Conscious Dying is a movement that invites a truly holistic and human-centered approach to life fulfillment in the context of advanced illness and at the end-of-life. Rooted in a Caring Science ontology (Watson, 2012, 2018), the Conscious Dying philosophy evokes a lived ethic of caring and compassion, and focuses the nurse and/or caregiver on facilitating the highest possible quality experience throughout the dying process for all involved (Rosa, Estes, & Watson, 2017). Conscious Dying is based on 10 Conscious Dying Principles and Practices, examples include: increasing beauty, pleasure, contentment; providing emotional and spiritual support, practicing self-care to reduce burnout and emotional fatigue, and learning how to be with intense emotions (Estes, 2011; Rosa, 2014). Additionally, attention to the Subtle Energy Realms is essential. Some examples include: acknowledging mysteries; being open to miracles; validating the presence of departed loves ones; and honoring the waiting in between (Estes, 2011). Conscious Dying identifies the nurse as a ‘primary healing instrument’ and emphasizes nurse self-care and both the art and science of nursing practice. Essentially, the focus of Conscious Dying philosophy is in cultivating what is known as evolving human-centered care, defined as, “compassionate and empathetic care that responds, attends, and conforms to the human as a living, breathing, evolving experience; human as a fluctuating phenomenological being of engagement; human as history, as story, and as narrative; human as presence, emergence, and possibility; human as fellow sojourner; human as caring-healing; and human as LOVE” (Rosa & Estes, 2016, p. 336). Conscious Dying continues to inform how nurses engage suffering, hope, and the multidimensional roles and responsibilities of compassionate care for the dying one (Rosa & Hope, 2017; Rosa, Estes, Hope, & Watson, 2019).
Earlier in 2018, the National Hospice and Palliative Organization (NHPCO) announced the formation of an End-of-Life Doula (EOLD) Advisory Council (NHPCO, 2018). This action represents a rising national awareness of the use, talents, and benefits of EOLDs. According to the NHPCO (2018), EOLDs are non-medical caregivers providing holistic and comforting support to patients and families throughout the dying process, assist in improving the relationship between patients/families and medical staff, and provide myriad levels of support for the dying one and involved caregivers. A recent systematic review by Rawlings and colleagues (2018) identifies EOLDs as sharing much in common with palliative care specialists and offering potential significant value in the delivery of personalized care for the dying, however, there is much more to be understood and additional research is needed to better understand the outcomes of their services. There is an articulated hope that EOLDs will be able to improve care around death by integrating humanity into the medicalized care setting and improve the quality of healthcare services delivery in modern societies (Fukuzawa & Kondo, 2017). A number of organizations are increasing awareness of EOLDs, representing their interests, providing education, and assisting in the integration of EOLDs into mainstream healthcare (Conscious Dying Institute; International End of Life Doula Association, 2017; National End-of-Life Doula Alliance, 2017).
Entheogens are plant medicines that engender an experience of the sacred; they exist within a longstanding global history of indigenous medicinal use and are currently being evaluated in clinical trials for patients with advanced serious illness. The class of medicines known as entheogens that have been traditionally used for spiritual healing and growth include plants such as psilocybin mushrooms, ayahuasca, peyote, iboga, and salvia divinorum (Schultes, Hofmann, & Ratsch, 1998). The 1960s saw over one hundred trials of lysergic acid diethylamide for physical, emotional, and spiritual purposes, boasting consistent government funding and varying degrees of scientific rigor (Liester, 2014). Psychedelic research was systematically defunded in the late 1960s due to political backlash and stigmatization – but it is making a noteworthy return to the research milieu. Griffiths and colleagues (2006) ran a double-blind placebo-controlled randomized controlled trial administering large doses of psilocybin mushrooms to patients with advanced cancer, with 67% of subjects rating the experience as either “the single most meaningful experience of his or her life or among the top five… similar, for example, to the birth of a first child or death of a parent” (p. 276-277). The same study methodology was replicated at both New York University and Johns Hopkins for patients with advanced cancer. Findings included immediate reduction of anxiety and depression symptoms with 6-month sustainment of such beneficial outcomes (Griffiths et al., 2016; Ross et al., 2016). The scholarly dialogue on the use of entheogens for patients at end of life is a nursing requisite that must continue to evolve in keeping with emerging data (Hope & Rosa, 2018; Rosa, Hope, & Matzo, 2018) and may be just one way of ensuring quality spiritual care, as dictated by the National Coalition for Hospice and Palliative Care (2018) in their Clinical Practice Guidelines for Quality Palliative Care (4thed.).
In summary, a number of trends reflect a holistic and human-centered approach to end of life and palliative care. A nursing lens is imperative to understanding, deepening, and advancing these discourses. Through discussion regarding the Conscious Dying philosophy, the End-of-Life Doula movement, and current knowledge regarding entheogens in the context of serious illness, nurses can better equip themselves to deliver whole-person care to the dying one and their families.