Kynnyksellä: Psykedeelinen ohjaus ja saattohoito

Introduction: Two Journeys, One Human Experience

Few experiences strip us down to our essence like altered states of consciousness and the final passage at life’s end. One is often entered deliberately – through breathwork, psilocybin, or other psychedelic practices – as an exploration of the inner landscape. The other arrives uninvited as a natural and irreversible transition.

I guide people through both kind of experiences. At first glance, their purposes could not be more different. Yet in practice, both journeys ask the same things of us: to face the unknown, to loosen our grip on control and to encounter ourselves without the usual psychological defenses. What distinguishes them is less the experience itself than the cultural, emotional, and ethical frameworks through which we approach it.

Across both settings, I have witnessed the same human patterns emerge: fear rising, resistance to letting go and at times, moments of profound release. What remains constant is the need for a particular kind of guiding presence: one that is grounded and attentive, yet unobtrusive; one that does not steer or interpret, but holds space for whatever unfolds.

What follows is an exploration of these parallels as lived realities and of how the ethical principles of end-of-life care can inform psychedelic guidance and how, in turn, insights from altered states can deepen our understanding of the final transition.

The Overlap: When the Mind Unravels

The first time I recognized the overlap was during my training as an end-of-life companion (end-of-life doula) in a Berlin hospice. The instructors described the physical and psychological stages of dying: the ebb and flow of consciousness, sudden surges of emotion, visions of departed loved ones, and moments of profound clarity followed by confusion. It sounded exactly like the psychedelic experiences I’d witnessed and, in some cases, my own.

This parallel is not purely anecdotal. Over the past decade, neuroscience has begun to map what happens in the brain during psychedelic states, and the findings echo features seen across a range of altered states of consciousness. Functional MRI studies show that psilocybin reduces activity and functional connectivity within the default mode network (DMN), a set of brain regions associated with self-referential thinking, autobiographical memory, and the narrative sense of identity (Carhart-Harris et al., 2012). Under psychedelics, the DMN becomes less dominant, while communication between brain networks that are normally more segregated increases. There is a shift toward a more globally integrated pattern of brain activity described across multiple studies in this research line.

This altered network organization is often associated with what participants describe as “ego dissolution”: a temporary loosening of the boundaries between self and world. Subjectively, this can manifest as a loss of personal identity, a sense of unity, or moments of striking clarity – experiences that may feel peaceful, unsettling, or both.

What happens in the brain as we die is far less well understood, and there is no evidence that the default mode network becomes hyperconnected during the dying process. Still, a growing body of research suggests that dying is not simply a passive shutdown of neural activity.

Animal studies show that cardiac arrest can be followed by a brief surge of highly synchronized brain activity, including increases in gamma oscillations and functional connectivity that, in some measures, exceed those seen during wakefulness (Borjigin et al., 2013). 

Human data, though limited, point in a similar direction: transient increases in organized EEG activity have been observed around the time of death in intensive care settings (Chawla et al., 2009), and rare recent recordings reveal short-lived bursts of gamma-band activity and connectivity in the final moments surrounding cardiac arrest (Xu et al., 2023). While these findings cannot tell us what dying individuals experience, they suggest that the brain’s final moments may be more dynamic than previously assumed.

Taken together, these observations raise an intriguing question. If psychedelics temporarily disrupt the neural systems that sustain a stable sense of self, could the dying brain sometimes enter a comparably altered state, marked by loosened boundaries of identity? At present, this remains speculative, and no direct link between psychedelic brain states and the neurobiology of dying has been established.

What can be said with confidence is that both involve profound reorganizations of brain activity. In each case, familiar mental structures may soften, vivid imagery can emerge, and the sense of a fixed self may briefly dissolve. Whether through chemistry or through biology’s final transition, these states confront us with the same fundamental questions about identity, meaning, and what it means to let go.

The Body as a Guide

But the connection runs deeper than the brain alone. When someone is in a psychedelic state or nearing the end of life, their body becomes a guide – revealing shifts in consciousness through physical sensations.

For example, sudden shifts in temperature are common. There can be a rush of cold or a flush of heat, as if the body is adjusting to something new. Muscles tighten and then relax – jaws clench, hands tremble and old tensions dissolve unexpectedly. Even breathing changes. In psychedelic sessions, facilitators often say, “Just breathe into it.” The same is true at the bedside of the dying, where each uneven or labored breath can become a moment of presence, a quiet surrender to what’s unfolding.

I once sat with a man in the final hours of his life. His breathing grew increasingly shallow, then paused for long stretches – only to resume with a sudden, deep inhale. His wife seemed very worried. But the hospice nurse gently placed a hand on her shoulder and reassured her, “This is his body’s way. He’s doing exactly what he needs to.” Weeks later, in a psilocybin session, a client’s breath followed the same pattern – pauses, gasps, releases – as she navigated a wave of grief. In both cases, the body was leading the way. 

Trusting the body can be profoundly helpful, whether in psychedelic experiences or at the end of life. And yet, people often struggle with this trust. Someone undergoing a psychedelic journey might view nausea or other uncomfortable bodily sensations as distractions or obstacles to the “real” experience they seek. Similarly, a dying person may feel betrayed by their body as it begins its natural process of shutting down.

But resisting these sensations only deepens the struggle. Accepting them as part of the journey, even when they’re uncomfortable, often eases the discomfort itself. The body, in both cases, isn’t working against us, it’s guiding us through a transition, if only we let it.

Psychedelics as a Rehearsal for Death

The idea that psychedelics can prepare us for death isn’t new. The Sufi poet Rumi wrote, “Die before you die”, a call to surrender the ego while still alive. This idea has later been echoed by spiritual teacher Ram Dass, who described psychedelics as a dress rehearsal for the ultimate letting go.

What makes these experiences so profound isn’t just their intensity, but their ability to dissolve the ego’s grip, even if only temporarily. In this state, the rigid boundaries of the self soften, and what remains is a sense of merging with something far greater. Even though this isn’t a physical death, it offers something equally transformative: a glimpse of what lies beyond the ego’s desperate clinging to life. For many, an experience like that becomes a turning point. Not because death itself changes, but because their relationship to it does. The terror of annihilation, usually so loud in our ego’s mind, quiets in the face of direct experience.

In this way, psychedelics don’t just simulate death, they reveal its psychological core. The fear we associate with dying often stems from the ego’s resistance to surrender, its insistence on control, on permanence, on being. But when that resistance dissolves, even briefly, what emerges isn’t emptiness, but a sense of connection to something unbroken, something whole and – at least for some – something sacred. Perhaps this is why those who’ve glimpsed ego dissolution, whether through psychedelics, meditation, or near-death experiences, often speak of death with less dread. They carry with them their own, comforting “felt truth” that the end of their ego isn’t the end of “everything”.

The Gift of Perspective

But psychedelics can not only ease the fear of death – they can also reorient us toward life. In a culture obsessed with productivity and distraction, these profound experiences often reveal what truly matters: love, connection and the simple joy of being alive.

A client came to me after she had a psilocybin session in which she relived a memory she’d avoided for years: her mother’s death. After a long integration process, she quit her high-stress job, reconnected with her estranged sister, and sought a more meaningful career. “I realized I’d been sleepwalking,” she told me. “Now I know what I want my life – and my death – to feel like.“

Studies show that psychedelic experiences often lead to lasting changes in values, with participants prioritizing relationships, personal growth, and inner fulfillment over material success or external validation (MacLean et al., 2011). This shift in perspective, rooted in a deeper sense of what truly matters, can transform how we approach life as a whole. When we live with intention, aligning our choices with what feels meaningful rather than what society or our own limiting beliefs expect of us, the prospect of death loses some of its terror. Instead of a source of dread, it can begin to feel like a natural culmination of a life well-lived: a final transition rather than an ending to be feared.

Yet this shift on how to look at or feel about death from a “safe distance”, is only part of the story. In clinical settings, psychedelics have also been studied for decades as a tool to ease existential suffering when death is just around the corner.

The Role of Psychedelics in Palliative Care

From Grof to Modern Research

The potential of psychedelics to alleviate existential distress in terminal patients has been explored since the 1970s, when Stanislav Grof’s LSD research suggested that psychedelic-assisted psychotherapy could help patients process unresolved emotional conflicts, reducing fear of death and improving quality of life. Alongside Grof, his then-partner Joan Halifax – a Zen priest and anthropologist – observed similar benefits in her work with dying patients, describing how psychedelics could facilitate a “good death” by helping individuals reconcile with their mortality and find peace (Halifax, 2008). While their methods were less standardized than today’s trials, their combined insights paved the way for modern psilocybin research.

In a 2016 study at Johns Hopkins, terminally ill cancer patients received a single dose of psilocybin in a supported setting. The results were striking: 80% reported significant reductions in death anxiety, and many described a newfound sense of peace and connectedness. One participant, a man in his 60s with advanced lymphoma, put it simply: “I realized that my fear of death was just my ego clinging to life. When that dissolved, so did the fear” (Griffiths et al., 2016).

In recent years, countries like Australia and states like Oregon in the U.S. have begun legalizing psilocybin therapy for mental health and end-of-life care, reflecting a growing recognition of its potential. In Germany, psilocybin is available under compassionate use programs for terminal patients, though access remains limited.

The Ethics of Accompaniment

Lessons from the Deathbed

In end-of-life care, the role of the doula or caregiver isn’t to direct the process, but to create a container – a safe, quiet space where the dying person can follow their own rhythm.

I truly believe that this is how we should approach psychedelic guidance as well: with humility, presence, and trust in the individual’s innate process.
Too often, psychedelic experiences are framed as something to be “managed” or “optimized,” as if the guide’s role is to steer the journey toward a specific outcome. But what if we approached these experiences the way we do the dying process? Not as something to control, but as a sacred transition to be held with reverence and trust. Just as no two people die the same way, no two psychedelic journeys unfold identically. The guide’s task is not to intervene, but to offer presence and support without interference, unless explicitly asked.

What this looks like in practice?

Often, the most powerful support comes not from doing, but from being. Words can feel heavy in these moments, while silence opens the door. To me, silence is not an absence but an invitation. There’s a natural urge to fill quiet moments with words, to explain or soothe or guide. But when we resist that impulse, we create space for whatever needs to arise, whatever wants to be felt or released. Sometimes, the simplest gestures like a hand resting gently on a shoulder or a cool cloth pressed to a forehead, can offer grounding without disrupting the natural rhythm of the experience.

During a psilocybin session, a client began to sob uncontrollably. My instinct was to ask, “What’s coming up for you?“ – to try to “help” him process it. But I caught myself. Instead, I simply sat beside him, offering tissues when he reached for them. Afterward, he told me, “I needed to cry without explaining why. Your silence gave me that.“

But above all, there is one rule: Follow their lead. If they need to speak, listen. If they need to scream, let the sound rise and fall without interruption. If they turn inward, honor the silence as you would a sacred pause. Occasionally, a gentle reminder, like a soft prompt to breathe, a whispered assurance that this, too, will pass, can help. But even then, the guiding principle remains: Trust that they know what they need. Your role is simply to witness it.

It sounds simple, but in practice it rarely is. Resisting the urge to “fix” what isn’t broken, to step in where no intervention is needed, is a skill that demands both humility and practice. It’s not just hard to learn, it’s harder still to uphold when discomfort arises.

What End-of-Life Care Can Learn from Psychedelic Guidance

The Illusion of the “Right” Way

To allow what feels uncomfortable to us might be the hardest part of being a guide – whether in psychedelic sessions or at the bedside. We project our own fears, ideals or definitions of “normal” onto others, assuming we know what their experience should look like. But what if their agitation, their unusual behaviors, or their intense emotions aren’t signs of disorder, but part of a process we don’t fully understand?

A family once asked a hospice nurse to “calm” their father, who was agitated and calling out for his long-deceased brother. Their instinct to sedate him was understandable, as his restlessness was painful to witness. But the nurse paused and asked, “What if this is his way of saying goodbye?” Instead of medicating him immediately, they dimmed the lights and allowed him space to speak. Within the hour, he settled into peaceful sleep and passed shortly after. Had they intervened, they might have interrupted a final, meaningful moment – one that belonged to him but could still be shared with his family.

Similarly, during a psychedelic session, a client became stuck in a loop of self-criticism. I felt the urge to comfort her with reassurances like “You’re being too hard on yourself!” But I held back. After what felt like an eternity, she laughed and said, “I just realized I’ve been fighting this my whole life. I think I’m ready to stop.” Had I interrupted, she might not have reached that insight on her own.

Redefining “Normal”

In end-of-life care, we often mislabel behaviors that make us uncomfortable, especially when they don’t fit our idea of a “good death” or our idea of who the dying person is. In the psychedelic work there is more openness to what might seem strange, chaotic or disturbing from the outside. It’s expected that someone might laugh or cry uncontrollably, speak in metaphors or move in unusual ways. These aren’t signs of disorder but part of the process that are all welcome. End-of-life care could benefit from this same openness.

Terminal agitation (restlessness, confusion, or distress in the final hours) is often met with alarm. Families may demand sedation, assuming their loved one is suffering. But research suggests these states can reflect unresolved emotions, spiritual encounters, or the body’s natural preparation for death (Griffiths et al., 2015). Instead of immediately medicating, caregivers might create a calm environment (soft lighting, familiar voices); offer gentle comfort (hand-holding, music) or trust the process, even when it’s unsettling. These experiences may feel spiritual to some, psychological to others.

A hospice patient began thrashing and calling out for her daughter, who lived overseas and couldn’t be there. The staff’s first instinct was to restrain her for safety. Instead, a nurse sat beside her and said, “She’s here with you now. You’re not alone.” The patient quieted almost immediately. Sometimes, presence is the best medicine.

Of course, not all agitation is existential. Physical pain, medication side effects, or untreated symptoms require attention. But before intervening, we must ask: Is this truly distress, or are we projecting our own discomfort? Are we mislabeling a natural process because it doesn’t fit our idea of how death (or a psychedelic journey) should unfold?

The key is to honor the individual’s reality, whatever form it takes. Whether in dying or in deep psychedelic states, the most ethical stance is again often the simplest: Trust the process. Witness without imposing. And remember that what looks like chaos to us might be exactly what’s needed.

Conclusion: The Sacredness of Not Knowing

In the end, psychedelic guidance and end-of-life care do not offer answers so much as they train us to stay present at the edge of what cannot be fully known. Both reveal the limits of control, interpretation and expertise. Our task is not to fix, direct or resolve these experiences, but to meet them with steadiness, humility, and a willingness to remain with uncertainty.

Psychedelic states remind us that what appears strange, chaotic, or overwhelming may carry its own internal intelligence. End-of-life care shows us that the final moments of life are not problems to be managed, but transitions to be accompanied. In both, meaning does not arise from explanation but from presence — from allowing experiences to unfold without forcing them into familiar frameworks.

At a time when Western culture seeks mastery over consciousness and control over death, these practices offer a different ethic: one rooted in trust, restraint and deep listening. They invite us to reconsider what care really means when transformation — rather than cure — is what is unfolding.

Perhaps this is their shared gift: a reminder that some of the most profound human experiences do not ask us to know more, but to hold more — more ambiguity, more vulnerability, more trust. At the threshold of altered consciousness and at the threshold of death, we are asked to meet life not by mastering it but by allowing it to move through us, on its own terms.

Vastuuvapauslauseke:

All examples shared in this article are anonymized and altered. While the core ideas and themes remain true to real experiences, details have been modified to ensure that no individual can recognize their own story or that of others. Circumstances and identifying features have been changed to protect privacy.