Palliative care is not a decision to stop caring. It is a decision to make comfort, dignity, communication, and quality of life central to care, wherever a person is in the course of serious illness.
For some patients and families in Clearwater, FL and Johnson City, TN, a conversation about palliative care may include ketamine therapy. That conversation should be careful. It should begin with what is difficult now, what matters most to the patient, and what support is already in place. It should never begin with a promise.
What palliative care ketamine therapy is
Palliative care addresses the full experience of serious illness, including physical symptoms, emotional distress, practical strain, family concerns, and the need to make decisions that reflect a patient’s values. It can be part of care alongside disease-directed treatment, and it can also be important when the focus has shifted primarily toward comfort.
Ketamine is an anesthetic medication with a long clinical history. In palliative settings, clinicians have discussed it in situations involving complex symptom burden, particularly when usual approaches have not provided an acceptable balance of benefit and burden. A review of ketamine in complex palliative pain describes its consideration as a specialized option rather than a routine first step (ketamine in complex pain care (Johnstone-Petty, 2018)).
Our role is to make room for an individualized discussion. We consider the patient’s medical history, current medications, goals, support system, and care team. We also discuss uncertainty plainly. Ketamine may be considered for palliative goals on an off-label basis, meaning it is not FDA-approved specifically for those goals.
Why comfort-focused goals need a wider conversation
Comfort is not one thing. It may mean less time consumed by distress. It may mean being able to speak with family, rest more easily, participate in meaningful routines, or feel more present in one’s own life. For another person, comfort may mean avoiding an intervention whose demands outweigh its possible benefit.
That is why a palliative conversation cannot be reduced to a medication decision. We ask what the patient hopes to preserve, what feels intolerable, and what tradeoffs they are willing or unwilling to make. Family members often carry their own questions and fears. They deserve clear information, but the patient’s voice remains central whenever they are able to express it.
The clinical literature reflects this complexity. A comprehensive review found that evidence for ketamine in palliative care was limited and varied across settings, dosing approaches, and patient circumstances, which supports cautious, case-by-case decision-making (the limits of current evidence (Goldman et al., 2019)).
There is no universal palliative plan. There is only the plan that makes sense for this person, at this time.
How we structure an individualized discussion
A consultation is a place to slow down. We want patients and families to understand what is being considered, why it may or may not fit, and what follow-up would look like before any decision is made.
When palliative care ketamine therapy is part of the discussion, we typically explore:
the patient’s current symptoms, medical diagnoses, and treatment history
medications, allergies, substance-use history, and relevant safety concerns
goals for comfort, function, connection, and day-to-day life
whether the patient has a prescribing clinician, palliative clinician, hospice team, or other care partners
practical details, including transportation, support after treatment, costs, and monitoring
what would lead us to reconsider, pause, or choose a different approach
Coordination matters. Palliative care can involve several clinicians, and medication changes should not happen in isolation. Through medication management, we can help make sure relevant treatment information is considered in the context of the larger plan.
Ketamine can affect perception, awareness, blood pressure, and coordination. Its potential adverse effects and medication-related considerations are among the reasons careful dosing, monitoring, and communication are important (clinical considerations for ketamine (Quibell et al., 2015)). A published case report of iatrogenic oral ketamine overdose in palliative care further illustrates why those safeguards matter (oral ketamine overdose case report (Dulin et al., 2021)).
What we emphasize with patients and families
We do not view palliative care as giving up. We view it as an honest form of care, one that asks not only, “What can be done?” but also, “What is worth doing for this person?”
We emphasize informed consent. That means discussing potential benefits, limitations, side effects, alternatives, and the fact that an individual response cannot be predicted in advance. We also emphasize that ketamine is one possible part of a broader comfort-focused plan, not a replacement for attentive medical care, emotional support, family communication, or spiritual care when those are important to the patient.
Our ketamine therapy conversations are grounded in the same principle: treatment should be guided by the person in front of us, not by a template. Some patients may decide that ketamine is not the right fit. That can be a thoughtful and appropriate outcome of consultation.
For patients experiencing depression alongside serious illness, the evidence is also still developing. A systematic review found limited studies and called for stronger research on ketamine’s efficacy and safety for depressive symptoms in palliative care (the need for better palliative research (Barbosa et al., 2023)). We discuss depression carefully and assess whether additional mental health support should be part of the care plan.
The support around the medication matters
Serious illness can narrow a person’s world. It can change relationships, sleep, identity, independence, and the sense of what the future holds. Those realities deserve attention whether or not ketamine is ever used.
Psychotherapy and coaching may offer a place to process fear, grief, changing roles, and difficult conversations. It can also give family members language for supporting someone they love without assuming they know what that person needs.
We encourage patients to involve the clinicians and loved ones they trust. At the same time, we respect privacy and autonomy. The right level of family involvement is not identical for everyone.
Frequently asked questions about palliative ketamine care
Does palliative care mean hospice?
No. Palliative care and hospice share a focus on comfort and quality of life, but they are not the same. Palliative care may be involved at many points during serious illness, including while a patient continues other medical treatment.
Is ketamine FDA-approved for palliative care goals?
No. Ketamine may be discussed off-label for palliative goals. Off-label use can be clinically appropriate in some circumstances, but it requires a clear explanation of rationale, risks, alternatives, and monitoring.
Can family members participate in the consultation?
Often, yes, when the patient wants them involved. Families may help describe changes at home, raise practical questions, and better understand how to support the patient afterward.
What if we are unsure whether to proceed?
Uncertainty is a valid reason to pause and ask more questions. We would rather patients understand their options than feel hurried into a decision. You can also review pricing and treatment options before making plans.
Key takeaways for a comfort-focused plan
Palliative care begins with the person, not the intervention. Ketamine therapy may be part of a carefully considered discussion for some patients, but it should be approached with realistic expectations, medical oversight, and an understanding of the limits of available evidence.
We believe the most useful question is often simple: what would make this time more livable for you? From there, we can talk through options with clarity and respect. If you or your family would like to begin that conversation, please contact our team or call us at 888-214-2144 to schedule a consultation.
If emotional distress includes thoughts of self-harm or immediate danger, call or text 988 for the 988 Suicide and Crisis Lifeline, call 911, or go to the nearest emergency department.
Medical disclaimer
This article is for general educational purposes and is not medical advice. Treatment decisions should be made with qualified clinicians who understand the patient’s complete medical history, current condition, medications, and goals of care.
Works Cited
1. Johnstone-Petty M. Ketamine Use for Complex Pain in the Palliative Care Population. https://pubmed.ncbi.nlm.nih.gov/30379800/
2. Goldman N, et al. The Efficacy of Ketamine in the Palliative Care Setting: A Comprehensive Review of the Literature. https://pubmed.ncbi.nlm.nih.gov/31090477/
3. Quibell R, et al. Ketamine. https://pubmed.ncbi.nlm.nih.gov/26096492/
4. Dulin JD, et al. Iatrogenic Oral Ketamine Overdose in Palliative Care. https://pubmed.ncbi.nlm.nih.gov/32208947/
5. Barbosa MG, et al. Efficacy and safety of ketamine for the treatment of depressive symptoms in palliative care: A systematic review. https://pubmed.ncbi.nlm.nih.gov/36574497/
6. 988 Suicide and Crisis Lifeline. https://988lifeline.org/
Disclaimer
This article is for educational purposes only and is not a substitute for individualized evaluation, diagnosis, or treatment from a qualified healthcare professional.
