Pubdate: Sun, 16 Jan 2005
Source: New York Times (NY)
Copyright: 2005 The New York Times Company
Author: Benedict Carey
Bookmark: (Ecstasy)


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

 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

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."