027. BJ Miller: Better Care, in Life and Death


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BJ Miller is an American physician, author, and speaker. He is a practicing hospice and palliative medicine physician, and is best known for his 2015 TED Talk, "What Really Matters at the End of Life". BJ, who served as an executive director of San Francisco's Zen Hospice Project, has been on the teaching faculty at UCSF School of Medicine since 2017, and is the subject of the Netflix Academy Award nominated short documentary, End Game. His book, A Beginner's Guide to the End, which he co-authored with Shoshana Berger, is an unflinching, compassionate, and intensely pragmatic guide to the end of life.

Today, BJ sees patients and caregivers through his online palliative care service, Mettle Health.


In this conversation we talk about:

  • Growing up with a mother who lived with polio, and how that influenced his thinking.
  • A severe accident early it life, which forced him to re-form his identity and informed the rest of his journey.
  • His path in Palliative care - and the insight that the health establishment is designed to treat diseases, not humans.
  • His insights into the meaning and wisdom one can find at the end of life.

It's been a rare pleasure to talk to someone like BJ, who is someone who steps into realms of experience most of us avoid at all costs, and to hear the precious types of wisdom he brings with him from there.

This episode, I think, is also a great introduction to the world of palliative medicine, which may be the first time the medical establishment put the patient's experience, quality of life, and constructed meeting at the heart of care, treating people as opposed to diseases. BJ and I discuss the ways the healthcare system and hospital system are badly designed, and what can be done about it.


[4:32] Life During Covid

[7:23] Early Childhood Spirituality

[12:30] An Accident and an Identity Crisis

[18:25] The Significance of a Snowball

[22:01] Palliative Care and the Dynamic Between Human Beings

[29:51] A Badly Designed Healthcare System

[32:20] Necessary vs Unnecessary Suffering

[35:13] Lessons in Death

[39:51] Wildness and Wonderment

[47:54] A Beginner's Guide to the End

[53:36] A Sermon on Life and Death