In this episode, we’re joined by Dr. James Downar, a leading Canadian voice in palliative and critical care, for a wide-ranging discussion on the emerging role of psychedelics in managing psychological and existential distress.

Psychedelics have gone from fringe to forefront in recent years, and we dig into what that shift might mean for patients facing critical illness or the end of life.

What psychedelics are and how they work

• Substances like psilocybin, LSD, ketamine, and MDMA

• Key effects: altered perception, ego dissolution, and emotional insight

• Risks and benefits in vulnerable populations

Psychedelic-assisted therapy: structure and process

• The three-phase model: preparation, the session itself, and integration

• Micro dosing vs. full therapeutic sessions

• Where current evidence stands

Potential applications in critical care and palliative medicine

• Helping patients process fear, isolation, and suffering

• How psychedelics differ from traditional symptom management tools like opioids

• Limitations in advanced illness due to physiological concerns

Research and implementation challenges

• Problems with study design and placebo controls

• The importance of ‘set and setting’

• Defining success in existential or spiritual distress

Ethical considerations and clinical integration

• Balancing innovation with compassion and caution

• Avoiding reductionism: why psychedelics should complement—not replace—human care

• The future role of these therapies in ICU and palliative settings