Psychedelic Experiences and Finitude in Serious Illness: A Qualitative Synthesis

Abstract Context : People living with serious illness frequently experience intense existential suffering related to awareness of finitude. Psychedelic-assisted therapies have been associated with reductions in death anxiety and existential distress, yet the experiential processes underlying transformations in the relationship with finitude remain insufficiently understood. Objectives : To synthesize qualitative evidence on the meanings, experiential processes, and transformations related to finitude reported by people with serious illness in the context of psychedelic use. Methods : A systematic review of qualitative evidence was conducted following JBI guidance and reported in accordance with ENTREQ and PRISMA-2020. Five databases and gray literature were searched without language or date restrictions. Qualitative primary studies involving adults with serious illness who used psychedelics in clinical/therapeutic or non-clinical contexts were included. Data were synthesized using thematic synthesis. Results : Nine qualitative studies were included. The synthesis identified a process of transformation in the relationship with finitude organized across three interrelated states. Prior to the psychedelic experience, finitude was experienced as a dominant threat marked by fear of death and illness-centered identity. During the psychedelic experience, states of expanded consciousness facilitated experiences of transcendence, including symbolic encounters with death, expansion of the ego's boundaries, spiritual experiences of connection and unity, and emotionally challenging experiences. These experiences enabled the reconstruction of personal narratives and the reinterpretation of suffering as transformative. In the post-experience state, finitude became integrated into the life experience, characterized by greater acceptance of mortality, reduced death anxiety, and revaluation of life priorities. Conclusion : Psychedelic-related experiences of transcendence appear to mediate a meaningful transformation in how people with serious illness relate to finitude. Rather than eliminating suffering, this process involves its experiential traversal and integration, supporting existential adaptation at the end of life.