Bringing Medicine and Spirituality Closer Together

Brad Stuart, MD, has practiced internal medicine for more than four decades, served for 25 years as a hospice medical director, and developed a national model of home-based care for people living with serious illness.

Through that work, he came to believe that healing and spirituality, however a person defines or experiences them, are deeply connected.

Brad will lead a lunchtime conversation at End Well 2023 on November 16 in Los Angeles.

EW: Tell us a little about yourself.

Brad Stuart: I have been a physician for more than 45 years.

I spent the first decade as an internist working in my office, the emergency room, the hospital, and the intensive care unit. Eventually, I realized I felt most drawn to the patients who were going to die regardless of what I did.

I had been aiming at the wrong target.

I knew how to cure disease, but I had never learned about healing. That is what matters when a person’s options for a cure have run out.

I left my practice and entered hospice and palliative care in the early 1990s. I developed one of the country’s first home-based palliative care programs, called Advanced Illness Management, or AIM.

After the program expanded nationally, I helped healthcare systems across the United States learn how to provide this new kind of care. I also worked with Medicare to develop new ways of funding it.

Eventually, I stopped trying to change American healthcare from within the system. I decided to go deeper and explore what had drawn me to end-of-life care in the first place.

That led me to write Facing Death: Spirituality, Science and Surrender at the End of Life, which describes what I learned about dying and how we might prepare for it.

EW: Was there a defining moment that ignited your passion for addressing the end of life openly?

Brad: Yes. It became the first chapter of my book.

In 1975, during my third year of medical school, I began working on the hospital wards. My first patient was a man with very advanced cancer.

I believed he was close to death, but my professors disagreed.

That conflict, and what I learned from it, determined the course of my career. I will not spoil the rest of the story here.

EW: How does your work intersect with the end of life and grief?

Brad: Throughout my career, I visited dying people and their families in their homes.

It is difficult to learn the most important lessons death has to teach when you experience it only inside a hospital. That is where most people, especially clinicians, encounter dying.

Home hospice has changed that experience for many patients and families, though unfortunately not for most doctors.

Many of the most meaningful moments happen quietly, behind closed doors.

When people trust you enough to let you into their lives as those lives are ending, you begin to learn who we really are. You also begin to discover who you are.

That is the secret, and it is why I wrote the book.

EW: Which societal belief about death and dying most needs to be challenged?

Brad: Many people do not understand the nature of suffering or the reality of healing.

When you have not come close to death, you may assume it involves intolerable suffering. Naturally, you fear it. You avoid talking or even thinking about it.

There is some suffering we cannot avoid in life, especially as life comes to an end.

There is often pain, but we know how to treat pain. The harder part is that dying requires us to prepare to lose everything we have.

What I discovered is that you do not lose everything you are.

Dying is a process of letting go, releasing everything until only your essential self remains. That is what you entered this life with, and it is what you leave with.

Spiritual traditions have taught this for centuries.

Healing depends on recognizing it within yourself through direct experience, rather than understanding it only as an idea.

Suffering is part of life and part of death. Loss and grief are inevitable. But healing can help people avoid a great deal of unnecessary suffering.

Healing is also not reserved for people who are sick or dying. It is for everyone, including the healers.

As long as you are alive, you need healing. You need to experience who you truly are.

EW: How can different professions and disciplines work together to create more human-centered end-of-life care?

Brad: I hope medicine and spirituality can come together.

They have been separated for centuries, particularly since science and technology gave us anesthesia, surgery, and antibiotics.

Today, revolutionary advances in genetics, immunology, and molecular medicine are only beginning to unfold. These discoveries make it easy to forget that the global mortality rate remains 100 percent.

Scientific medicine may allow us to cure, but it is powerless to heal on its own.

One reason is that science often rejects deep spirituality. I do not mean a set of beliefs or dogma. I mean spirituality grounded in experience.

We need to move beyond the limitations scientific medicine places on our thinking so we can experience what is ultimate and enduring.

Ironically, emerging scientific research may help us do that.

Psychedelic research is already changing how we approach death anxiety and severe depression. In my book, I discuss recent studies involving brain imaging, meditation, psychedelics, and near-death experiences.

These findings could transform how we understand life, death, consciousness, and even the nature of reality.

EW: Is there a book, film, artwork, or other piece of media that profoundly shaped your views on mortality?

Brad: In 1991, just as I was moving from internal medicine into hospice care, I saw The Doctor, starring William Hurt.

He played an accomplished academic surgeon who was arrogant, intolerant, and abusive. He represented the worst stereotype of a physician until he was diagnosed with life-threatening cancer.

The experience transformed him.

He eventually began teaching medical residents how to understand the suffering and mortality their patients were confronting.

The movie ended, but I was still crying in my seat when the theater staff came through to sweep up the popcorn cups.

That film helped convince me I was on the right path.

EW: Why are you attending End Well 2023?

Brad: I have always attended professional meetings to discuss clinical issues, program design, or health services research.

End Well gives us an opportunity to bring the end of life out of the closet.

I would love to discuss a form of spirituality that is neither romanticized nor glorified. It is practical, grounded, and easy to apply in life or in death.

EW: Who do you hope to meet there?

Brad: I would love to meet people who recognize that there may be something within life and death beyond what we can see, touch, and measure.

The most important task is discovering who we really are, then realizing that, in some sense, we have always known.