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Conscious Dying: The Role of Ketamine For End of Life Distress

In the world of end-of-life care, the concept of conscious dying is gaining more and more attention.

What does this term mean? And how can ketamine-assisted therapy help bridge the gap between the principles of conscious dying and the current state of affairs?

Conscious Dying and Why it Matters for Terminally Ill Patients

Traditional approaches to end-of-life (EOL) experiences tend to focus on physical comfort.

However, when faced with death, many experience what is called existential distress. This refers to one’s angst due to a perceived loss of meaning.

Existential distress has been defined as:

  • Hopelessness
  • Feeling like a burden to others
  • Loss of sense of dignity
  • Desire for death
  • Loss of will to live
  • Threats to self-identity

Keeping this in mind, it becomes clear that focusing solely on physical comfort is not enough.

Recognizing the importance of psychological and emotional well-being in the final stages of life, conscious dying offers a holistic approach that goes beyond the physical.

The Role of Ketamine in End-of-Life Care

In line with traditional EOL approaches, ketamine’s role in palliative care initially focused on pain management. However, recent research has highlighted other potential.

Ketamine targets not just the body but also the mind. And thanks to its ability to induce altered states of consciousness and enhance emotional processing, it could alleviate the inner turmoil often experienced by terminally ill patients.

Understanding Conscious Dying: A Paradigm Shift

What does conscious dying mean?

Conscious dying is a framework rooted in a human caring ontology. It strives to embrace a patient’s journey toward death as an integral part of the circle of life.

When we think about the end of life, we usually think about physical pain. But conscious dying is different.

It is not only about the body but also the mind.

It is about how people feel inside — instead of just fixing physical pain, it looks at all the emotions someone might be dealing with.

It is also about helping people feel okay about facing death. Making them less fearful and more relaxed is just as important as stopping their pain.

Why feelings matter at the end of life

The mind and body can be seen as a two-way street — what goes on in your mind affects what happens in your body, and vice versa.

For example, studies have found that higher anxiety in patients is consistently related to increased pain perception and decreased pain tolerance.

Mental health is also known to have wide-ranging effects on the immune system.

Finally, a patient’s psychological state can influence how the disease progresses. For example, interventions that improve depressive symptoms have been related to longer survival times in cancer patients.

The intersection of Ketamine and Palliative Care

In palliative care, ketamine is a valuable asset in two important domains:

  • Managing physical pain
  • Easing emotional pain and existential distress

Managing pain with ketamine

Among the various challenges of terminal illness, pain often takes center stage. On average, about half of patients report significant pain, and many do not experience adequate pain relief.

Ketamine has been widely recognized for its analgesic (pain-relieving) properties, and it is considered by the World Health Organization (WHO) as an essential drug for pain management.

By blocking N-methyl-D aspartate (NMDA) receptors, ketamine inhibits the brain’s normal pain response and brings rapid and potent pain relief.

This is particularly useful for patients who are unresponsive to or have become tolerant of opioids.

Ketamine’s role in easing psychological and existential distress

Studies are currently being undertaken to explore ketamine’s efficacy in treating anxiety and death distress, but its usefulness has already been well documented in other areas.

Ketamine is most famously known to treat depression, where it can have rapid and lasting anti-depressant effects even after a single session.

Although less studied, it is also effective in treating a spectrum of treatment-resistant anxiety disorders.

Given the high prevalence of symptoms of anxiety and depression during a terminal illness, this is not unimportant. The shift towards emotional tranquility can greatly enhance the quality of the EOL experience and offers a more serene transition.

Bridging the Gap: A Case Study on Ketamine and Conscious Dying

Ketamine’s unique properties act as a bridge between the principles of conscious dying and the current reality of end-of-life care.

The following case study underscores the profound impact ketamine can have.

A 64-year-old cancer patient faced excruciating neck and nerve pain along with severe depression, even yearning for a hastened death. His wife claimed that “he is just not himself anymore.”

Hospitalized in California, the patient received continuous IV ketamine. Within hours, his pain reduced from 8/10 to 3/10, and the next day, it vanished completely. 

When he was reevaluated four days later, his mood had improved considerably. He was smiling and stated that he was feeling better. He no longer had suicidal ideation, and his wife thanked the hospital staff for “bringing him back.”

Following his discharge from the hospital, the therapy continued, culminating in a peaceful passing at home two weeks later.

Types of Ketamine Administration in End-of-Life Care

Comparing ketamine administration methods

Ketamine can be given through the veins (IV), under the tongue (sublingual), through the nose (nasal esketamine), or into the muscles (IM).

Each method has its pros and cons.

Finding the right fit can enhance the benefits. This depends on what the patient needs and feels most comfortable with.

Ketamine administration from the patients’ perspective

Understanding the patient’s viewpoint is pivotal when considering ketamine administration. Factors like ease, comfort, and practicality all play a big role.

Here is a brief overview of each method:

  • IV ketamine: Offers a quick onset of effect, which translates into rapid relief. However, it requires medical expertise, and the needle may cause discomfort or anxiety.
  • IM ketamine: IM injections are more straightforward than IV injections, but the fear of needles might still pose a challenge.
  • Sublingual ketamine: A less invasive option that still ensures relatively fast absorption. Yet, the tablet’s taste may be unpleasant, and keeping it under the tongue could be complicated for some patients.
  • Nasal ketamine: Quick, convenient, and non-invasive. It offers rapid effects and can be self-administered under medical supervision. However, nasal irritation might arise.

Practical Considerations and Potential Risks

When using ketamine in EOL care, there are some practicalities and potential risks that require extra attention.

Picking the right setting

The setting plays a crucial role in shaping the experience and outcomes. This refers to the environment in which ketamine is administered. Ideally, you want a setting that promotes tranquility, comfort, and a sense of security.

Providing adequate support

Emotional support is a cornerstone of conscious dying. The presence of caring healthcare professionals, family members, and friends, or trained support personnel contributes significantly to the patient’s well-being.

Risk awareness

Ketamine administration, like any medical intervention, presents certain risks. These could involve temporary confusion, disorientation, or even hallucinations. Ketamine’s dissociative effects might also influence a patient’s emotional state, potentially leading to distress. 

While the correct setting and support already go a long way, there are some additional steps that can be taken to mitigate potential risks:

  • Conduct patient assessments to identify those at risk of adverse effects.
  • Tailor dosing according to the patient’s condition and needs.
  • Ensure continuous monitoring during ketamine therapy.
  • Maintain open communication with the patient, their family, and the care team.

Ketamine-Assisted Therapy for End-of-Life in Los Angeles

Bringing together the ideas of conscious dying and the potential of ketamine, we see a future where the end of life can be more peaceful and dignified.

By addressing not only physical pain but also emotional and existential distress, this approach offers a more compassionate way to navigate life’s final journey.

The Psychedelica Collective offers ketamine-assisted group therapy sessions to help those who are terminally ill come to terms with the psychological and emotional challenges that present themselves in the fila stages of life. Call us today for a free consultation.