When a Patient's Experience Challenges the System: Reflections on Medicinal Cannabis in Palliative Care
Written by Catherine Hanson
As a social worker and counsellor working in cancer care and palliative care, I have often found myself sitting at the intersection of competing realities. There is the reality of policy, organisational processes, clinical guidelines and professional boundaries. Then there is the reality of the person sitting in front of us, living with pain, fear, uncertainty and, sometimes, the knowledge that they are approaching the end of their life.
A recent experience highlighted this tension for me.
I was supporting a young woman (aged 23) with advanced illness who was nearing the end of life. Like many people in her situation, she was experiencing a range of distressing symptoms, including pain, anxiety and poor sleep. Through her own informal networks, she had obtained cannabis and reported that it was helping significantly. She described improvements in her comfort, reduced anxiety and better sleep. Most importantly, she felt she had found something that was improving her quality of life at a time when quality of life mattered enormously.
As her condition deteriorated, I wondered whether a prescription for medicinal cannabis might provide a safer and more clinically supported pathway than relying on an informal supply. I raised the possibility with a member of the hospice team, expecting at least a discussion about whether this might be an option worth exploring.
The response was clear: medicinal cannabis was not something the service was considering.
Oreti beach
What struck me was not the response itself. Clinical teams make difficult decisions every day, and there may have been valid reasons behind that position. Rather, what stayed with me was how quickly the conversation seemed to close down. There appeared to be little space for curiosity about the patient's experience, despite her reporting tangible benefits.
I do not see this as a debate about cannabis alone. Rather, it raises wider questions about innovation, patient autonomy and the ways healthcare systems respond to change. As interest grows in medicinal cannabis, psychedelic-assisted therapies and other novel approaches to alleviating suffering, these questions are likely to become increasingly relevant across palliative care settings.
The situation above left me reflecting on a broader question: what happens when patients' lived experiences challenge established models of care?
Palliative care has long championed person-centred practice. We encourage patients to tell us what matters most to them. We seek to alleviate suffering in all its forms: physical, emotional, social and spiritual. In many parts of the world, palliative care has also been at the forefront of compassionate access and “right to try” approaches, recognising that people facing life-limiting illness may sometimes wish to explore therapies outside standard treatment pathways when conventional options are limited. In theory, this suggests a field that is willing to engage with innovation in service of reducing suffering.
Yet I have come to see that the existence of such pathways is not the same as fostering a culture of curiosity and openness within everyday clinical practice. Even where compassionate access is possible, clinicians and organisations may still feel constrained by regulatory uncertainty, institutional culture, professional risk, limited education, or longstanding stigma surrounding certain therapies.
As a result, when it comes to emerging therapies or medicines that sit outside traditional practice, healthcare systems can sometimes struggle to remain open to the lived experiences of patients, even when those experiences suggest meaningful benefit.
Bluff
The barriers are understandable. There are regulatory considerations, limited evidence in some areas, organisational policies, funding constraints and concerns about safety. There are also cultural factors. Decades of stigma surrounding cannabis continue to shape attitudes, even as medicinal cannabis becomes increasingly accepted within healthcare settings internationally.
Healthcare professionals may also find themselves navigating uncertainty. Many have received little education regarding medicinal cannabis and may feel uncomfortable discussing it with patients. In such contexts, caution can become the default response.
Yet from a palliative care perspective, I wonder whether there is value in asking different questions:
What can we learn from patients who tell us that a particular intervention has improved their quality of life?
How do we balance evidence-based practice with compassionate responsiveness to individual experience?
How do we create space for conversations about emerging therapies without becoming polarised into positions of advocacy or opposition?
Most importantly, how do we ensure that people approaching the end of life feel heard when they describe what is helping them?
For me, the experience served as a reminder that progress often begins with conversation. Before new approaches can be integrated into practice, there must first be space for curiosity, reflection and respectful dialogue.
The patient at the centre of this story will never know the impact she had on my thinking. (Sadly, she died at the beginning of April 2026.) Yet her experience continues to prompt an important question: when someone living with a life-limiting illness tells us that something is helping, how do we ensure we are truly listening?
Bio:
Catherine Hanson is a Registered Social Worker, counsellor and trauma-informed therapist with more than 35 years of experience working across healthcare, Child Protection, Humanitarian settings, mental health, cancer care, and palliative care in New Zealand and internationally. She currently works within a Cancer Psychosocial Service, supporting people and whānau navigating the emotional, social, and existential challenges of cancer and serious illness.
Catherine holds a Master of Health Science with Distinction, with an endorsement in Palliative Care. Her Master’s research explored the emerging role of psychedelic-assisted therapies in palliative and end-of-life care, reflecting her interest in innovative, compassionate approaches to alleviating suffering and supporting meaning, dignity and quality of life at the end of life.