Dr. Brad Stuart has been practicing internal medicine for decades, spent twenty-five years as a hospice medical director and founded a national model of care to assist people with serious illness at home. During this time, he’s come to believe that healing and spirituality – no matter how you define or connect with it – are deeply entwined.
Brad will be leading a lunchtime conversation at End Well 2023 on November 16th in Los Angeles.
Q: Tell us a bit about yourself.
I’ve been a physician for over 45 years. I spent the first 10 as an internist working in my office, the ER, the hospital, and the ICU. Finally, I realized I was most drawn to the patients who were going to die no matter what I did. I’d been aiming at the wrong target. I knew how to cure disease, but I hadn’t learned about healing – and that’s what matters once a person’s options for cure have run out. I left my practice and went into hospice and palliative care in the early 1990s. I developed one of the first home-based palliative care programs in the country, called Advanced Illness Management (AIM). After it went national, I helped health systems across the U.S. learn how to provide this new kind of care and helped Medicare develop new funding for it. Then I stopped trying to change American healthcare from the inside. I decided to go deeper and explore what had attracted me to end-of-life care. I wrote a book called Facing Death: Spirituality, Science and Surrender at the End of Life describing how I learned about dying and how we might prepare for it.
Q: Was there a defining moment in your life that ignited your passion to address end-of-life experiences openly?
Yes, it’s Chapter 1 in my book. In 1975, my 3rd year of medical school, I went on the hospital wards. My first patient was a gentleman with very advanced cancer. I felt he was close to death, but my professors didn’t agree. That conflict, and what I learned from it, determined the entire course of my career – but I won’t spoil the story here.
Q: Given your unique background, how does your work intersect with end-of-life and/or grief?
Throughout my career, I visited dying people and their families in their homes. It’s hard to learn the important lessons death has to teach if you only see it in the hospital. That’s where most people, especially clinicians, experience it. Home hospice has changed this picture for patients and families – but unfortunately not for most doctors. Many vital experiences happen quietly, behind closed doors. But when people trust you enough to let you into their lives, even when they’re ending, that’s when you learn who we really are – and who you really are. That’s the secret – that’s why I wrote the book.
Q: In your experience, what is the most significant societal norm or belief about death and dying that needs to be challenged or redefined?
When it comes to dying, most people don’t understand the nature of suffering and the reality of healing. When you haven’t come close to death, you tend to believe that it involves intolerable suffering, so naturally you fear it. You avoid talking or even thinking about it. And let’s be honest. There’s a certain amount of suffering you can’t avoid in life, especially as it’s coming to an end. There’s often pain, but we know how to deal with that. The hard part is, when you’re dying you’re preparing to lose everything you have. But what I discovered was – you don’t lose everything you ARE. Dying is a process of letting go, releasing everything until only the real YOU remains. That’s what you came into this life with, and that’s what you leave with too. All spiritual traditions teach this. Healing depends on realizing this – not just thinking about it, but realizing it inside yourself through direct experience. You can’t deny that suffering is part of life and part of death. Loss and grief are inevitable. But healing can help people avoid a lot of unnecessary suffering. And healing is not just for those who are sick and dying. It’s for everyone, including the healers. As long as you’re alive, you need healing. You need to experience who you really are.
Q: How do you hope various professions and disciplines can come together to create a more human-centered approach to end-of-life care and experiences?
I hope medicine and spirituality can come together. They’ve been separated for centuries, especially since science and technology gave us anesthesia, surgery and antibiotics. Today, revolutionary discoveries in genetics, immunology, and molecular medicine are just beginning to ramp up. This allows people to forget that the worldwide mortality rate is still stuck at 100 percent! Scientific medicine may enable us to cure, but it’s powerless to heal. A big reason for this is that science rejects true, deep spirituality – not a set of beliefs or dogma, but the spirituality of experience. We need to move beyond the limitations that scientific medicine imposes on our thinking so we can experience what’s ultimate and eternal. That’s our true heritage. Ironically, new scientific findings may do just that! Psychedelic research is already changing the way we deal with death anxiety and severe depression. In my book I talk about recent research using brain imaging in meditation, psychedelics, and near-death experiences. These findings could revolutionize our views about life, death, consciousness, and even the nature of reality itself.
Q: Is there a book, movie, piece of art, or another form of media that profoundly impacted your views on mortality?
I remember in 1991, just as I was switching from internal medicine to hospice, I saw The Doctor, starring William Hurt. He played an ace academic surgeon who was arrogant, intolerant, and abusive. He was the stereotypical worst kind of doctor – until he was diagnosed with a life-threatening cancer. The experience turned him around, and he ended up teaching residents how to truly understand the suffering and dying their patients were grappling with. The movie ended, but I was still crying in my seat when they came around to sweep up the popcorn cups. That movie helped convince me I was on the right track.
Q: Why are you attending End Well 2023?
I’ve always come to meetings to talk about clinical issues, program design, or health services research. End Well gives us a chance to bring the end of life out of the closet. I’d love to discuss a kind of spirituality that’s not romanticized or glorified. Instead, it’s down-to-earth, practical and easy to apply in life – or death.
Q: Who do you hope to meet there?
I’d love to meet others who know that there’s something in life and death beyond just what we can see, touch and measure. But what’s most important is to discover who we really are – and then to realize that we’ve always known it.
Brad Stuart MD
Dr. Brad Stuart has practiced internal medicine in his office, the Emergency Room, the hospital, and the ICU. He spent twenty-five years as a hospice medical director and founded a national model of care to assist people with serious illness at home. But most importantly, he learned how to become a healer.