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Palliative Medicine Dr. BJ Miller Explains Why We Shouldn’t Fear Dying

The idea of facing death is never easy, though it’s a concept we all must deal with at some point in our lives.

“There is nothing wrong with you for dying,” palliative care doctor B.J. Miller and Shoshana Berger write in their new book, A Beginner’s Guide to the End: Practical Advice for Living Life and Facing Death. “Our ultimate purpose here isn’t so much to help you die as it is to free up as much life as possible until you do.”

The book is the first-ever practical, compassionate, and comprehensive guide to dying—and living fully–until you do, and offers everything from step-by-step instructions for how to do your paperwork and navigate the healthcare system, to answers to questions you might be afraid to ask your doctor, to how to break the news to employers.There are also lessons for survivors, like how to shut down a loved one’s social media accounts, clean out the house, and write a great eulogy.

We recently spoke with Miller about his research.


Q. What’s the first thing someone should do to prepare for death?

MILLER: There’s a logistical and emotional answer. On the logistical side, the single most important thing is to name your healthcare proxy, as part of a process called “advance care planning”; (it’s also important that you name a durable power of attorney for finances). Otherwise, the single most important thing to do is to remember that as long as a day can feel, life is generally shorter than most of us want it to be. We’re not joking when we say you have to remind yourself that someday, you will die. This thought contextualizes your life and will help you prioritize what’s important to you and what can you let go of. Doing this will help you live well, with fewer regrets. What makes anything precious but that it ends?

 Q. How should someone who’s coping with dying and their loved ones deal with the multitude of emotions they are feeling?

For everyone involved, it’s important to make space for the full range of emotions coming your way. Emotions resist control; better to make space for them, let them come, and let them go. It can be very helpful to process your emotions either by journaling, or making art, or sharing those feelings with others, or all of the above. The emotional world is not a tidy one. Indeed, you may need to apologize or forgive yourself or somebody else for what behavior flows from feelings, but remember that your emotions are not your fault; when it comes to emotions, there’s nothing to feel ashamed of.

 Q. Can we find hope as we face death?

Hope is a powerful force, but it needs to be used thoughtfully – false or unrealistic hope can be a set up for more disappointment. When thinking about hope, it’s important to frame it. Hope for what? As you move through illness, you may need to reframe your hope again and again. Once it might have been for a cure, later on, for more time, farther still, a comfortable passing; or hope for something for those you leave behind. Hope is dynamic and requires an object.

 Q. What advice can you give someone who is grieving?

Grief is surreal and often tricky. As dark as grief can make you feel, I encourage you to welcome it. Grief is going to have its way with you, one way or another. If you embrace it, you will likely come to realize the relationship between grief and love: if you don’t love, you don’t grieve. That may help soften some of the harder moments. Keep in mind that, in general, grief doesn’t stick around forever. Especially if you respect it, someday it will pass, and you will feel like yourself again. Meanwhile, expect to be altered. It’s the period in which your old relationship to your loved one ends while a new one begins. Cherish it that way.

Caveat: Complicated grief is when grief persists and slips into mental illness, like depression or mania, and is not something to overcome alone. If you recognize this kind of grief in yourself, please reach out to a mental health professional. This needs to be taken seriously. Even if you’re not depressed or otherwise consumed, seeing a psychotherapist can be wonderfully helpful, as can group therapy or peer support. Grief represents an opportunity to learn all sorts of things about life and yourself within it.

Q. What do you hope readers will learn from this book? 

While dying isn’t easy, it doesn’t have to be as hard as it’s become in our modern world. The standard response form patients and families that I and others in this field get is: “I wish I had known about these things sooner,” and that’s the impulse behind the book. We’re not trying to mandate any particular way of dying, mind you; we’re merely laying out the issues that you will very likely need to navigate, now or in the future, sprinkled with some of our own advice along the way. We simply want to inform and support, not imply that there is a right or wrong way to die; that is for you to judge. If there is a belief underlying these pages, it is that pondering death will help you live better.

“A Beginner’s Guide to the End: Practical Advice for Living Life and Facing Death” is by BJ Miller, MD, and Shoshana Berger. Click here to purchase a copy.

This Q & A was featured in the July 28th edition of The Sunday Paper. The Sunday Paper inspires hearts and minds to rise above the noise. To get The Sunday Paper delivered to your inbox each Sunday morning for free, click here to subscribe.