At the end of our lives, what do we most wish for? For many, it’s simply comfort, respect, love. BJ Miller is a hospice and palliative medicine physician who thinks deeply about how to create a dignified, graceful end of life for his patients. Take the time to savor this moving talk, which asks big questions about how we think on death and honor life.
ABOUT THE SPEAKER
BJ Miller · Palliative care physician
Using empathy and a clear-eyed view of mortality, BJ Miller shines a light on healthcare’s most ignored facet: preparing for death.
For most people, the scariest thing about death isn’t being dead, it’s dying, suffering. It’s a key distinction.
We know from research what’s most important to people who are closer to death: comfort; feeling unburdened and unburdening to those they love; existential peace; and a sense of wonderment and spirituality.
So much of life comes down to loving our time by way of the senses, by way of the body — the very thing doing the living and the dying.
As long as we have our senses — even just one — we have at least the possibility of accessing what makes us feel human, connected.
So, if teasing unnecessary suffering out of the system was our first design cue, then tending to dignity by way of the senses, by way of the body — the aesthetic realm — is design cue number two. Now this gets us quickly to the third and final bit for today; namely, we need to lift our sights, to set our sights on well-being, so that life and health and healthcare can become about making life more wonderful, rather than just less horrible.
Here, this gets right at the distinction between a disease-centered and a patient- or human-centered model of care, and here is where caring becomes a creative, generative, even playful act. “Play” may sound like a funny word here. But it is also one of our highest forms of adaptation. Consider every major compulsory effort it takes to be human. The need for food has birthed cuisine. The need for shelter has given rise to architecture. The need for cover, fashion. And for being subjected to the clock, well, we invented music. So, since dying is a necessary part of life, what might we create with this fact? By “play” I am in no way suggesting we take a light approach to dying or that we mandate any particular way of dying. There are mountains of sorrow that cannot move, and one way or another, we will all kneel there. Rather, I am asking that we make space — physical, psychic room, to allow life to play itself all the way out — so that rather than just getting out of the way, aging and dying can become a process of crescendo through to the end. We can’t solve for death.
We can design towards it. Parts of me died early on, and that’s something we can all say one way or another. I got to redesign my life around this fact, and I tell you it has been a liberation to realize you can always find a shock of beauty or meaning in what life you have left, like that snowball lasting for a perfect moment, all the while melting away. If we love such moments ferociously, then maybe we can learn to live well — not in spite of death, but because of it. Let death be what takes us, not lack of imagination.
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