#354 – What the dying can teach us about living well: lessons on life and reflections on mortality | BJ Miller, M.D. and Bridget Sumser, L.C.S.W.

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Jun 23, 2025

Guest

Bridget Sumser

Guest

BJ Miller, MD

BJ Miller, a hospice physician and co-founder of Mettle Health, and Bridget Sumser, an expert social worker in serious illness, discuss profound insights from their work in end-of-life care. They explore the emotional and physical realities of dying, the importance of candid conversations about mortality, and how many await hospice care too late. With reflections on fear, forgiveness, and how dying can teach the living to embrace life more fully, they emphasize the transformative potential of understanding our mortality.

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INSIGHT

Hospital Deaths Aren’t Always Bad

Hospitals can facilitate beautiful deaths despite common negative perceptions.
Many assumptions about dying settings stem from trauma, not the full reality of care.

ADVICE

Respect Individual End-of-Life Wishes

Some patients prefer hospital death over home due to personal or familial reasons.
Preferences must be respected even if they differ from common assumptions about dying at home.

INSIGHT

Social Safety Nets Affect Dying

Western healthcare often disconnects social supports from medical care, complicating death at home.
Social determinants like housing and finances intensify difficulties in dying well in the US.

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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.

We discuss:

The personal journeys of BJ and Bridget into end-of-life care, and the connection between living and dying [3:30];
What dying looks like: the physical, cognitive, and emotional realities at the end of life [13:15];
How historical perspectives on death contrast with modern experiences of dying [25:30];
The difference between palliative care and hospice care [30:45];
The systemic challenges surrounding hospice care: why patients often enter it too late to receive its full benefits [35:30];
How delayed hospice referrals and unspoken preferences often prevent patients from dying where and how they truly want [39:30];
The realities of home hospice: challenges, costs, and burdens placed of families [43:45];
How proactively engaging with the reality of death can avoid unnecessary suffering and promote a more peaceful ending [53:30];
How palliative care is misunderstood and underutilized—especially in cancer care [1:02:45];
Palliative care in the case of Alzheimer’s disease: emotional support, future planning, and family involvement [1:12:15];
The importance of having an advance directive: defining what matters most before it’s too late [1:23:00];
The differences between how young and old individuals experience dying from cancer [1:30:15];
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];
Dying well: the power of self-honesty and human connection at the end of life [1:47:00];
How psychedelics like psilocybin can unlock emotional breakthroughs and deepen connection for patients near the end of life [1:55:15];
Lessons from the dying on how to live well [1:57:30];
The physical process of active dying, and the emotional and practical considerations for loved ones [2:09:30]; and
More.

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