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Peter Attia MDPeter Attia MD

#135 - BJ Miller, M.D.: How understanding death leads to a better life

BJ Miller is a hospice and palliative care specialist on a quest to reframe our relationship with death. In this episode, BJ begins with how his own brush with death radically shifted his perspective and ultimately forged his path towards palliative care and helping patients integrate and understand their life in a meaningful way. BJ recounts several moving stories from his patients, which reveal important lessons about overcoming the fear of death, letting go of regret, and what’s most important in life. He discusses the major design flaws of a “death phobic” healthcare system. Furthermore, he makes the case that seeing death as a part of life allows us to live well, as opposed to living to evade death itself. He concludes with a discussion around physician-assisted death as well as his hopes around the use of psychedelics to reduce suffering in end-of-life care. We discuss: 00:00:00 - Intro 00:03:00 - BJ’s accident leading to the loss of his limbs and his experience inside a burn unit 00:14:30 - Coping with his amputations—being tough, the grieving process, and the healing properties of tears 00:28:15 - Going from art history to medical school: the value of a diverse background in medicine 00:40:00 - How BJ’s new body liberated him 00:47:15 - How losing his sister to suicide and his disillusionment with medicine altered his path 00:55:30 - Discovering his path of palliative care—distinct from hospice—in medicine 01:02:15 - Our complicated relationship with death, and how acknowledging it can release its grip and improve living 01:10:00 - The different distinctions around the fear of death, and how BJ helps his patients negotiate fears 01:14:15 - The major design flaws of a “death phobic” healthcare system 01:23:00 - Common regrets, the value of time, and other insights from interactions with patients in their final moments of life 01:33:45 - The story of Randy Sloan—a case study of playing life out 01:39:45 - Hastening death with physician-assisted dying: Legality and considerations 01:45:45 - The use of psychedelics in end-of-life care, and what BJ is most excited about going forward Show notes page: https://peterattiamd.com/bjmiller/ About: The Peter Attia Drive is a weekly, ultra-deep-dive podcast focusing on maximizing health, longevity, critical thinking…and a few other things. With over 30 million episodes downloaded, it features topics including fasting, ketosis, Alzheimer’s disease, cancer, mental health, and much more. Peter is a physician focusing on the applied science of longevity. His practice deals extensively with nutritional interventions, exercise physiology, sleep physiology, emotional and mental health, and pharmacology to increase lifespan (delay the onset of chronic disease), while simultaneously improving healthspan (quality of life). Learn more: https://peterattiamd.com/ Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on: Facebook: http://bit.ly/PeterAttiaMDFB Twitter: http://bit.ly/PeterAttiaMDTW Instagram: http://bit.ly/PeterAttiaMDIG Subscribe to The Drive: Apple Podcast: http://bit.ly/TheDriveApplePodcasts Overcast: http://bit.ly/TheDriveOvercast Spotify: http://bit.ly/TheDriveSpotify Google Play: http://bit.ly/TheDriveGooglePlay

Peter AttiahostDr. BJ Millerguest
Nov 2, 20201h 54mWatch on YouTube ↗

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At a glance

WHAT IT’S REALLY ABOUT

BJ Miller on Loss, Dying Well, and Living Fully

  1. BJ Miller describes surviving a severe electrical burn at Princeton that cost him both legs below the knee and one arm below the elbow, and how his grief unfolded slowly after an initial phase of joking and toughness.
  2. He explains how his injuries, his mother's polio, and his older sister Lisa's suicide led him from art history to medical school, brief disillusionment with medicine, and finally palliative care.
  3. Miller distinguishes palliative care, which pursues quality of life at any stage of serious illness, from hospice, which is end-of-life care, and argues that medicine's focus on disease rather than the person is a design flaw driven by death phobia.
  4. From his patients he reports that deathbed regrets center on fear and not loving enough, that the final hours rarely bring big revelations, and that facing death early frees people to take life seriously.
  5. He discusses aid in dying through the story of Randy Sloan, and says he is most excited by psychedelic research and by the wider cultural conversation about death beyond medicine.

IDEAS WORTH REMEMBERING

5 ideas

Grief and acceptance cannot be rushed.

Miller initially joked and acted tough, and his first tears came only weeks later when a nurse confronted him; he says real mourning took months and years.

Palliative care is not the same as hospice.

Palliative care aims at quality of life during any serious illness with no time limit, while hospice is the end-of-life subset; confusing them leads people to avoid support they could use for years.

Fear of dying differs from fear of being dead.

Fear of the dying process can be eased with medications and reassurance, while fear of being dead calls for accompaniment, reflection, and investing in the world beyond oneself.

Healthcare's flaw is its focus on disease over the person.

Miller argues that the definition of palliative care should be the mission of all healthcare, with clinicians serving the human condition rather than treating death as an enemy.

Accepting that death is certain can liberate people.

If failure is guaranteed, Miller says, the pressure to be perfect lifts while the reason to take life seriously grows, and patients' regrets are often about fear and not loving more.

WORDS WORTH SAVING

5 quotes

The fact that it ends is what makes it precious.

— Dr. BJ Miller

I love life. My relationship to death, even my acceptance of death, is only to do with my love of life.

— Dr. BJ Miller

I don't love death. I love reality, and reality happens to include death.

— Dr. BJ Miller

I'd rather feel something, even if it's pain, than feel nothing. Anesthesia is a way-- A numbness is a way to die before we have to die. That seems to be a bigger tragedy to me than is death in the first place.

— Dr. BJ Miller

You're left with a lot of zombies. You're left with a lot of people with pulses, but have no idea why it's amazing to have a pulse in the first place.

— Dr. BJ Miller

Electrical burn injury and amputationsGrieving and the healing power of tearsFrom art history to medicinePalliative care versus hospiceDeath phobia and healthcare design flawsDeathbed regrets and the value of timeAid in dying and psychedelics at end of life

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