Death is a difficult concept to confront. Staring at our own mortality, or at the mortality of our loved ones, is something which can cause us a great deal of emotional pain or distress. However, the inevitability of death is something which needs to be confronted, not ignored. By turning a caring yet bold eye towards death, BJ Miller gave one of the most moving and important TED talks currently available on the topic. A palliative care physician, Miller helps people to understand that in the cases where they can see death approaching, there are certain things that matter much more than others during the final stage of life.
The Downfall of the Medical System
One of the points which Miller addresses at the outset of his talk is one of the key downfalls of the medical system. He is careful to not paint all health care practitioners with one brush, going so far as to say that the vast majority of them enter the healthcare field with good intentions. Despite those intentions, these healthcare practitioners-to-be are entering what is a fundamentally flawed system. According to Miller, the problem lies in the fact that medicine is at its core focussed on diseases, and the curing of diseases, instead of focusing on people.
The Universality of Death
It’s an unpleasant, but unavoidable reality. Death comes to us all. However, within that concept there also comes a connection to our fellow man. Along with birth, death is one of the only truly universal experiences that we must all pass through. This connection, this shared experience, is therefore a critical field to look for understanding of true, shared human experience. In Miller’s study of death, he seeks to find things which are, potentially at least, universal needs and desires at the end of life.
What is Important at the End of Life?
Through his study of death, Miller has discovered several things which seem to be important to the vast majority of people as they move through the final stage of living. These include:
- Finding comfort and avoiding unnecessary suffering
- Feeling unburdened
- Feelings of peace
- A connection to the spiritual
- A sense of wonderment
These commonalities among patients lead Miller to develop his model and vision for hospice care.
Hospice Care
Miller works at a hospice center, and his theories for practice are directly related to hospice care. He believes that through implementing certain principles, we can fundamentally change the experience of death for patients in hospice programs.
The removal of unnecessary suffering is a hugely important part of this, but he also talks about moving the body and the patient into a more aesthetic realm. By using their senses to provide them with experiences that bring pleasure, comfort and beauty into their lives, their experience of life even in the face of death can be improved.
All of these points relate to his key message: that life in hospice should not only about reducing how horrible life and disease can be, but about making life during those final stages more wonderful, more engaging, and more filled with joy. He’s not advocating for treating death casually or lightly, and understands that these approaches cannot or will not work in every case. But he contends that it is vital that we make space for these approaches to work when they can. That instead of sterilizing and numbing ourselves in the face of death that we need to embrace life as we can, when we can.
Why is This Conversation So Important?
The United States is home to an aging population. Currently, the percentage of people who are over 65 sits at roughly 15 percent of the country’s population. However, by 2060 that number will increase to as much as 24%. This has truly massive implications for health care in the country. The risks of many serious and terminal diseases increase as people move into the later years of their life. The role of hospice care is going to become more and more essential to a larger segment of the population as we move into the coming decades.
There are several paths which end of life care could move down as the population continues to age. The temptation to many policy makers will be to further embrace the health care system as it stands, expanding hospitals and moving ever increasing numbers of patients through their doors. However, as Miller says in his talk, hospitals are not places to live out your final days in the face of terminal illness. They are places designed to cure treatable disease and injuries. For dying, a new model such as the one pioneered at hospice centers like Harbor Light Hospice could provide a much more elegant and truthful way forward for people as they near the end of their life.
This type of move would require a fundamental shift in thinking in much of the health care system. One of Miller’s opening points in his talk is the downfall of healthcare, lying in its focus on disease instead of on people. For this type of move to hospice care that allows for a better kind of death, the focus of at least some of the people in the system will have to shift to the people, rather than their diseases.
What Happens Next?
Miller’s talk has been one of the most shared and most influential TED talks given over the last few years. He has been interviewed by media personalities from around the world who have been awed by his perspective. However, simple awareness of his message isn’t enough. It is vital that his perspective is put into practice in actual hospice care settings.
When you think of the sterility of a hospital, it is hard to imagine a dog being brought in to comfort a patient. Miller mentions the extreme joy brought to one patient who gets to spend time with her dog. Dogs being brought into visit hospice care patients is just one way in which the vision of Miller can be implemented. Contact with a loving animal is a tremendous way to stimulate the senses and to bring joy to a suffering person. This is just one, small example of how the principles that Miller espouses can be used to improve the quality of hospice care. It will be fascinating and important to see where his ideas propel hospice care to in the future.
