For many with terminal illness, facing mortality can be one of the most profound and challenging experiences a person endures, sometimes even more so than the physical pain or limitations of the illness. It can result in an overwhelming fear of death, known as end-of-life anxiety or existential distress, which not only diminishes the quality of life for patients but also for their families and caregivers.
Hospice and palliative care specialists find ways to address this distress with compassion. Coping tools, ranging from relaxation practices to antidepressants, can help. And recent research into psychedelic-assisted therapy for end-of-life care is showing increasing promise in creating lasting peace for those with terminal illness.
End-of-life anxiety often manifests as existential distress, a psychological and spiritual pain that arises when a person confronts their own mortality. Patients may experience:
Studies by Holland et al., 2013 and others estimate that up to 50% of terminally ill patients may experience significant existential or death-related anxiety, creating a negative feedback loop of rigid thought patterns that can reduce pain tolerance and amplify their suffering.
Many patients express a longing not just for symptom relief, but for a sense of peace, purpose, and connection as they approach death. Traditional palliative care approaches, such as antidepressants, talk therapy, occupational therapy, or spiritual counseling, can help, but sometimes fall short in addressing the psychological and existential aspects of terminal illness.
After decades of prohibition, psilocybin, a naturally occurring psychedelic compound found in specific species of mushrooms, has shown promise in helping terminally ill patients find meaning and acceptance as they grapple with the end of their lives.
Research says…
Unlike medications or interventions that only treat symptoms or have a short-term effect, psilocybin can combine both the pharmacological and psychotherapeutic approaches for lasting relief. This combination helps patients confront and transform their fear rather than “numb out” by facilitating experiences of deep emotional release, spiritual connection, and acceptance.
These therapeutic benefits are in part due to psilocybin’s varied effects in the brain. Because psilocybin is structurally similar to the neurotransmitter serotonin, it can affect specific receptors and areas of the brain that are involved in emotional regulation and self-identity. When psilocybin activates these areas, it greatly affects mental processes. This flurry of activity calms fear centers, scrambles connections, and boosts the brain’s ability to make new connections, strengthens neural growth through neuroplasticity, and reduces activity in areas of the brain related to the sense of self.
In short, it provides a neurobiological reset where the brain’s rigid patterns loosen, the ego quiets down, and patients feel more spiritually and emotionally open. Some patients describe psilocybin sessions as “years of therapy in one day.” This phenomenon has been explored in best-selling books such as How to Change Your Mind and documentary films such as Fantastic Fungi, in which terminally ill patients share their positive experiences. \
Two pivotal studies conducted in 2016, one at Johns Hopkins University and a parallel one at NYU Langone Medical Center, brought psilocybin therapy for end-of-life anxiety into the scientific spotlight.
Both were randomized, double-blind studies of cancer patients struggling with existential distress, and both found that a single psilocybin session produced profound and sustained psychological benefits. Since the publication of these two landmark papers, more research has been unfolding that supports the original findings.
Both studies emphasized safety and tolerability. Adverse events were rare and transient, with most participants describing the experience as challenging but ultimately healing.
Johns Hopkins’ lead researcher, Roland Griffiths, who himself was diagnosed with a terminal illness, has said of his own psychedelic treatment, “My experience during the [psychedelic] session felt informative and validating: I would indeed eventually die from the cancer. There was no trace of fear or anxiety, but there was something exquisitely beautiful, uplifting, and deeply meaningful about the process.”
Follow-up studies by NYU and others by Johns Hopkins confirm that the antidepressant and anxiolytic effects of psilocybin can persist for months or even years. Patients often report enduring changes in their feelings about death and dying.
Studies have shown that psychedelic palliative care patients fear potential mental distress, providers who aren’t adequately trained, and exploitation. Because psilocybin induces powerful altered states, ensuring informed consent is essential. Other key considerations include: screening, support with medical oversight, and integrative care to make patients feel more comfortable.
It has also been noted that access to therapy sessions comes with socioeconomic barriers. Some clinics have high rates for psychedelic palliative care or require travel for the legal use of psilocybin, which is more difficult for geriatric or sick populations. Also, access and research are often biased toward white, financially privileged individuals.
However, as laws change and the field of palliative care evolves, accessibility and research are also expanding. Training for therapists who are adept at both clinical care and spiritual presence will allow them to hold space for such profound journeys.
Psilocybin remains a Schedule I substance in many countries, but momentum in drug reform is growing. Though the FDA rejected the use of MDMA for therapy in 2024, stating more research was needed, it has granted psilocybin and psilocybin analogs “breakthrough therapy” designations for depression over the years.
Clinicians and researchers remain undaunted as promising results from pilot studies in psychedelic palliative care have led to larger, multi-center trials. This includes phase 2 and phase 3 studies currently underway to further investigate efficacy, safety, and optimal dosing in more diverse palliative care populations, with more studies on the horizon.
If approved, psilocybin could soon become an integral tool in helping patients die with dignity, peace, and connection.
Currently, psilocybin is illegal for general use in most countries, though reform is happening. A few countries, such as Jamaica, where Beckley retreats are held, do not regulate psilocybin use. Additionally, some U.S. cities and states have decriminalized it, while others, such as Oregon and Denver, have legalized it for use in treatment centers and offer limited compassionate-use programs for palliative care.
How safe is psilocybin for terminally ill patients?While more research is necessary to understand dosing and other side effects of psilocybin for sensitive populations, when administered in controlled settings with trained therapists, psilocybin is considered physiologically safe. Any psychological risks, such as temporary anxiety or confusion, are mitigated through preparation and support.
What are the benefits of psilocybin for death anxiety?Psilocybin can reduce fear, depression, and existential distress, while fostering acceptance, peace, and a sense of connection that helps patients face death with calm and meaning.
Will psilocybin change my personality at the end of life?Rather than changing personality, psilocybin often helps patients reconnect with their authentic selves, reducing emotional rigidity and deepening their compassion and gratitude for life.
How does psilocybin-assisted therapy work in hospice care?In hospice settings, psilocybin therapy may involve collaboration between palliative care providers, therapists, and spiritual counselors to ensure holistic support before, during, and after the session. Though legally, there are only a few places where this type of care can take place.