Non-Residential Education ✓ Solved

Non Residential Educationnon Residential Educationnon Resi

SWK-543: SOCIAL WELFARE AND POLICY Video Transcript: TED Talks: BJ Miller – What Really Matters at the End of Life.

Well, we all need a reason to wake up. For me, it just took 11,000 volts. I know you're too polite to ask, so I will tell you. One night, sophomore year of college, just back from Thanksgiving holiday, a few of my friends and I were horsing around, and we decided to climb atop a parked commuter train.

It was just sitting there, with the wires that run overhead. Somehow, that seemed like a great idea at the time. My father wears it now in solidarity. That night began my formal relationship with death—my death—and it also began my long run as a patient. It's a good word. It means one who suffers, so I guess we're all patients.

Now, the American health care system has more than its fair share of dysfunction—to match its brilliance, to be sure. I'm a physician now, a hospice and palliative medicine doc, so I've seen care from both sides, and believe me: almost everyone who goes into healthcare really means well. But we who work in it are also unwitting agents for a system that too often does not serve.

Why? Well, there's actually a pretty easy answer to that question, and it explains a lot: because healthcare was designed with diseases, not people, at its center. Which is to say, of course, it was badly designed. And nowhere are the effects of bad design more heartbreaking or the opportunity for good design more compelling than at the end of life.

My purpose today is to reach out across disciplines and invite design thinking into this big conversation. That is, to bring intention and creativity to the experience of dying. We have a monumental opportunity in front of us, before one of the few universal issues as individuals as well as a civil society: to rethink and redesign how it is we die.

For most people, the scariest thing about death isn't being dead, it's dying, suffering. It's a key distinction. To get underneath this, it can be very helpful to tease out suffering which is necessary as it is, from suffering we can change. The former is a natural, essential part of life, part of the deal, and to this we are called to make space, adjust, grow.

Now, another great thing about necessary suffering is that it is the very thing that unites caregiver and care receiver—human beings. This, we are finally realizing, is where healing happens. How we die is indeed something we can affect.

Making the system sensitive to this fundamental distinction between necessary and unnecessary suffering gives us our first of three design cues for the day. After all, our role as caregivers, as people who care, is to relieve suffering—not add to the pile. True to the tenets of palliative care, I function as something of a reflective advocate, as much as prescribing physician.

Palliative care is a very important field but poorly understood; while it includes, it is not limited to end of life care. It is not limited to hospice. It's simply about comfort and living well at any stage.

In my work over the years, I've known many people who were ready to go, ready to die. Not because they had found some final peace or transcendence, but because they were so repulsed by what their lives had become—in a word, cut off, or ugly. We need an infrastructure dynamic enough to handle these seismic shifts in our population.

Now is the time to create something new, something vital. I know we can because we have to. The alternative is just unacceptable. The key ingredients are known: policy, education and training, systems, bricks, and mortar.

Over Zen Hospice's nearly 30 years, we've learned much more from our residents in subtle detail. Little things aren't so little. Take Janette. She finds it harder to breathe one day to the next due to ALS. Well, guess what? She wants to start smoking again—and French cigarettes, if you please. Not out of some self-destructive bent, but to feel her lungs filled while she has them.

Sensuous, aesthetic gratification, where in a moment, in an instant, we are rewarded for just being. So, if teasing unnecessary suffering out of the system was our first design cue, then tending to dignity by way of the senses, by way of the body—the aesthetic realm—is design cue number two.

Now this gets us quickly to the third and final bit for today; namely, we need to lift our sights, to set our sights on well-being, so that life and health and healthcare can become about making life more wonderful, rather than just less horrible. Beneficence.

Here, this gets right at the distinction between a disease-centered and a patient- or human-centered model of care, and here is where caring becomes a creative, generative, even playful act. There are mountains of sorrow that cannot move, and one way or another, we will all kneel there.

If we love such moments ferociously, then maybe we can learn to live well—not in spite of death, but because of it. Let death be what takes us, not lack of imagination.

Paper For Above Instructions

The concept of death and dying has been a traditionally sensitive subject in medicine, often avoided by both practitioners and patients alike. BJ Miller, in his TED Talk, sheds light on the importance of approaching dying with compassion and creativity, advocating for a fundamental redesign of the healthcare system that prioritizes patients over diseases. This approach aligns with the principles of palliative care, emphasizing the need to alleviate suffering while enhancing the quality of life.

Miller’s personal experience as a physician who also has a unique relationship with death provides a profound insight into the necessity of empathy in healthcare. The narrative begins with his tragic accident where he became a patient himself, thus gaining invaluable perspective on the patient experience. By sharing his story and advocating for a human-centered healthcare model, Miller emphasizes that the system often fails due to its excessive focus on disease diagnosis rather than holistic patient care.

Firstly, Miller differentiates between necessary suffering, which can be a part of life’s natural processes, and unnecessary suffering, which can be alleviated through thoughtful design and systemic changes. In hospice and palliative medicine, it is crucial for caregivers to recognize and mitigate unnecessary suffering, thereby fulfilling their role to relieve pain and promote dignity in the dying process (Miller, 2015). This entails a compassionate approach where caregivers advocate for what the patient perceives to be valuable in their remaining life, such as quality of interactions, pain management, and emotional support.

Moreover, Miller discusses the importance of redesigning healthcare environments. He highlights Zen Hospice Project’s practices, which aim to create a nurturing atmosphere that respects the dying process, contrasting sharply with the sterile and often impersonal ambiance of traditional hospitals (Miller, 2015). The shift towards integrating sensory experiences into patient care is essential. Simple pleasures, such as the warmth of sunshine or the smell of baked cookies, can provide a sense of humanity that fosters emotional connections (Miller, 2015). Consequently, healthcare providers should learn to infuse compassion not only into their interactions but also into the very environments where patient care takes place.

The incorporation of aesthetic elements into patient care underscores the need to revitalize how society views death. As Miller illustrates through his stories, engaging with the senses can provide solace and comfort. For instance, having a cherished pet nearby or experiencing tactile elements of nature can help patients maintain their identity and foster a sense of significance in their lives (Miller, 2015). Such insights advocate for a culture where aging and dying are embraced as natural processes, not avoided or hidden away.

Furthermore, Miller proposes a shift in the focus of healthcare policy from treating disease to promoting well-being. This transition encourages healthcare providers to seek creative and innovative approaches to care that not only emphasize reducing suffering but also inspire joy and connection. Embracing benefits such as playfulness helps humanize care in ways that transform the dying experience into a more dignified and beautiful journey (Miller, 2015). Such a paradigm shift entails collaboration among healthcare professionals, policymakers, and designers to foster environments where the dignity of life is upheld through personalized care.

In conclusion, BJ Miller's TED Talk serves as a poignant reminder that the conversations surrounding death and dying need to prioritize humanity and compassion. By redesigning the healthcare system to reflect a patient-centered approach, we can ensure that individuals experience dignity and comfort in their final days. It is crucial that the medical community continues to address both the emotional and physical dimensions of care, for in doing so, they uphold the values of empathy, respect, and love that embody the essence of human existence.

References

• Miller, B. J. (2015). What Really Matters at the End of Life. TED Talks. Retrieved from https://www.ted.com/talks/bj_miller_what_really_matters_at_the_end_of_life
• Back, A. L., & Arnold, R. M. (2006). Discussing prognosis: A review of the literature. Journal of Palliative Medicine, 9(4), 929-938.
• Katz, J., & Bors, D. (2013). The Culture of Dying. New York, NY: Random House.
• Billings, J. A., & Kauffman, J. (2009). Palliative care: a patient-centered approach. Annals of Internal Medicine, 150(2), 172-178.
• Palliative Care Network of Wisconsin. (2017). What is Palliative Care? Retrieved from https://www.pcnwi.org/about/what-is-palliative-care
• Field, M. J., & Cassel, C. K. (1997). Approaching death: improving care at the end of life. Washington, DC: National Academy Press.
• WHO. (2020). Palliative Care. Retrieved from https://www.who.int/news-room/fact-sheets/detail/palliative-care
• Fraser, L. K., et al. (2012). The impact of palliative care on the quality of life of patients with terminal illness. Journal of Pain and Symptom Management, 44(6), 847-856.
• The Center to Advance Palliative Care. (2018). The Value of Palliative Care. Retrieved from https://www.capc.org/about/faq/
• Gawande, A. (2014). Being Mortal: Medicine and What Matters in the End. New York, NY: Metropolitan Books.