Americans want assisted suicide

Rev. Nancy Butler

On Wednesday the Rev. Nancy Butler of Riverside Family Church in Hartford died voluntarily. For two years she had been suffering the debilitating effects of ALS even as she continued to pastor the evangelical church she established in 2008 as “theologically open minded, diverse, empowering women and affirming of LGBT people.”

The letter she wrote to her flock last week begins:

I have decided to go off my feeding tube and vent this week and . . . how should I put it . . . die. I knew my suffering would reach this tipping point and caring for me would become impossibly demanding. What I didn’t know was whether or not God would want me to suck it up for some unseen purpose or end my life this way.

I am a little surprised God is confirming this decision. Nice to know He isn’t a sadist. He is oh so tender right now. He tells me my work is done and it’s the right time to come home.

Having a feeding tube removed does not legally count as assisted suicide, but we shouldn’t be fooled by the passive voice. Someone took the tube out, very likely a medical professional. Nancy Butler died of her own will, with assistance.

So did my mother Bernice, who consulted with her internist before deciding to stop eating and drinking six years ago. She was facing a painful death from peritoneal cancer and chose instead to end her life voluntarily. That was not, technically, assisted suicide either.

Assisted suicide is defined as “knowingly and intentionally providing a person with the knowledge or means or both required to commit suicide, including counseling about lethal doses of drugs, prescribing such lethal doses or supplying the drugs.”

Most Americans have no problem with that, so long as the person is facing a painful terminal disease. Indeed, according to a new study from LifeWay Research, fully two-thirds of them find it morally acceptable.

To be sure, a moral distinction can be drawn between providing a person with a lethal drug and withholding or withdrawing treatment or sustenance. But it’s a distinction without a difference, as far as most are concerned.

The moral issue, it seems, is not how death comes about but whether the terminally ill get to choose. The answer, increasingly, is yes. That goes for 70 percent of American Catholics, whose church has worked hard and with some success to prevent state approval of assisted suicide laws.

“The concept of physician-assisted suicide is a major affront to the teachings of the church,” Michael C. Culhane, executive director of the Connecticut Catholic conference, said last year.

But as a matter of public policy, the argument ought to be prudential. Will terminally ill persons be hustled into the next world without their really wanting to be?

The best empirical evidence we have in the U.S. comes from Oregon, where assisted suicide became legal in 1998. Since then, the annual number of legally sanctioned suicides has risen from 16 to 132, with a doubling since 2010.

That’s under four percent of Oregonians who died last year. Of them, 77 percent were dying of malignant cancers and 9 percent had ALS — as has been the case throughout the history of assisted suicide in the state.

I know that my mother chose what she wanted, and I’m confident that Nancy Butler did too. I’m with most other Americans in not wanting to stand in the way of those terminally ill persons who choose to do the same by way of lethal prescription. I cannot speak for God.

Complete Article HERE!

NICE guidance on care for dying children highlights importance of supporting families

Care for dying children must take full account of the emotional and practical needs of their family as well as the young person, according to new guidance from the National Institute for Health and Care Excellence.

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The challenges of improving productivity and quality, while also saving money, will prompt massive change in the hospital sector

The guideline, published today, also recommended an “advance care plan” detailing treatment decisions that should be routinely updated and that should include information about whether the child wants to donate their organs.

Children approaching the end of their life, as well as families and carers, may find it distressing to discuss the plan, noted the guidance. It added that they might, therefore, be reluctant to speak about it and may also have differences of opinion over what decisions are recorded in it.

Parent and carers must also be talked to about the support they can expect when the child dies as part of developing the plan, stated the document.

The guideline makes recommendations about how to discuss treatment withdrawal, and what can be done to help families when a child is approaching the end of life, such as preparing for important rituals, having photographs and any considerations around the use of social media.

It also covers how to discuss the preferred place of death for the child, how to manage pain in children, possible seizures, respiratory distress and nutrition.

A specialist paediatric palliative care team should be involved in managing distressing symptoms and must include, at a minimum, a paediatric palliative care consultant, a nurse with expertise in paediatric palliative care, a pharmacist with the same level of expertise, and also professionals who have experience in supporting families and children with practical and social elements of their care.

In addition, information on how to recognise whether a child is in the last few days of their life, about rapid transfer arrangements to their preferred place of death and how to provide care at home is discussed in the guidane.

However, it called for more research about how to identity when a child with a life-limiting condition is likely to die within hours or days.

“Healthcare professionals are often asked to estimate how close a child or young person may be to death. There is very little evidence on which to base any such estimate,” stated the guideline – called End of life care for infants, children and young people with life-limiting conditions: planning and management.

“To help predict when a child or young person is in the last hours or days of life, a clearer understanding is needed of which groups of signs and symptoms indicate this most clearly, it said.

“This would improve healthcare planning, but importantly would also allow families to realistically address their ‘hopes and wishes’ for their child’s care while preparing themselves for the child’s or young person’s last hours and days of life,” it added.

The guidance also stated that clear, easy to explain information tailored to the child’s age and level of understanding should be provided to them. This could include using art, digital media or music to explore their feelings and questions.

Dr David Vickers, consultant paediatrician at Cambridgeshire Community Services NHS Trust and chair of the NICE guideline committee said: “Providing care for a dying child can be an enormous challenge. It can place a substantial strain on the family.

“Mothers and fathers can be forced into a medical role in order to provide the care their son or daughter needs. It is important for us to recognise this and offer help to alleviate the pressure,” he said.

“By getting this right, and being there for whoever needs us, wherever they need us, we can ensure siblings continue to be a brother or sister, and parents can have time to simply be mum and dad,” he added.

Complete Article HERE!

Life after death and the fear of dying

By Heidi Anderson

Heidi Anderson, with her Nan and brother, has been thinking about life after death.

[O]n the 16th of August this year, my beautiful 96 year-old Nan passed away. Since then, I have rode one hell of a roller-coaster with my emotions all over the shop.

 
Nan and I always had a pact that if there were something on the other side, that she would come back and tell me about it.

She never believed there was anything else after you die and she would always say to me: “Once you’re dead, you’re dead. That’s it. There is nothing else.”

That is what terrifies me. The thought of “that’s it” petrifies me. I’m seriously scared of dying and for years this has given me anxiety.

I have worked with my psychologist about this fear. Dying is inevitable, but I still find it so hard to comprehend.

I’m not sure any of the sessions have helped, I still think about it a lot.

People constantly say to me: “Why stress about something you have no control of?”

Or, “You won’t know when you’re dead that you’re dead, so chill out.”

Heidi Anderson’s Nan, who passed away in August age 96.

Believe me, if I could switch it off I would but that’s easier said than done. It’s not the thought of how I die that bothers or upsets me, it’s the thought of the unknown. Not knowing what’s next.

This consumes my thoughts far too often and it’s something that I have tried to come to terms with over the past few years with no such luck.

When my Mum told me that Nan was dying and she wouldn’t recover from her fall, I flew straight to her bedside, along with all the family.

Saying goodbye to my Nan was the hardest thing I have ever had to do in my life.

Once Nan knew herself that she was dying and had accepted her fate, she called me into her room to speak. At this stage, she didn’t have much energy but she was putting all her fight into saying goodbye to people individually.

“Heidi, we all die. That’s life,” she said to me. “That’s the one thing are guaranteed in life. We’re born to die.”

Looking back, I think Nan was speaking to herself, as she too was always so afraid of death.

Over the next few days, Nan went downhill and eventually she stopped speaking and just slept.

Family came and went and said their goodbyes, but I stayed around.

I wanted to be with Nan as she exited this world. I wanted to hold her hand as she took her last breath.

Looking back, I think I also wanted to confront my fear of death. If I saw what actually happens, maybe I wouldn’t be so scared.

So I hung around the hospital like a bad smell, rarely leaving Nan’s bedside.

I played her music, told her stories and relived all our good times.

Unfortunately, by that stage she was no longer talking, but she would twitch her lips or flicker her eyes.

I swear she could hear everything, she just couldn’t respond.

In the end, I flew home to Perth. She was holding on and I felt Nan just didn’t want to die in front of any of her grandkids.

12 hours after I got home, Nan took her last breath with her three daughters at her side.

The nurses at the hospital said it was very common for people, when they’re dying, to choose who is with them.

Although I wanted so desperately to be with Nan, I felt she knew it was best that I wasn’t there.

When I arrived home in Bathurst for her funeral, I still felt that I wanted to confront my fear of death and see Nan.

Mum took me to the funeral home the morning of her farewell and I saw Nan for the first time since she passed away.

She was dead and she even looked it. No amount of makeup was hiding the fact that she was gone.

It hit me like a ton of bricks. Nan was dead and she was never coming back.

Thoughts started flooding my brain.

“Where is she? Is there something else out there? Is she with Pop? What happens? Where has she gone?”

Her body was there but that wasn’t my Nan.

My friends asked later if she looked peaceful and I found that hard to explain. She looked like she was gone and that is something I won’t ever really understand.

I’m not sure seeing my Nan in her coffin has helped my fear of dying, but it definitely gave me some kind of closure.

I am still waiting for Nan’s spirit to visit me and let me know if there is anything else out there.

I have had a couple of dreams about her and I talk to her all the time but I am yet to feel her or hear if there is life after death.

Complete Article HERE!

Terminally ill children should be asked about ‘life ambitions’, experts say

Children and young people with life-limiting illnesses should be asked if they have a wishlist of achievements they want to accomplish, health officials have said.

 
Medics or care workers developing care plans for youngsters should ask about their “life ambitions and wishes”, according to new guidance on end-of-life care for children and young people from the National Institute for Health and Care Excellence (Nice).

It may be appropriate to ask youngsters what they want to do with social media accounts, such as Facebook or Twitter pages, before they die, experts said

Terminally ill children may wish to close down their social media accounts or keep them as memorial pages

Young people or their families should be asked about what they hope to achieve in life, including ambitions for social activities, relationships and educational attainment, the guideline suggests.

Dying teenagers might want to complete their GCSEs or make specific wishes on who should be given their personal belongings , according to Dr Emily Harrop, who helped to develop the guideline.

The child or a parent, depending on the child’s age, should also be asked about life ambitions, she said.

The paediatric palliative care consultant said: “When we start a conversation about end-of-life planning, rather than introduce that with a very closed question or a very negative question, we often start by asking for things like ‘What do you hope for? What do you aspire to do for yourself? What would you hope your child to achieve?’

“It is incredible what you get back actually. It’s rarely as simple as you’d think.

“It is always very, very individual.

“Some people I counsel are still pregnant but have a baby who has a condition which is life-limiting. One way to deal with the horror of that is to say to the couple ‘what do you and your family still hope for?’. It opens up a conversation where you can look to help them achieve what they hope for and look to be able to talk about, or even dispel, that which they fear.

“For the adolescents I care for, a lot of it is about their legacy, what they leave behind.

“It’s about what they wish to achieve with the time they have – do they want to do their GCSEs? If they have treasured possessions, are they desperate to know who they are going to leave those to?

“On one level, it opens a conversation you need to have and on the next level, it promotes you to think about them as an individual, not just as a person whose medical or social care you are delivering.”

Meanwhile, terminally ill teenagers may want to be asked if they would like social media accounts to be closed down or turned into memorial pages.

The new guidance states that when a child or young person is approaching the end of their life, health or care workers should talk to parents about “what would help them”, such as plans for social media content.

Dr Harrop, who works for Helen & Douglas House Hospices in Oxfordshire, said: “Some young people are old enough to have their own social media pages and when someone passes away, there is a mechanism to make ‘in mem’ (memorial) pages where people can add tributes but the content is limited.

“It was brought up as something that might come into a conversation with parents, or conversations parents have with a young person, to say ‘do you have a specific wish of what we do with your Facebook page or Whatsapp? Do you want us to leave something about you on the net because your friends might find that very meaningful or would you like us to take it all down because it is private to you?'”

The new guidance, which aims to improve the end-of-life care for babies, children and young people, suggests that h ospital, hospice and home care staff must look after the whole family, practically and emotionally, when a child is dying.

It is estimated that more than 40,000 children and young people in England are living with a life-limiting condition – where there is no hope of cure.

Professor Mark Baker, director for the centre of guidelines at Nice, said: “To lose a child is a tragic, life-changing event. But the care given to a child and their family during this difficult time can offer great comfort, if done properly.

“This guidance clearly sets out best practice for all those involved in palliative care, whether that be at home, in a hospice or in a hospital. I hope it will be implemented fully so that those families going through the worst time of their lives are properly supported.”

Complete Article HERE!

Doctors slow to have end-of-life conversations

Advance care planning is becoming more popular among patients.

By Kay Manning

[W]hen the concept of paying doctors to help patients plan for end-of-life care first came up as part of health reform, opponents thumped it as a step toward “death panels” and “pulling the plug on grandma.”

Advance care planning was scuttled then, but seven years later, it has been rather quietly incorporated into services reimbursable by Medicare. Patients now can seek guidance from their physicians and other health care professionals about what they want and don’t want in terms of life-sustaining or life-prolonging care and have it included in their medical records.

But codifying what many describe as a sea change in thinking may have come about too quietly. The Centers for Medicare and Medicaid Services, known as CMS, can’t say how many physicians have billed for these conversations since the provision took effect Jan. 1, but a poll released in April showed only about 14 percent of doctors who regularly treat patients over 65 have submitted such bills to Medicare.

While that indicates physicians either don’t know about ACP or are hesitant to engage in such conversations, said Angela Hult, executive director of Oregon-based Cambia Health Foundation, one of three poll sponsors, the public is very solidly in favor.

The California Health Care Foundation, another sponsor, found in a 2012 survey that 80 percent of respondents said it would be important to talk to doctors about their final wishes if they were seriously ill, and 60 percent said it was “extremely important” that their families not be burdened by tough decisions, like stopping nutrition or breathing assistance.

ACP, also called end-of-life directives, is gaining steam among nonprofits, foundations and academic institutions focusing on patient-centered care that also can help health systems be more efficient and save money. Books such as best-seller “Being Mortal” by Massachusetts surgeon Atul Gawande, and “Hope for a Cool Pillow” by Illinois anesthesiologist Margaret Overton use personal experiences to advocate for change in health care of the elderly and raise the profile of what all families eventually face but few typically talk about before a crisis.

Planning ahead instead of guessing what a loved one would want, which can cause emotional rifts in a family even as time is of the essence, serves both patient and caregivers. A 40-year nurse, commenting in a blog post about the absence of ACP wrote: “It has been the cause of severe moral distress among my nurse colleagues in the ICU and the source of many personal nightmares over the years. It is so very frightening to think what we do to the elderly, in particular,” by mustering medical technology to prolong life when that might not be desired.

Physicians even have a term for it — the luge ride, said Michael Preodor, a palliative care doctor at Advocate Lutheran General Hospital in Park Ridge.

“It’s more surgery, more disease intervention, without fixing the problem,” Preodor said. “The key to helping is to align our care with what the patient desires, and that’s dependent upon having these conversations.”

He recently had a patient with a sudden spinal injury and infection that a number of specialists gave opinions on how to treat, overwhelming his wife. She wanted the advice of her trusted family physician and because of the ACP reimbursement, she was able to have several conversations about what to do, deciding on comfort care in hospice, Preodor said.

“I have no doubt he’d be in the ICU, having surgery or other interventions with more and more suffering regardless of the outcome,” Preodor said. “Now there’s time for closure, time with family free of pain, time to deal with dying, which we don’t do very well in this country.”

Gundersen Health System in La Crosse, Wis., has been working more than 20 years to change that. Bud Hammes, an ethicist who started the Respecting Choices program that is cited by many as a model for advance care planning, said more than 96 percent of the 120,000 people in La Crosse County have plans in place before death on how they want to be treated as their health declines. Talking about death is a part of community conversation and happens in clinics, hospices and nursing homes, guided by specially trained personnel, he said.

“Patients have plans that go from very aggressive treatment to comfort care,” Hammes said, eliminating what he called the “terrible dilemma” of families trying to do the right thing but not knowing their loved one’s wishes. “They come to the self-realization of why they need to do this very challenging activity.”

The focus on ACP also has saved Gundersen money. The number of days a patient spent in the hospital in the last two years of life was a national average of 20.3 in 2010, but only 9.7 at Gundersen, according to The Dartmouth Atlas of Health Care, and the total cost of care in those two years was a national average of $79,337, but just $48,771 at Gundersen.

Hammes sees Medicare’s approval of ACP as a “positive step forward that indicates a policy shift from when no one talked about this.” Physicians can bill for 30 minutes of conversation about advance directives with patients, family members or surrogates and be reimbursed $86, which drops to $75 for a second such conversation. CMS has yet to promulgate guidelines for the conversations but has stipulated that while physicians must “meaningfully contribute” to them, other professionals such as RNs and physicians’ assistants can conduct them. And starting in 2017, ACP can be part of an annual Medicare wellness visit.

Ironically, while Hammes supports Medicare’s move to reimbursement and is working with others on ACP training, physicians in the Gundersen system will not seek to be paid for these conversations because of internal billing issues and what they perceive as too little time allowed given the complexities of the issues, he said.

Other possible impediments to full participation by physicians across the country include lack of preparation and clarity on what constitutes an ACP conversation, said Dr. David Longnecker, who co-chairs a committee with the nonprofit National Quality Forum to improve advanced illness care. He suggests simulations, such as are used for training in other parts of medicine, to ease doctors’ discomfort with the topic, community input to adjust for faith and culture concerns, and adoption of ACP by health systems instead of just individual doctors.

“The enemy of good is perfect,” Longnecker said. “We have to start somewhere.

“We don’t want ‘yes, doctor,’ but partnerships (between patient and physician), which are essential to delivering a high quality of care,” he said.

Cambia Health Foundation is building on its poll results with nationwide focus groups “as a deeper dive into what are the barriers to ACP, how do we educate and engage physicians, what tools do they need to have these conversations,” Hult said.

“The conversations are so important for end of life, but also for chronic or life-limiting illnesses. How do we ensure that each person receives what they perceive as quality of life?” she said. “It makes all the difference in approach once you understand the patient is the center of care.”

The Conversation Stopper poll showed 75 percent of 736 physicians surveyed in 50 states believe they are responsible for initiating ACP talks. But if they don’t, a nonprofit, The Conversation Project, offers tips on how patients and family members can broach the subject, decide what they want to accomplish and ensure their plan is followed.

The Conversation Project, co-founded by author Ellen Goodman, implores people not to wait until there’s a crisis.

“It always seems too early … until it’s too late,” say its guidelines, which also suggest: Tell your physician you want to talk about end-of-life wishes. Share any experiences that are shaping your thinking. Ask questions about medical problems, such as ‘what is my life likely to look like six months from now, one year from now, five years from now?’ Probe options for care and how they may affect your independence, and ask what you can expect if you do nothing. Request that your wishes be documented and included in your medical record.

Overton, whose book “Hope for a Cool Pillow” is named after the simple but caring gesture of flipping a pillow for patients, grew up in a family where death and dying were discussed, she said, so she didn’t realize it wasn’t common until she became an anesthesiologist.

“I just want to get people talking, to take the fear out of it,” said Overton, who works at Advocate Lutheran General Hospital. “Having a conversation when you’re not stressed … have a coffee, a lemonade, a glass of wine … those are ideal times.

“Typically, doctors don’t know you as well as your family, your values, what you want. When family is part of the decision or knows what the individual wants, there is an element of empowerment. If people are clear about what they want, it’s hard to override that, and physicians are more likely to get on board,” she said.

Complete Article HERE!

Grief work can be inspiring and rewarding

By Robin Glantz

children and grief

[F]or many of us, grief from the loss of loved ones can be stronger than ever during the holidays. Hospice by the Bay is here to provide support. The need is great, so we are looking for additional professionals to join our bereavement team.

I hope that my story will inspire others.

For the past few years, I’ve been a member of Hospice by the Bay’s bereavement team. I haven’t always done this kind of work; I used to own a bookkeeping company and had also been a human resources director. People often ask me, “What prompted you to make the change?” “How are you able to do such heart-wrenching work?”

Like many who work in hospice, I have experienced profound loss, in particular the death of my father. Losing him was painful but also life-changing. Before, I had been afraid of death and dying — but something “switched” when I was with him while he was dying; I realized that being with someone at this time is a gift.

I can’t say that I handled my grief very well. I moved too fast and was also grieving the “empty nest” after my daughter left for college.

Ultimately, I sought help, and soon realized that it had been a long time since I had been involved in work that came from my heart.

So I went back to school for my graduate degree in psychology with a vague idea to work in the drug treatment field. But one day it came to me, really as a calling: I wanted to do hospice work.

After completing internships in inpatient hospices, I felt a need to round out my work by helping families and individuals who were grieving. I completed Hospice by the Bay’s Bereavement Internship Program and became a licensed marriage and family therapist.

Today, I work with Hospice by the Bay as a community grief counselor, providing crisis and ongoing counseling to individuals and groups as well as grief education to schools, workplaces and organizations in need. All of these services are available to anyone, whether or not their loved one was our patient.

I get a lot out of my work. Rather than becoming depressed or detached (as some might think), it is uplifting. I get to be a “holder of hope” as I meet people at a critical time of their lives — when they are vulnerable, in pain, and may be all alone with their grief.

No matter how emotional the work is, at the end of the day, it is rewarding to know that I am guiding people when they are rudderless and adrift in an ocean of grief. It is an honor. This work has a positive impact on my personal, day-to-day life as well.

I appreciate life more, because I know that it is short. I make more meaningful choices, treasure “the moments,” and experience an expanded capacity for love.

Bereavement work is not for everyone, but it’s a calling for others.

Hospice by the Bay invites qualified candidates to apply for our Bereavement Internship Program. A part-time and yearlong paid program, it offers highly professional training and supervision.

Candidates must have a master’s degree in mental health, counseling, psychology or social work, and be registered as an intern with the Board of Behavioral Sciences.

If you or someone you know is drawn to this type of work, is mature of heart, respectful, and in search of a meaningful placement, please contact Hospice by the Bay at sohri@hbtb.org.

For the right person, helping others through their grief can be one of the most rewarding experiences you will ever have. It has been for me.

Complete Article HERE!

Psilocybin: A Journey Beyond the Fear of Death?

Johns Hopkins clinical pharmacologist Roland Griffiths talks about a major new study hinting at psychedelic drugs as therapeutic powerhouses

By Richard Schiffman

psychedelic-drugs

In one of the largest and most rigorous clinical investigations of psychedelic drugs to date, researchers at Johns Hopkins University and New York University have found that a single dose of psilocybin—the psychoactive compound in “magic” mushrooms—substantially diminished depression and anxiety in patients with advanced cancer.

Psychedelics were the subject of a flurry of serious medical research in the 1960s, when many scientists believed some of the mind-bending compounds held tremendous therapeutic promise for treating a number of conditions including severe mental health problems and alcohol addiction. But flamboyant Harvard psychology professor Timothy Leary—one of the top scientists involved—started aggressively promoting LSD as a consciousness expansion tool for the masses, and the youth counterculture movement answered the call in a big way. Leary lost his job and eventually became an international fugitive. Virtually all legal research on psychedelics shuddered to a halt when federal drug policies hardened in the 1970s.

The decades-long research blackout ended in 1999 when Roland Griffiths of Johns Hopkins was among the first to initiate a new series of studies on psilocybin. Griffiths has been called the grandfather of the current psychedelics research renaissance, and a 21st-century pioneer in the field—but the soft-spoken investigator is no activist or shaman/showman in the mold of Leary. He’s a scientifically cautious clinical pharmacologist and author of more than 300 studies on mood-altering substances from coffee to ketamine.

Much of Griffiths’ fascination with psychedelics stems from his own mindfulness meditation practice, which he says sparked his interest in altered states of consciousness. When he started administering psilocybin to volunteers for his research, he was stunned that more than two-thirds of the participants rated their psychedelic journey one of the most important experiences of their lives.

Griffiths believes that psychedelics are not just tools for exploring the far reaches of the human mind. He says they show remarkable potential for treating conditions ranging from drug and alcohol dependence to depression and post-traumatic stress disorder.

Clinical pharmacologist Roland Griffiths.
Clinical pharmacologist Roland Griffiths.

They may also help relieve one of humanity’s cruelest agonies: the angst that stems from facing the inevitability of death. In research conducted collaboratively by Griffiths and Stephen Ross, clinical director of the NYU Langone Center of Excellence on Addiction, 80 patients with life-threatening cancer in Baltimore and New York City were given laboratory-synthesized psilocybin in a carefully monitored setting, and in conjunction with limited psychological counseling. More than three-quarters reported significant relief from depression and anxiety—improvements that remained during a follow-up survey conducted six months after taking the compound, according to the double-blind study published December 1 in The Journal of Psychopharmacology.

“It is simply unprecedented in psychiatry that a single dose of a medicine produces these kinds of dramatic and enduring results,” Ross says. He and Griffiths acknowledge that psychedelics may never be available on the drugstore shelf. But the scientists do envision a promising future for these substances in controlled clinical use. In a wide-ranging interview, Griffiths told Scientific American about the cancer study and his other work with psychedelics—a field that he says could eventually contribute to helping ensure our survival as a species.

[An edited transcript of the interview follows.]

What were your concerns going into the cancer study?
The volunteers came to us often highly stressed and demoralized by their illness and the often-grueling medical treatment. I felt very cautious at first, wondering if this might not re-wound people dealing with the painful questions of death and dying. How do we know that this kind of experience with this disorienting compound wouldn’t exacerbate that? It turns out that it doesn’t. It does just the opposite. The experience appears to be deeply meaningful spiritually and personally, and very healing in the context of people’s understanding of their illness and how they manage that going forward.

Could you describe your procedure?
We spent at least eight hours talking to people about their cancer, their anxiety, their concerns and so on to develop good rapport with them before the trial. During the sessions there was no specific psychological intervention—we were just inviting people to lie on the couch and explore their own inner experience.

What did your research subjects tell you about that experience?
There is something about the core of this experience that opens people up to the great mystery of what it is that we don’t know. It is not that everybody comes out of it and says, ‘Oh, now I believe in life after death.’ That needn’t be the case at all. But the psilocybin experience enables a sense of deeper meaning, and an understanding that in the largest frame everything is fine and that there is nothing to be fearful of. There is a buoyancy that comes of that which is quite remarkable. To see people who are so beaten down by this illness, and they start actually providing reassurance to the people who love them most, telling them ‘it is all okay and there is no need to worry’— when a dying person can provide that type of clarity for their caretakers, even we researchers are left with a sense of wonder.

Was this positive result universal?
We found that the response was dose-specific. The larger dose created a much larger response than the lower dose. We also found that the occurrence of mystical-type experiences is positively correlated with positive outcomes: Those who underwent them were more likely to have enduring, large-magnitude changes in depression and anxiety.

Did any of your volunteers experience difficulties?
There are potential risks associated with these compounds. We can protect against a lot of those risks, it seems, through the screening and preparation procedure in our medical setting. About 30 percent of our people reported some fear or discomfort arising sometime during the experience. If individuals are anxious, then we might say a few words, or hold their hand. It is really just grounding them in consensual reality, reminding them that they have taken psilocybin, that everything is going to be alright. Very often these short-lived experiences of psychological challenge can be cathartic and serve as doorways into personal meaning and transcendence—but not always.

Where do you go from here?
The Heffter Research Institute, which funded our study, has just opened a dialogue with the FDA (Food and Drug Administration) about initiating a phase 3 investigation. A phase 3 clinical trial is the gold standard for determining whether something is clinically efficacious and meets the standards that are necessary for it to be released as a pharmaceutical. Approval would be under very narrow and restrictive conditions initially. The drug might be controlled by a central pharmacy, which sends it to clinics that are authorized to administer psilocybin in this therapeutic context. So this is not writing a prescription and taking it home. The analogy would be more like an anesthetic being dispensed and managed by an anesthesiologist.

You are also currently conducting research on psilocybin and smoking.
We are using psilocybin in conjunction with cognitive behavioral therapy with cigarette smokers to see if these deeply meaningful experiences that can happen with psilocybin can be linked with the intention and commitment to quit smoking, among people who have failed repeatedly to do so. Earlier we ran an uncontrolled pilot study on that in 50 volunteers, in which we had 80 percent abstinence rates at six months. Now we are doing a controlled clinical trial in that population.

How do you account for your remarkable initial results?
People who have taken psilocybin appear to have more confidence in their ability to change their own behavior and to manage their addictions. Prior to this experience, quite often the individual feels that they have no freedom relative to their addiction, that they are hooked and they don’t have the capacity to change. But after an experience of this sort—which is like backing up and seeing the larger picture—they begin to ask themselves ‘Why would I think that I couldn’t stop cigarette smoking? Why would I think that this craving is so compelling that I have to give in to it?’ When the psilocybin is coupled with cognitive behavioral therapy, which is giving smokers tools and a framework to work on this, it appears to be very helpful.

You are also working with meditation practitioners. Are they having similar experiences?
We have done an unpublished study with beginning meditators. We found that psilocybin potentiates their engagement with their spiritual practice, and it appears to boost dispositional characteristics like gratitude, compassion, altruism, sensitivity to others and forgiveness. We were interested in whether the psilocybin used in conjunction with meditation could create sustained changes in people that were of social value. And that appears to be the case.

So it is actually changing personality?
Yes. That is really interesting because personality is considered to be a fixed characteristic; it is generally thought to be locked down in an individual by their early twenties. And yet here we are seeing significant increases in their “openness” and other pro-social dimensions of personality, which are also correlated with creativity, so this is truly surprising.

Do we know what is actually happening in the brain?
We are doing neuro-imaging studies. Dr. Robin Carhart-Harris’s group at Imperial College in London is also doing neuro-imaging studies. So it is an area of very active investigation. The effects are perhaps explained, at least initially, by changes in something [in the brain] called “the default mode network,” which is involved in self-referential processing [and in sustaining our sense of ego]. It turns out that this network is hyperactive in depression. Interestingly, in meditation it becomes quiescent, and also with psilocybin it becomes quiescent. This may correlate with the experience of clarity of coming into the present moment.

That is perhaps an explanation of the acute effects, but the enduring effects are much less clear, and I don’t think that we have a good handle on that at all. Undoubtedly it is going to be much more complex than just the default mode network, because of the vast interconnectedness of brain function.

What are the practical implications of this kind of neurological and therapeutic knowledge of psychedelics?
Ultimately it is not really about psychedelics. Science is going to take it beyond psychedelics when we start understanding the brain mechanisms underlying this and begin harnessing these for the benefit of humankind.

The core mystical experience is one of the interconnectedness of all people and things, the awareness that we are all in this together. It is precisely the lack of this sense of mutual caretaking that puts our species at risk right now, with climate change and the development of weaponry that can destroy life on the planet. So the answer is not that everybody needs to take psychedelics. It is to understand what mechanisms maximize these kinds of experiences, and to learn how to harness them so that we don’t end up annihilating ourselves.

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