Purpose: To understand the fear of death, spirituality and good death in patients with terminal cancer. Method: A retrospective study of death fear in patients with terminal cancer was done at a palliative care unit of National Taiwan University Hospital. Data was collected from case report by Clinical Buddhist chaplains who took care of patients as other core team members during Jan 2005 to Dec 2007. The original descriptive clinical record included patient's basic demographic data, special forms of spirituality, clinical manifestations of death dear, various levels of death fear and good death score etc. The records were reviewed by research team members to reach a common consensus regarding degree of spirituality and death fear transferred from qualitative to quantitative data, Results: The basic demographic data was shown as follows: Total 50 patients, male 58%, mean age 58 years old, primary hepatoma (18%) the most diagnosis, 80% with one religion belief, mean survival time 35.5 days and 76% death at hospital. The common three clinical manifestations of death fear were: psychologic symptoms of uncertainty to make efforts; anomalous fear presentations; loss of thrive to face inevitable death. Among various items related to death fear score, the degree of spiritual disturbance was the only significant variable before intervention. Conclusion: The results supported the previous death fear mechanism attributed from that the inner life strength embraced by people unable to overcome the issue of death. For patients, especially terminal patients, long-time belief in those survival rules plus uncertainty of prognosis and worry about the worst outcome results in various behaviors of unacceptance and avoidance in the face of death.