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Field Notes · May 5, 2026

Government Psilocybin? Over My Dead Body.

There is something quietly strange about a society that has made dying easier to access than healing.

Not wrong, necessarily. Just worth sitting with.

Two Pathways

Medical Assistance in Dying (MAID) has been legal in Canada since 2016. Since 2021, imminent death is no longer required to qualify. The process is standardized, publicly funded, and available across the health system. It is, by design, accessible.

Psilocybin-assisted therapy for end-of-life distress follows a different path. A physician must submit a case-by-case application to Health Canada’s Special Access Program. Conventional treatments must have been tried first. Moreover, the therapy itself — typically six to eight hours in a clinical setting with trained practitioners — is not covered by insurance. In many regions, there is no qualified therapist nearby. Since the SAP opened to psilocybin in 2022, a total of 301 authorizations had been granted by mid-2025 (CBC News, June 2025). Health Canada approved 78% of applications as of February 2024 — Even so, the number of applications submitted remains small, constrained by awareness, geography, and the scarcity of practitioners able to navigate the process.

The contrast isn’t a scandal. It’s a philosophical puzzle. One pathway ends life. The other changes how a person relates to dying. Both require courage. Only one requires a federal exemption.

The Evidence Is Serious

The clinical case for psilocybin in palliative care is not fringe. Studies from Johns Hopkins, NYU, and Imperial College London consistently show rapid, durable reductions in death anxiety and existential distress — effects persisting months after a single session. A 2024 Université Laval study published in Palliative Medicine, surveying 2,800 Canadians, found that 79% consider psilocybin-assisted therapy a reasonable medical choice for patients at end of life (Plourde et al., DOI: 10.1177/02692163231222430).

The risks are real too. Psilocybin can induce acute psychological distress, panic reactions, and adverse effects in vulnerable individuals or unsupervised settings. This is precisely why clinical infrastructure — trained practitioners, proper protocols, rigorous oversight — matters. The science needs to be done carefully. No serious advocate for access would argue otherwise.

The question isn’t whether the bar should be high. It’s how urgently we’re trying to clear it.

The Practitioner Problem

Building that infrastructure requires practitioners who understand the experience they’re guiding patients through. Hundreds of Canadian health professionals applied for exemptions to use psilocybin as part of clinical training. Health Canada refused the majority of those applications. After a legal challenge, however, the Federal Court of Appeal ruled in June 2025 that those refusals were unreasonable, ordering reconsideration.

But the years lost matter. Psilocybin-assisted therapy isn’t like prescribing an antidepressant. It requires sustained, skilled presence through a profound altered state. Some clinicians have said publicly they would not feel equipped to offer it without having experienced it themselves. Whether or not that’s a regulatory requirement, it points to something true about the nature of the work — and the difficulty of building a competent workforce when access to the substance itself is so tightly constrained.

Fewer trained practitioners means fewer clinical sites, which in turn means fewer trials and slower evidence accumulation. The pace feeds itself.

What We’d Like to See

Canada’s regulatory caution around psilocybin comes from a reasonable place. Psychedelics carry genuine risks, the history is complicated, and moving carefully with novel therapies is defensible. No one should rush this carelessly.

But careful and slow are not the same thing. Canada has shown it can move with purpose on end-of-life policy when it chooses to — MAID expanded significantly within five years of legalization. Psilocybin research, training infrastructure, and SAP accessibility deserve that same sense of purpose.

People facing terminal diagnoses don’t have the luxury of waiting for the pace to pick up on its own.

The irony isn’t that the system is broken. It’s that it’s working exactly as designed — and the design hasn’t yet caught up with what the dying actually need.

Sources & Further Reading