<p><a href="https://peterattiamd.com/bjmillerandbridgetsumser/?utm_source=podcast-feed&utm_medium=referral&utm_campaign=250623-pod-bjmillerandbridgetsumser&utm_content=250623-pod-bjmillerandbridgetsumser-podfeed"> View the Show Notes Page for This Episode</a></p> <p><a href="https://peterattiamd.com/subscribe/?utm_source=podcast-feed&utm_medium=referral&utm_campaign=250623-pod-bjmillerandbridgetsumser&utm_content=250623-pod-bjmillerandbridgetsumser-podfeed"> Become a Member to Receive Exclusive Content</a></p> <p><a href="https://peterattiamd.com/newsletter/?utm_source=podcast-feed&utm_medium=referral&utm_campaign=250623-pod-bjmillerandbridgetsumser&utm_content=250623-pod-bjmillerandbridgetsumser-podfeed"> Sign Up to Receive Peter's Weekly Newsletter</a></p> <p>BJ Miller, a hospice and palliative care physician, and Bridget Sumser, a licensed social worker specializing in serious illness and end-of-life care, join Peter to share insights from their decades of work supporting people at the end of life. In this episode, they explore the emotional and physiological processes of dying, the cultural barriers that prevent meaningful conversations about death, and how early engagement with mortality can lead to greater clarity and connection. The conversation highlights the distinctions between hospice and palliative care, the nature of suffering beyond physical pain, and the transformative role of honesty, forgiveness, and relational awareness in the dying process. Through stories and reflections, BJ and Bridget reveal what truly matters in the end—and how the dying can teach the living not only how to face death but how to live more fully.</p> <p><strong>We discuss:</strong></p> <ul type="disc"> <li>The personal journeys of BJ and Bridget into end-of-life care, and the connection between living and dying [3:30];</li> <li>What dying looks like: the physical, cognitive, and emotional realities at the end of life [13:15];</li> <li>How historical perspectives on death contrast with modern experiences of dying [25:30];</li> <li>The difference between palliative care and hospice care [30:45];</li> <li>The systemic challenges surrounding hospice care: why patients often enter it too late to receive its full benefits [35:30];</li> <li>How delayed hospice referrals and unspoken preferences often prevent patients from dying where and how they truly want [39:30];</li> <li>The realities of home hospice: challenges, costs, and burdens placed of families [43:45];</li> <li>How proactively engaging with the reality of death can avoid unnecessary suffering and promote a more peaceful ending [53:30];</li> <li>How palliative care is misunderstood and underutilized—especially in cancer care [1:02:45];</li> <li>Palliative care in the case of Alzheimer's disease: emotional support, future planning, and family involvement [1:12:15];</li> <li>The importance of having an advance directive: defining what matters most before it's too late [1:23:00];</li> <li>The differences between how young and old individuals experience dying from cancer [1:30:15];</li> <li>The difference between pain and suffering, role of medicine in pain relief, and why emotional healing is essential at the end of life [1:35:45];</li> <li>Dying well: the power of self-honesty and human connection at the end of life [1:47:00];</li> <li>How psychedelics like psilocybin can unlock emotional breakthroughs and deepen connection for patients near the end of life [1:55:15];</li> <li>Lessons from the dying on how to live well [1:57:30];</li> <li>The physical process of active dying, and the emotional and practical considerations for loved ones [2:09:30]; and</li> <li>More.</li> </ul> <p>Connect With Peter on <a href="https://twitter.com/PeterAttiaMD">Twitter</a>, <a href="https://www.instagram.com/peterattiamd/">Instagram</a>, <a href="https://www.facebook.com/peterattiamd/">Facebook</a> and <a href="https://www.youtube.com/channel/UC8kGsMa0LygSX9nkBcBH1Sg">YouTube</a></p>
Actionable Insights
1. Live the Way You Wish to Die
Cultivate the habits, relationships, and mindset you desire for your death now, as people tend to die as they have lived; this builds the necessary ‘muscles’ for the end of life.
2. Practice Radical Self-Honesty
Dare to know yourself over time, looking at all parts of yourself, including fears and blind spots, to live a richer life and be ready to ‘die well’.
3. Cultivate Awareness While Alive
Develop deep emotional, spiritual, and relational awareness while alive, as this profoundly shapes your experience of dying.
4. Integrate Dying and Living
Recognize that dying and living are not at odds but are part of a continuous whole, encouraging a more integrated perspective on existence.
5. Contemplate Mortality While Healthy
Engage with the reality of your own mortality when you are healthy and feel good, as this builds a ’life-giving muscle’ for grappling with life’s uncertainties.
6. Practice Radical Acceptance of Emotions
Learn to accept everything within yourself, including fear, regret, and even suffering, which helps to ‘defang’ these difficult emotions and foster peace.
7. Reframe Fear and Regret
Change your relationship with fear and regret, understanding them as natural parts of being human rather than something to be ashamed of or run from.
8. Be True to Your Feelings
Avoid the common regret of not letting yourself feel or not being true to what you actually felt; express your true self and feelings to prevent wedges between yourself and loved ones.
9. Prioritize Connection
Actively foster connection to yourself, your environment, and the people around you, as this promotes ‘beautiful experiences’ during dying, regardless of mental clarity.
10. Practice Serenity Prayer’s Wisdom
Discern what you can control, what you can influence, and what you must surrender, building flexibility and learning to sit with what you cannot control.
11. Live in the Present Moment
Stay tethered to the reality that ’tomorrow is not promised,’ using this awareness to live tenderly, align actions with values, and appreciate the present moment.
12. Express Core Sentiments
Make an effort to say ‘I love you,’ ‘I forgive you,’ ‘Please forgive me,’ and ‘Thank you’ aloud to loved ones, as these are powerful for connection, reconciliation, and closure.
13. Seek Reconciliation, Avoid Grudges
Pursue reconciliation and avoid holding grudges, as these actions prevent unnecessary suffering for yourself and others.
14. Define Quality of Life Personally
Clearly articulate what ‘quality of life’ means to you, as this highly personal definition should guide all care decisions.
15. Prioritize Quality of Life
Make quality of life the central focus of your healthcare decisions, whether in palliative care or hospice, rather than solely quantity of life.
16. Prepare for Death Independently
Understand that the healthcare system’s default is to prolong life, and you may need to actively decline interventions to achieve a peaceful death aligned with your wishes.
17. State End-of-Life Wishes Explicitly
Clearly document and communicate your end-of-life wishes to avoid unwanted medical interventions that prioritize a pulse over quality of life.
18. Create Advanced Directive at 18
Complete an advanced directive as soon as you are 18, as this crucial document ensures your wishes are known and alleviates burden on loved ones.
19. Designate Medical Decision Proxy
Appoint a trusted individual as your medical decision-maker (proxy) to speak on your behalf if you become unable to communicate your wishes.
20. Discuss Wishes with Proxy Thoroughly
Have deep, ongoing conversations with your designated proxy to ensure they fully understand your values, desires, and what you want and don’t want for your care.
21. Revisit Advanced Directives Regularly
Recognize that your wishes and capacity for adaptation can change; regularly review and update your advanced directive and end-of-life plans.
22. Focus Planning on Desired Experiences
Frame end-of-life discussions around desired experiences and what brings meaning (e.g., being at home, hearing loved ones’ voices), rather than just listing interventions to avoid.
23. Adopt ‘Allow Natural Death’ Language
Consider using ‘Allow Natural Death’ (AND) instead of ‘Do Not Resuscitate’ (DNR) to shift the focus from what not to do to what is desired in end-of-life care.
24. Manage Physical Symptoms
Prioritize the management of physical symptoms like pain and nausea, as reducing this ’noise’ creates space to address emotional, spiritual, and existential suffering.
25. Clarify Opioid Use in Care
Discuss any fears or biases regarding opioid use with your care team, understanding that they are used judiciously for symptom management, not euthanasia or addiction, at the end of life.
26. Understand Delirium in Dying
Be aware that delirium is common at the end of life and can cause loved ones to say things that are not literal; understanding this can prevent unnecessary suffering for family.
27. Discuss Delirium Management Preferences
If facing end-of-life, discuss with your care team whether you prefer delirium to be medicated (e.g., for sleep) or allowed to express itself, aligning with your personal wishes.
28. Challenge ‘Perfect Death’ Notion
Let go of the expectation of a ’tidy,’ ‘immaculate,’ or ‘perfect’ death, as dying is often a messy and complex process; accepting this can reduce unrealistic expectations.
29. Ask Caregivers About Experience
Remember to ask family members and care partners how they are doing, as they often carry a significant burden and may feel unseen and unheard.
30. Take Breaks from Bedside Vigil
Caregivers should prioritize their own basic needs (sleep, food, walks) during a vigil, as stepping away may not only help them but also allow the dying person to let go.
31. Allow Dying Loved Ones Solitude
Be open to the possibility that a dying loved one may need to be alone in their final moments to ’let go,’ and stepping out of the room might be what they need.
32. null
Note that you do not need a lawyer to complete an advanced directive, making this important planning tool more accessible.