Pubdate: Sun, 16 Jan 2005 Source: New York Times (NY) Copyright: 2005 The New York Times Company Contact: http://www.nytimes.com/ Details: http://www.mapinc.org/media/298 Author: Benedict Carey Bookmark: http://www.mapinc.org/mdma.htm (Ecstasy) GOING HIGH INTO THAT GOOD NIGHT If there's a drug for social phobia, maybe there could be one to help us relax in the company of death. Last month, the Food and Drug Administration gave the go-ahead to a Harvard University plan to study the recreational drug "ecstasy" as a treatment for anxiety in terminal cancer patients. Elsewhere, researchers in California are studying the effect of psilocybin - the active ingredient in hallucinogenic mushrooms - in similar patients. Both teams hope to learn whether the drugs, which can induce effusiveness and heightened awareness, will help people express and manage their fears in a therapeutic setting. Although these illegal drugs are controversial, their use is a natural outgrowth of the medicalization of all emotional difficulty, from childhood shyness to adult phobias and depression. Doctors already prescribe antidepressants widely to dying patients, as well as anti-anxiety medications, like Valium, which can be emotionally numbing. The possibility of using potent consciousness-altering agents raises a question: At what point do the theological, cultural and personal significance of mortality become altered, or lost? Does going high into that good night risk mocking end-of-life customs - prompting rave flashbacks rather than life review, rude jokes rather than amends? "I see death not only as an opportunity to reflect on the meaning of your own existence, but to offer your life as a gift to others," said the Rev. Donald Moore, a professor of theology at Fordham University. The end presents us with a time to ponder - and discuss, if possible - what life has meant and might continue to mean for others. Any drug that interferes with that experience comes at a steep cost, he said. "If I never ponder these things," Father Moore said, "if I never face up to these questions intellectually, if I'm so spaced out it doesn't make any difference, then I think the experience is pretty empty and meaningless. In death we can become more a part of others' lives, and if I have decided simply to escape, I may have missed that opportunity." From the sixth-century politician Boethius, who turned to philosophy for consolation at the end, to Mozart, who plunged into his requiem Mass, history is filled with examples of those who faced the unknown unaided, and apparently shared in some universal reckoning with their purpose. But there is no philosophical or psychological reason why existential questions should wait to the end of life. Death itself hardly respects concerns about meaning or timing. It strikes friends and loved ones often without warning. Moreover, it casts a deepening psychological shadow starting in middle age, which gives most people ample opportunity to contemplate the purpose and content of their lives simply by virtue of living to adulthood, psychologists say. If a drug taken at the end can help them simply reflect on the pleasure of having lived, that in itself might provide comfort and meaning to those left behind, said Dr. Simon Blackburn, professor of philosophy at the University of Cambridge. "If you look at what people envy as opposed to what they say they like, I think we envy people who go out on a high," he said. "An old don in my college, he had a stroke at the end of college dinner, and died on the spot, sitting in his suspenders, in candlelight, holding a wine glass. It was the perfect end for him, just incredible, and I think it struck people as very admirable." The insistence on making amends, on finding or declaring meaning, stems as much from cultural expectations of a good death as it does from the needs or the psychological state of a dying person, psychiatrists say. Some people have an anguished need to talk with loved ones, but cannot bring themselves to do so; others simply want to say goodbye and laugh their way out. And the effect of even a strong drug may not alter those desires much. Researchers tested LSD in terminal patients in the 1960's, and heroin in the 1980, and neither drug made much difference in the emotional or family experience at the end of life, said Dr. David F. Musto, a professor of psychiatry and medical history at Yale University School of Medicine. "The larger danger is that we try to manage a death along the lines of what we consider the right way of doing it," Dr. Musto said. "Some want to leave peacefully, and others are anxious to find some meaning and get things taken care of," and new drug treatments may help both. Not to mention those who want simply to laugh, and trust their maker to understand their choice. "There was some one thing that was too great for God to show us when He walked upon our earth," wrote the Catholic philosopher and commentator G. K. Chesterton, in his classic "Orthodoxy," "and I have sometimes fancied it was His mirth."