Psychedelic-assisted therapies for existential and spiritual suffering in palliative care

Existential and spiritual suffering are frequently reported by individuals facing serious illnesses, particularly at the end of life, and are associated with diminished quality of life, increased psychological distress, and requests for hastened death. While Palliative Care (PC) aims to provide holistic support, existing therapeutic options often fail to adequately address the profound disruptions in meaning, connection, and dignity experienced by patients. Psychedelic-Assisted Therapies (PAT), notably those using psilocybin, have re-emerged as promising interventions capable of eliciting transformative experiences that may alleviate existential and spiritual distress. This chapter explores the potential role of PAT in PC, beginning with a historical and conceptual overview of PC and an analysis of existential and spiritual suffering in this context. It then reviews scientific evidence on the therapeutic applications of classical psychedelics, with a focus on existential and spiritual suffering. Practical, clinical, ethical, and legal considerations for the integration of PAT into PC are discussed, including the challenges of implementation and the need for spiritually and existentially informed treatment models. The chapter concludes by reinforcing the urgency of innovative and compassionate responses to existential suffering and highlighting PAT as an emerging pathway toward improving the quality of life-and death-of individuals with serious illnesses.