center in Nanaimo, British Columbia, in August.

By Meryl Davids Landau

When Brian Meyer received a Stage 4 prostate cancer diagnosis three years ago at age 62, he was determined to make the most of his remaining years. He immediately retired from a decades-long career in the grocery business and took every opportunity to hike, camp and — his all-time favorite — fish for salmon. Brian and his wife, Cheryl, regularly visited their two grown children and three grandsons and spent time with their many friends.

But it was sometimes hard to keep his mind off his pain and the reality that life was nearing an end. “It tugs at the heart all the time,” Meyer, from Vancouver Island, British Columbia, said in August. A calm person by nature, he found his anxiety skyrocketing.

By November, though, despite a new, highly aggressive liver cancer that shrank his prognosis to months or weeks, Meyer felt calm much of the time. The prime reason: a 25-milligram dose of the psychedelic drug psilocybin he had taken several months earlier, due to a Canadian program being watched elsewhere for the emotional benefits it may offer people nearing death.

In mid-August, Meyer and nine other people with terminal cancers had gathered in two rooms, and there, lying on plush floor mats with blankets covering their bodies, their eyes covered by sleeping masks and music piped in over headphones, they swallowed the psilocybin capsules. The consciousness-altering drug, administered by the nonprofit Vancouver Island wellness center Roots to Thrive, set Meyer and the others on a six-hour journey of fantastical images and thoughts. The hope was that this “trip” would lead to lasting improvements in mood and lessen their angst around death. It was accompanied by weeks of Zoom group therapy sessions before and after, along with an in-person gathering the evening before for a medical clearance and the opportunity for participants and their spouses to meet in person.

Canadian health-care providers have been able to offer this otherwise illegal drug since 2022 when the country’s national health-care system began a special access program for certain patients with serious or life-threatening diseases. To date, 168 Canadians have been authorized to receive the drug under the program. Similar access is not available in the United States, because a terminal patient’s right to try experimental therapies excludes psychedelics, which are banned by the Controlled Substances Act. Oregon and Colorado are in the early stages of allowing psilocybin-assisted psychotherapy due to ballot initiatives passed in the states, but people who receive the drug there could be charged with a crime under the federal law.

Clinical trials assessing psychedelics for various mental health concerns tend to administer them to patients individually. But Roots to Thrive prefers to do it in groups. “The group process in psychedelic-assisted therapy allows for a shared experience that helps people realize they are not alone in experiencing difficult emotions, symptoms or challenging life circumstances,” said Pam Kryskow, the center’s medical director.

By the time Meyer swallowed the psilocybin capsule, he felt comfortable with his cohort. Some, like Christine “Cat” Parlee, 53, who has Stage 4 melanoma that has spread to her lungs and throat, had become friends. At a restaurant where Parlee, her husband, Cory, and Cheryl gathered before the in-person meeting, Brian and Cat shared their hope that the drug experience would be joyful and that it would subsequently enhance their peace of mind.

The day after taking the psychedelic, however, sprawled on a couch in the resort room Brian and Cheryl had rented for the week, Meyer couldn’t conceal his disappointment. Although he didn’t have a negative trip, two of the other participants were overwhelmed by the drug’s intense effects and spent the hours yelling for it to stop. This repeatedly pulled Meyer away from the intriguing images filling his mind, including sword-fighting in a medieval castle yard and cooking elaborate meals of lobster and lamb in a massive industrial kitchen.

His mental journey was also interrupted by having to urinate regularly, a symptom of his prostate cancer, although he was struck by the intense spiritual connection he felt with one of the facilitators, registered nurse Gail Peekeekoot, as she touched his hands to guide him to the restroom. “It was like she was me, I was her. We were one together,” he marveled.

Psychedelic journeys don’t always proceed as people anticipate, leaving some feeling dissatisfied immediately after, said Barb Fehlau, a palliative care practitioner on Vancouver Island and the medical facilitator in the room, who herself has pancreatic cancer. Regardless of the experience while the drug is active, though, psychological healing often follows, she said.

That was the case for Meyer. In addition to his enhanced calmness, he remarked in November that taking the drug seemed to have deepened the connection he felt toward the friends and family who had streamed into his and Cheryl’s home following his worsened prognosis. “I have a way more sensitive outlook. I feel more love toward people,” Brian relayed at the time. Three weeks later, in a hospital surrounded by more than a dozen family members, Brian died. “He remained calm, peaceful and joyful” to the end, Cheryl said.

Should psychedelics ever be legalized as medicine — the first, methylenedioxy-methamphetamine, or MDMA, to treat post-traumatic stress disorder was submitted to the U.S. Food and Drug Administration in December by the MAPS Public Benefit Corporation (now called Lykos Therapeutics) — people who might benefit most are those who have a terminal diagnosis, said Anthony Bossis, a clinical assistant professor of psychiatry at New York University.

Psychedelics do not alter the course of the person’s disease, but they can help make the remaining time more meaningful, Bossis said. He is co-author of a 2016 study of 29 cancer patients that found that a single dose of psilocybin significantly reduced depression and anxiety and “led to decreases in cancer-related demoralization and hopelessness, improved spiritual wellbeing, and increased quality of life,” the study reported.

Feeling a sense of connection to something larger than themselves, akin to what Meyer experienced with Peekeekoot, may be especially important, the study found. “After this experience, people often say, ‘I realized I’m not just my cancer. I’m not just this body. I’m something more enduring.’ This is a real gift,” Bossis said.

How psychedelics might change a person’s outlook is under investigation. One study with mice this past summer by Johns Hopkins University researchers found that the drugs reopen “critical learning periods” in the brain for months after their use. Mice studies don’t translate exactly to humans, but this finding suggests that psychedelics may cause people to be especially receptive to new ideas and ways of being.

Still, the research on psilocybin for those at the end of their lives is in the early stage, and whether the drug might prove harmful for some isn’t yet known. Roots to Thrive’s unpublished research surveying 20 people from its prior three psilocybin group sessions found many felt more positive, peaceful, lighter and less stressed. But four felt little to no change.

Cat Parlee, who participated with Meyer in the August session, had taken psilocybin two prior times at Roots to Thrive in the previous 18 months. While some people experience lasting transformation after taking the drug once, Parlee found that after six months her fears and anxiety would return.

Reclining on a comfortable hammock chair on their home’s back patio the day after Parlee’s August session, her husband, Cory, says the two have come to view the psyche as if it were a cookie with pieces bitten off around the edges. “The psychedelics help Cat find the missing pieces that make her more whole,” Cory reflected. “Psychedelics help you answer questions you may not know or give yourself permission to ask.”

Cat Parlee agreed. “Every time I’ve walked out of psychedelic medicine session, I feel like I’ve left weight behind — weight I’ve consciously decided I’m not going to carry anymore,” she said. This included the negative emotions she had felt toward her deceased mother and the people who badgered her to try the cancer “cures” they read about online. “A lot of energy was wasted on a lot of anger, a lot of sadness and a lot of guilt. I realized I don’t have time to waste on that anymore,” she said.

While many people might benefit from addressing psychological issues that impede their lives, the urge to confront such demons often intensifies when a person is given a few months or years to live, according to Shannon Dames, the founder of Roots to Thrive. Most of us operate under the illusion that we have time to change these things, Dames said. “When you’re at a place when you don’t have that perception of time, there’s a calling that’s really potent.”

About a month before his death, Meyer credited the psychedelic with reducing the discomfort he felt about dying. “I don’t want to say I’m excited, but I am very curious now,” he said. He realized the mushrooms had taken him to an unknown, altered world; death would do the same.

In Parlee’s case, her fear “was that there is nothing — just emptiness — after you’re dead.” During her second psilocybin trip, she watched herself swim in brightly lit, vivid waters amid an intense feeling of love. She was soothed by the sense that experience may be similar to the afterlife.

Since her August session, Parlee has also increasingly found pleasure in standing up for her needs, rather than always worrying about other people as she had previously done. “There’s one thing I want to do before I leave this world: It’s to know that I spent my last few years happy. One thing I can say right now is I don’t have any real regrets,” she said.

Then she took a deep breath and smiled. “I don’t know if I would have ever gotten to that place without this psilocybin journey.”

Complete Article HERE!

Death by Doctor May Soon Be Available for the Mentally Ill in Canada

— The country is divided over a law that would allow patients suffering from mental health illnesses to apply for assisted death.

Jason French has undergone years of treatment for his depression without any improvement. He says he wants access to assisted death so he can die on his own terms.

By Vjosa Isai

Canada already has one of the most liberal assisted death laws in the world, offering the practice to terminally and chronically ill Canadians.

But under a law scheduled to take effect in March assisted dying would also become accessible to people whose only medical condition is mental illness, making Canada one of about half a dozen countries to permit the procedure for that category of people.

That move has divided Canadians, some of whom view it as a sign that the country’s public health care system is not offering adequate psychiatric care, which is notoriously underfunded and in high demand.

The government of Prime Minister Justin Trudeau, which has been criticized for its rollout of the policy, has defended its actions by pointing to a 2019 court decision in Quebec that officials say mandates the expansion.

Members of the Conservative Party have accused the government of promoting a “culture of death.” There has also been opposition from politicians on the left who would like the government to focus its health policy on expanding mental health care.

Jason French is among those building a case for why a doctor should help him die.

With copies of a document describing his troubled mental health history tucked in his backpack, he attended an event in Toronto to lobby for making assisted dying available to people like him.

He has severe depression and has tried twice to end his own life, he said.

“My goal from the start was to get better,” said Mr. French, of Toronto, who agreed to share his name, but not his age because so many in his life don’t know about his illness. “Unfortunately, I’m resistant to all these treatments and the bottom line is, I can’t keep suffering. I can’t keep living my life like this.”

But Dr. John Maher, a psychiatrist in Barrie, Ontario, who specializes in treating complex cases that often take years to improve said he was concerned that hopeless patients will opt for assisted death instead.

“I’m trying to keep my patients alive,” he said. “What does it mean for the role of the physician, as healer, as bringer of hope, to be offering death? And what does it mean in practice?”

Canada’s existing assisted death law applies only to people who are terminally ill or living with physical disabilities or chronic, incurable conditions. The country’s Supreme Court decriminalized assisted death in 2015 and ruled that forcing Canadians to cope with intolerable suffering infringes on fundamental rights to liberty and security.

About 13,200 Canadians had an assisted death last year, a 31 percent increase over 2021 according to a report by the federal health ministry. Of those, 463 people, or 3.5 percent, were not terminally ill, but had other medical conditions. Patients who are approved have the option to end their lives using lethal drugs administered by a physician or nurse, or by taking drugs prescribed to them.

There is still uncertainty and debate over whether assisted death will become available to the mentally ill early next year as scheduled. Amid concerns over how to implement it, Parliament has delayed putting it into place for the past three years and could delay it again.

Clinical guidelines were released to address those concerns last March, but some people involved in providing mental health care say they are insufficient.

A person wearing a dark jacket and an orange top stands near a body of water.
Lisa Marr, a paramedic diagnosed with post-traumatic stress disorder, said the wait for the assisted dying law to take effect has been grueling.

But supporters say denying mentally ill people access to the same humane option to end their suffering amounts to discrimination.

“I have a very deep empathy for patients who suffer deeply,” said Dr. Alexandra McPherson, a psychiatry professor at the University of Alberta and assisted death provider. She said she treats a small number of patients “with severe disabling mental health disorders who suffer equally to the patients that I see in cancer care.”

Lisa Marr, a former paramedic diagnosed with post-traumatic stress disorder who lives in Nova Scotia, said she was desperate to take advantage of the new law. She has bipolar disorder, depression and excoriation disorder, or skin picking, from anxiety and has made, she estimates, 15 attempts on her life but “always managed to pull myself out.”

A person covered by a blanket sits on a couch. A cat is nearby.
Ms. Marr at home with her support cat, Fig. “All the medications I take just barely keep me together,” she said.

Canada amended its criminal code to legalize assisted death for the terminally ill in 2016, and in 2021, responding to the court ruling in Quebec, the country loosened the law to add other severely ill people experiencing “grievous and irremediable” conditions.

Eligible patients must wait 90 days before receiving an assisted death and be approved based on the assessments of two independent physicians. One of the assessors must be a specialist in the patient’s illness or have consulted with a specialist.

A panel of experts and a special parliamentary committee have worked to address concerns from the public and medical community, by laying out practice standards and advising clinicians and regulators.

The government has also funded the development of a training program for physicians and nurses who assess patients for assisted death.

“The work has been done,” Dr. Mona Gupta, the chair of a government-appointed expert panel — who is a psychiatrist and bioethics researcher at the University of Montreal — told a special parliamentary committee in November. “We are ready.”

Anyone in Canada seeking assisted death must be deemed by the physicians or nurse practitioners who assess them as not impulsive and not suicidal, and those who are mentally ill would need to be evaluated to show that their condition is “irremediable.”

But even some psychiatrists worry that they may not always be able to determine if someone seeking an assisted death could actually get better or not.

“The research that we have shows psychiatrists are no better at identifying who’s not going to get better,” said Dr. Maher, the psychiatrist in Ontario. “The challenge for us is it’s not a short term process. When people have been sick for years, healing takes years.”

The Centre for Addiction and Mental Health, Canada’s largest teaching hospital for psychiatric care and research, has said that clinicians need more guidance to assist them in assessing who is acutely suicidal or capable of making a rational choice to end their lives.

“We’ve been clear that we have concerns about expansion at this time,” said Dr. Sanjeev Sockalingam, chief medical officer at the center, which has convened several professional groups to assist physicians in preparing for March.

A man in a suit leans against a pole looking out the window.
Dr. Sanjeev Sockalingam is the chief medical officer at the Centre for Addiction and Mental Health, Canada’s largest teaching hospital for psychiatric care and research.

Ms. Marr, the paramedic, said the wait for the law to take effect has been grueling. She takes eight psychiatric drugs every day. “All the medications I take just barely keep me together,” said Ms. Marr, who is on disability leave and spends most days in her room, leaving home only for therapy.

Her father had an assisted death after being diagnosed with prostate cancer, and her mother died shortly after, all while she was juggling her job as a paramedic.

“Then, my mental health started to rear its ugly head,” she said.

The uncertainty over whether the mentally ill would be allowed assisted death motivated Mr. French to leave his home after work, something his depression rarely allows him, to attend a screening of a documentary financed by Dying With Dignity, a charity promoting assisted death.

He went with several copies of a five-page document he created explaining his case, hoping to give it to medical experts at the screening.

Death doesn’t scare him.

“My biggest fear is surviving,” he said.

He said he’s not suicidal. But, he added, “I don’t want to have to die terrified and alone, and have someone find me somewhere. I want to do it with a doctor. I want to die within a few minutes, peacefully.”

A person in a hooded sits on a bench facing a playground.
“My biggest fear is surviving,” Mr. French said.

Both Canada and the United States have a three-digit suicide and crisis hotline: 988. If you are having thoughts of suicide, call or text 988 and visit 988.ca (Canada) or 988lifeline.org (United States) for a list of additional resources. This service offers bilingual crisis support in each country, 24 hours a day, seven days a week.

Complete Article HERE!

Can magic mushrooms help patients dying in hospice care?

— Dana-Farber researchers want to find out.

From left to right: Dr. Alden Doerner Rinaldi, Dr. Caitlin Brennan, Dr. Zachary Sager, Dr. Roxanne Sholevar, and Dr. Yvan Beaussant pose for a portrait inside one of the rooms at the Care Dimensions “Hospice House” in Lincoln where dying patients can receive synthetic psilocybin as part of a small trial by researchers at Dana-Farber Cancer Institute.

By Jonathan Saltzman

Sixty years after Harvard fired Timothy Leary over his experiments with psychedelic drugs, a hospital affiliated with the university has reopened the door on such research by testing whether hallucinogenic mushrooms can help dying patients face death.

The small trial by researchers at Dana-Farber Cancer Institute’s Psychedelic-Assisted Therapy program is the first to test synthetic psilocybin — the active ingredient in so-called magic mushrooms — in patients in hospice care, according to experts. The patients have cancer, heart disease, and other terminal illnesses and six months or less to live.

The pilot study, which combines a single dose of the psychedelic drug with talk therapy, began in 2022 with the approval of the Food and Drug Administration, and has so far provided psilocybin to eight patients, six of whom have since died. The trial, which is expected to be completed next year after two more patients receive doses, is gauging how well dying patients tolerate the drug and whether it eases their “psychological and existential distress.”

It is only the second study of psychedelics at a Harvard-affiliated institution since the school fired Leary as a psychology lecturer in 1963 for unethical scientific practices, according to researchers. McLean Hospital, a psychiatric teaching hospital of Harvard Medical School, began testing another psychedelic, MDMA, or ecstasy, on cancer patients with anxiety in 2006. But controversy derailed the study, which ended without publication of findings.

Dr. Yvan Beaussant, a palliative care physician at Dana-Farber who is leading the new trial, said he hopes it shows whether psilocybin — used for centuries by the indigenous peoples of Mexico and Central America — along with talk therapy can relieve “demoralization syndrome,” a clinical term for the hopelessness and meaninglessness often experienced by hospice patients.

“These people are facing the most challenging phase of life, dying,” said Beaussant. The eight psilocybin recipients reported varying reactions to the drug, he said, but many later felt a renewed sense of purpose and deeper connections to loved ones. To confirm those benefits, Beaussant said he hopes to launch a larger trial.

Dr. Yvan Beaussant, a palliative care physician at Dana-Farber who is leading a small trial testing synthetic psilocybin — the active ingredient in so-called magic mushrooms — in patients in hospice care.
Dr. Yvan Beaussant, a palliative care physician at Dana-Farber who is leading a small trial testing synthetic psilocybin — the active ingredient in so-called magic mushrooms — in patients in hospice care.

Psilocybin, like LSD and other psychedelics, is illegal to buy, possess, or distribute outside of a clinical trial; in 1970 the Nixon administration placed it on the federal government’s list of Schedule One substances, on par with heroin.

But over the past 15 years or so, researchers have tested psilocybin’s potential therapeutic benefits, particularly for people with severe depression and anxiety. Some experts say a growing body of evidence shows that under the right circumstances, psilocybin can improve the mood of patients much faster than traditional psychiatric drugs or talk therapy.

Dr. Roxanne Sholevar, a Dana-Farber psychiatrist and fellow investigator in the psilocybin trial, said she was profoundly moved by the experiences of two terminally ill patients whom she counseled and stayed with during mind-altering trips.

One was a 47-year-old woman who had withdrawn emotionally from her two teenaged children while facing death from pulmonary fibrosis, a progressive lung disease. After taking the drug, the woman reported a mystical experience during which she came upon a primordial river where life began, Sholevar said.

She told Sholevar afterward that she realized that all living things had come from the river, and, like them, she would return to it when she died. That helped allay her depression and anxiety and led her to leave a videotaped message to her children saying she would always be with them.

The other patient, an 81-year-old man who was a devout Catholic, felt life was meaningless because of his impending death, and the death of his wife several years earlier. The man, who also had pulmonary fibrosis, took the capsule containing psilocybin and found himself transported to a dark cathedral where he encountered an “ominous presence” that scared him, Sholevar said.

The researchers summoned a hospice chaplain to comfort him, and the man’s agitation faded. He later told Sholevar that he realized that the purpose of his remaining days was to receive and share God’s love.

“These shifts that I’m describing are the type of things that take years of psychotherapy,” said Sholevar. “I am stunned and reverent and just deeply curious about what we are seeing here and how we can develop this to further enhance its safety and rigor.”

Sholevar and Beaussant said the study could also have a side benefit: repairing the reputation of Timothy Leary.

Timothy Leary caused a furor as a lecturer in clinical psychology at Harvard in the early 1960s when he was studying psilocybin, which was legal at the time.
Timothy Leary caused a furor as a lecturer in clinical psychology at Harvard in the early 1960s when he was studying psilocybin, which was legal at the time.

Leary caused a furor as a lecturer in clinical psychology at Harvard in the early 1960s when he was studying psilocybin, which was legal at the time. Faculty members and administrators complained that he was giving hallucinogens to students and sometimes taking the substances with people he was studying. Leary contended that psychedelic drugs, including LSD, could transform personality and expand human consciousness.

After his firing, Leary went on to urge young people to “turn on, tune in, drop out,” becoming an oracle to hippies and a publicity-seeking crackpot in the eyes of critics. President Richard Nixon allegedly described him as “the most dangerous man in America.”

Still, the psychologist helped to pioneer the importance of “set” ― mindset — and “setting” in the safe use of psychedelic drugs, said Beaussant and Sholevar. That insight is crucial to the team of researchers who guide terminally ill patients through mind-altering trips.

All the participants are in home hospice care provided by Care Dimensions, a hospice provider in Massachusetts. The patients must undergo two counseling sessions at home with a team of two therapists who prepare them to take psilocybin and discuss what they hope to get out of it. Patients are advised to “trust, let go, and be open” to the experience “even if it’s intense or uncomfortable,” Beaussant said.

“People might have blissful experiences,” he said, but others have “very challenging” trips. “Sometimes what might come up is a sense of what you’ve lost, past trauma, painful memories,” he explained. “The idea is not to avoid that.”

Patients undergo two more therapy sessions at home after using the drug to discuss how the experience affected them and how that might change how they live the rest of their lives.

The setting for the trips is the 18-bed Care Dimensions Hospice House, located on 12 wooded acres in Lincoln. Patients typically sit on a recliner or lie in a bed in a room with a patio and a view of landscaped gardens. They wear eye masks to focus their attention inward. Donning headphones, they listen to soothing music on a playlist synched to the onset, peak, and fading effects of the psychedelic experience, which typically lasts about six hours.

At least one researcher stays by the patients’ side, checking their heart rate and blood pressure, both of which typically rise modestly under the influence of psilocybin. It’s critical that patients feel safe.

“The idea of set and setting — we know these factors are really important in shaping the nature of the experience and its potential therapeutic value,” Beaussant said. “That’s work Timothy Leary introduced.”

A curled-up Timothy Leary reads a book in 1961.
A curled-up Timothy Leary reads a book in 1961.

The notion of rehabilitating Leary’s reputation may seem improbable. But so is the surging interest in the potential benefits of hallucinogens to treat a variety of maladies, from depression to post-traumatic stress disorder to obsessive compulsive disorder — even to irritable bowel syndrome.

“We call it the psychedelic renaissance,” said Rick Doblin, a psychedelic drug activist and founder of the Multidisciplinary Association for Psychedelic Studies, who lives in Belmont. His organization hopes to win FDA approval in mid-2024 of MDMA as part of a treatment for post-traumatic stress disorder.

In recent years, the country’s top medical schools have raced to set up psychedelic research centers, and investors have funneled millions of dollars into start-ups exploring the therapeutic potential of such compounds.

Prominent medical schools supporting psychedelic research include Johns Hopkins, NYU and UCLA.

Massachusetts General Hospital, another Harvard-affiliated teaching hospital, established the Center for the Neuroscience of Psychedelics in 2021 to study the substances. It is planning trials of psychedelics for maladies ranging from rumination to fibromyalgia but hasn’t started testing the compounds yet.

Michael Pollan, author of the best-selling 2018 book “How to Change Your Mind: What the New Science of Psychedelics Teaches Us About Consciousness, Dying, Addiction, Depression, and Transcendence,” was startled to hear about the Dana-Farber study.

“That’s a big deal because of Harvard’s history with psychedelics and the institutional embarrassment over the Timothy Leary episode,” said Pollan, who teaches creative writing at Harvard but is on leave this semester. “I would have thought they’d be the last university in America to venture back into the water.”

Pollan was not surprised, however, by the scientific interest in psychedelics to treat mental disorders.

“The mental health care system is broken,” he said, and clinicians are “desperate for new tools.”

A bed in one of the rooms at the Care Dimensions "Hospice House" in Lincoln where dying patients can receive synthetic psilocybin as part of a small trial by researchers at Dana-Farber Cancer Institute.
A bed in one of the rooms at the Care Dimensions “Hospice House” in Lincoln where dying patients can receive synthetic psilocybin as part of a small trial by researchers at Dana-Farber Cancer Institute.

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Does Thinking About Dying Increase Your Risk Of Death?

By Tricia Goss

The human mind and body are intricately connected. The relationship between the two is so profound that it can significantly impact our well-being. Whether thinking about death increases the risk of death delves deep into this complex relationship. The age-old saying “mind over matter” suggests that our thoughts have the power to shape our physical reality, and scientific research supports this notion.

Psychoneuroimmunology studies how emotions, thoughts, and beliefs affect the immune and nervous systems (via Reference Module in Neuroscience and Biobehavioral Psychology 2017). A 2017 study in Physiological Reviews shows that the brain communicates directly with the immune system, releasing chemicals and hormones that can profoundly impact how your body functions. Stress hormones like cortisol, released when we experience psychological stress, can lead to health problems like cardiovascular issues and weakened immune responses (per the Mayo Clinic).

The placebo and nocebo effects illustrate this even further. Believing that a treatment will work can trigger remarkable healing responses, while negative expectations can have detrimental consequences.
Ultimately, it’s clear that our thoughts and physical well-being are intricately connected. By exploring the science behind psychosomatic illnesses and how the fear of death influences health, we can better understand how our thoughts shape our bodies’ realities.

Psychosomatic illnesses and their impact

woman touching bridge of nose

Psychosomatic illnesses are physical conditions stemming from psychological factors like stress, anxiety, or emotional distress. Studies have consistently shown how psychological distress can trigger or worsen various physical health issues (per Healthline). For instance, 2014 research published in the World Journal of Gastroenterology highlighted that patients with IBS often exhibit high levels of anxiety and stress, which can worsen their symptoms.

Additionally, psychosomatic illnesses can affect our hearts. According to 2021 research published in Circulation, negative psychological factors — such as stress, anxiety, and depression — can increase our risk of developing cardiovascular disease (CVD). In contrast, positive psychological factors — such as optimism, resilience, and social support — can reduce our risk of developing the disease.

Similarly, psychological factors also play a significant role in chronic pain conditions. For example, a 2017 report in Neural Plasticity demonstrated a link between depression and chronic pain.

These examples provide compelling evidence of the profound connection between the mind and body.

The positive aspects of mortality awareness

happy mother, daughter, and granddaughter

The idea of mortality is a complicated issue that encourages us to explore the depths of our human experience. Realizing that your time on this planet is limited can bring about many emotions, such as fear, anxiety, and despair. However, this realization can also provide you with an opportunity for personal growth and positive change. It urges you to reflect on your life, evaluate your priorities, and cherish every moment.

Embracing life’s impermanence can be a powerful catalyst for personal growth as well as developing and changing habits. It can help motivate you to live a more authentic, meaningful, and purposeful life. By accepting that life is fleeting, you can be inspired to wake up each day with a sense of purpose and gratitude for the world around you. By facing your fears with resilience and courage, you’ll learn to appreciate life’s uncertainties and make the most of the time you have.

What to do if thinking about dying causes anxiety

man speaking with mental health professional

While it’s important to recognize that death is a natural part of life, it’s also vital to avoid fixating on it and letting it cause undue stress or anxiety. The good news is that there are plenty of constructive steps we can take to address our concerns and maintain a positive outlook on life. A study published in 2022 in Current Psychology has shown that people who find meaning in their lives and can effectively manage stress are less likely to experience death anxiety. This means growing and cultivating resilience in the face of existential fears is possible.

If you worry about death frequently or feel like these fears are starting to impact your daily life, seeking mental health support is a great way to be proactive and get the help you need. Mental health therapists and psychologists can offer guidance, coping strategies, and emotional support to help you navigate your fears and feel more resilient. By embracing the challenges of mortality and seeking support when needed, you can lead a more balanced, fulfilling life and face life’s uncertainties with greater confidence.

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