Can we change the way we die?

That’s the question being asked by BJ Miller, a palliative care specialist at the University of California San Francisco medical center.

Miller wants to redefine death through a new kind of palliative care — one that incorporates more spirituality and patient engagement than ever before. His goal is to help patients prepare for death “realistically, comfortably, and on their own terms” — taking them out of the hospital and into an environment where they can live out their last days in comfort.

How an Accident Led to a New Outlook

Miller’s own personal brush with death is what led to his passion for palliative care and being prepared for death. During college, Miller was in an electrical accident that cost him three limbs and almost took his life.

Miller told PBS Newshour in an interview that “The whole reason I went into medicine was because I became a patient… It was sort of an introduction to my own death, my own sense of mortality, my own finiteness.”

The accident laid the foundation for his future work in palliative care, where Miller now serves as the Executive Director of the Zen Hospice Project.

Preparing for Death: A Spiritual Approach

The work and values of the Zen Hospice project are what drew Miller to the organization.

In an interview with the UCSF Medical Center, Miller said, “I’ve been interested in the project since I first learned about it in medical school because it’s a place that’s fueled by kindness and compassion, rather than invention and resources. Along with my work at UCSF, it’s the perfect hybrid of the medical model and the social model that touches everyone. It’s allowed me to branch into all the non-medical components that I’m very interested in — arts, spirituality, individuality, community.”

“I think a lot of us are really worried, not so much about the fact that we die, but how we die,” he told PBS.

Miller wants to take dying out of the hospital and make it a more personal experience. He believes that hospitals are meant for treatable illnesses or acute trauma but aren’t designed as a place to live and die.

Miller believes that the approach to dying should involve a more well-rounded experience as opposed to simply preventing suffering — it means incorporating ideas of comfort, spirituality, support, and acceptance.

The Guest House: A New Kind of Palliative Care Facility

The Guest House is the Zen Hospice project’s main hub. It’s a six-bed care facility that houses people with a life expectancy of around six months or less. The residents are there because they have chosen not to pursue a cure but to live out their final moments in comfort and a compassionate environment.

What makes the Guest House special are the volunteers. They include people from all backgrounds who choose to volunteer their time at the Guest House. The medical duties are left to doctors and nurses, leaving plenty of time for the volunteers to simply spend time with the residents, sharing stories and meals.

The Guest House also offers residents a variety of services, such as spiritual and communal support, meditation and therapeutic rituals, and even homemade comfort food ranging from handcrafted sorbets to hearty soups. The facility has a vastly different feel than the sterile or medical environment of a hospital which, to many facing death, can feel unnerving.

The goal of Zen Hospice, according to their website, is:

“Imagine a society where we support each other in the quest to live fully all the way through to the very last moment of life — then beyond for the family and friends in wake. That’s the cornerstone of our caregiving model.”

Miller hopes to see a similar model spread to more end-of-life care facilities.

What Really Matters at the End of Life

In a recent Ted Talk, Miller raises the question, “At the end of our lives, what do we most wish for?”

For most of us, it’s to leave this world in comfort and love — and it’s the goal of palliative care to provide that dignified and graceful end to their patients’ lives. Watch the video below to learn more about BJ Miller’s story and his hope for a more dignified way of dying.