June 23, 2025

#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.

2 hours 16 minutes

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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
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By Peter Attia, MD

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