Episode 6: Dr Jessica Zitter

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“Here’s to dying well”

Dr Jessica Zitter

In this episode, I spoke with Dr Jessica Zitter. She first came to my attention after I read this New York Times article, which crystallised the dissonance and conflict I suspect a lot of critical care physicians feel around the marshalling of the end of life for their patients.

The ‘slow burn’ of psychedelic science is as it should be – the gradual percolation of their empirically ratified benefits through medicine and then hopefully into mainstream society. At the time of writing, the research into the therapeutic benefits of psilocybin in end-of-life care, for example, seems to be proceeding at a pace that Goldilocks would approve of - not excessively slowed down by obfuscating bureaucrats, nor impatiently pushed along by overzealous stakeholders and evangelists. This gives us time to have a cultural conversation about how we can best integrate these substances into the care of the dying.

If the phase 3 trials for psilocybin and other psychedelics in the fields of palliative care produce a shade of the benefits seen in phase 2, then the proposition of their normative prescription for end of life issues will move from the realms of absolute psychonaut fantasy to possible medical reality.  

Furthermore (and barring some massive paradigm shift in the nature of health care hierarchy), doctors will very likely spearhead the prescription of such substances to the dying. I wanted to get a ‘Physicians eye view’ of the current state of play in the world of palliative medicine - and that’s where Jessica comes in.

She speaks with a nice combination of candour and humour, and confidence mediated with circumspection. I hope you enjoy the conversation.

We discuss

  • Her Netflix documentary Extremis

  • The rise of the palliative care movement

  • Her paradigm shift to more holistic care and her straddling of the two worlds of palliative care and intensive care

  • Her book Extreme measures

  • Her article - ‘on being relevant’ and a recalibration of hierarchical structures

  • How spiritual and physiological suffering require different skill-sets in terms of treatment

  • Jessica’s work with her chaplain and her mixed feelings of being part of a team

  • Michael Pollan and Ayalet Waldman

  • Jessica’s hope for the phase 3 trials coming back with useful tool that perform an ‘incredibly heavy lift’ for people needing help at the end of life

  • the phenomena of Extremis and how it might reveal an unmet societal need

  • Her new movie about ‘caregiver burden’

  • ‘First sex ed, then Death ed’

  • Teaching her own Daughters sex ed (for which I argue she should be immediately struck off)

  • Further scarring her kids by teaching them about Herpetic Penises (don’t even ask)

  • Not being able to make it through Friday night dinner without talking about death

  • How kids can cope with properly calibrated and age appropriate conversations about death

  • Other podcasts where Dr Zitter has spoken at length about the legality if things such as advanced directives and legal issues surrounding end of life

  • Her deepest fear about end of life,

  • Her article miracles don’t come cheap about the relative rarity of people coming back from the brink

  • Jessica’s desire for a ‘peace blanket’ at the end, and how psychedelics might aid with this

  • Resources for how to get ready for your death

  • Her website and her socials

Dr Jessica Zitter M.D.

Critical and Palliative Care specialist - Author of Extreme measures

Dr Jessica Zitter MD MPH  (source ncp.org)

Dr Jessica Zitter MD MPH (source ncp.org)

Dr. Jessica Nutik Zitter, MD, MPH, is a national advocate for transforming the way people die in America.  She is Harvard and UCSF-trained to practice the unusual combination of Critical and Palliative Care medicine.  She works as an Attending Physician at a public hospital in Oakland, California.

Dr. Zitter is the author of the newly released Extreme Measures: Finding a Better Path to the End of Life. She is a regular contributor to The New York Times and her articles have appeared in The AtlanticTime Magazine, Journal of the American Medical Association, The Washington Post and many other publications.

Dr. Zitter’s work is featured in the Academy and Emmy-nominated short documentary “Extremis,” available on Netflix.

Niall Campbell