{SUMMARY} This paper utilizes a case study of a woman in the final stage of Frederick's Ataxia, who, together with her carer, participated in an interview just days before she died. As a consequence of impairment associated with the later stage of the disease, the participant's verbal communication was limited. There are various ways in which individuals who are confronting the end of life experience spirituality. For this woman, spirituality was expressed as a connection with significant others, rather than as religiosity. Key findings are expressed in terms of the importance of insights offered by people with non-verbal communication, spirituality rather than religiousness, and the importance of domiciliary palliative care. The most important gift that pastoral carers, and carers in general, have to offer is the gift of relationship.