Herein, we describe the first asymmetric total synthesis and determination of the relative and absolute stereochemistry of naturally occurring 16-hydroxy-16,22-dihydroapparicine. The key steps include 1) a novel phosphinimine-mediated cascade reaction to construct the unique 1-azabicyclo[4.2.2]decane core, including a pseudo-aminal-type moiety; 2) a highly stereospecific 1,2-addition of 2-acylindole or a methylketone through a Felkin-Anh transition state for the construction of a tetrasubstituted carbon center; and 3) an intramolecular chirality-transferring Michael reaction of the ketoester, with neighboring-group participation, to introduce a chiral center at C15 in the target molecule. In addition, we evaluated the antimalarial activity of synthetic (+)-(15S,16R)-16-hydroxy-16,22-dihydroapparicine and its intermediate against chloroquine-resistant Plasmodium falciparum (K1 strain) parasites.