Courageous Compassion: Pediatric Palliative Care

Good morning, End Well.

No, no, no. I said, good morning, End Well.

That is more like it.

I am Dr. Justin Baker, and at Stanford Children’s, I am affectionately known as the chief koala bear.

I have a question for you: Who wants a koala?

What a catch. You just caught courageous compassion in plush form.

I know what you are thinking: Did this guy really bring a stuffed animal to End Well?

No. I brought several.

I am grateful to be with you today because this koala is more than a toy. It represents a movement.

At Stanford, QOLA means Quality of Life for All: every child, every family, every moment. No exceptions.

As the chief koala bear, I have dedicated my career to figuring out how we can help all children and families live fully, even amid serious illness, death, and grief.

I spend my days thinking about how to make every day the best day possible. Every moment, in fact, the best moment possible.

That is my one thing. It is the heartbeat of everything I do, and it is what this koala represents.

To accomplish that, we must rethink how we talk about suffering.

It takes courageous compassion.

Courageous compassion means leaning into suffering rather than avoiding it and relentlessly pursuing quality of life for all.

I want to take you back to when I was a child.

I was a little unusual. I always knew I wanted to be a pediatrician, though I was not entirely sure what a pediatrician did.

I imagined I would sing songs, play with Legos, do a few art projects, and probably play some guitar. While doing all of that, I would write a prescription for Augmentin and help treat a child’s ear infection.

Maybe I got part of it right.

I have always been passionate about helping children, but I have also been somewhat naive. Some of that naivety remains today.

When I finally reached medical school, I was disappointed. Everything seemed to be about numbers and laboratory values, disease and pathophysiology.

I became disillusioned.

I asked myself: Where is the person? Where are the children?

I almost quit.

Then, during my third year of medical school, I met someone I want you to picture.

His name was Jake.

Jake had freckles and red hair. He also had a terrible liver tumor.

I met him in San Antonio, Texas, when his cancer had returned yet again.

Jake had already undergone many surgeries. He had received enormous amounts of highly toxic chemotherapy. He had even undergone a liver transplant.

Jake and his parents were struggling. They were hoping for what seemed like an impossible cure.

Then I watched someone do something radically brave.

A palliative care physician, who became my mentor and friend, met with Jake and his family.

He did not discuss another chemotherapy regimen. He did not talk about the cancer at all.

He looked at Jake and asked, “What is most important to you right now? Given what you are facing, what are you hoping for?”

I remember that moment as though it happened yesterday.

I had never heard anyone ask that question before.

What are you hoping for?

The question had a profound effect on Jake. He became emotional and, through his tears, said, “I want to go home. I want to play with my dog. I want to try to golf again.”

That represented a complete shift in perspective.

So we made it happen.

We helped Jake focus on his quality of life and return home. We contacted Make-A-Wish, which gave him a beautiful new set of Nike golf clubs. I was a little jealous.

My mentor and I visited Jake at home. Instead of concentrating on his cancer, we considered how to help him regain strength and stamina so he could golf again.

A few weeks later, I received the most incredible video.

It showed Jake hitting a drive straight down the middle of the fairway. He was smiling from ear to ear.

That smile was pure joy.

That is why I love this work.

Jake taught me many things.

First, he taught me that palliative care is not about giving up. Palliative care is about hope.

Say it with me: Hope.

Palliative care means fighting for the person rather than focusing only on fighting the disease.

Jake also taught me that pediatric palliative care was my calling. It is why God placed me on this earth.

Every day, I have the privilege of working with an extraordinary team and incredible patients like Jake. I feel blessed to do this work.

Something else was born that day: the koala.

Jake taught me that palliative care is about quality of life for all.

Who wants another one?

Throwing koalas into an audience may be a little radically brave. I think it qualifies.

I have now worked in this field for many years, and I remain deeply grateful for the opportunity.

Interestingly, the questions people ask have not changed much.

Is pediatric palliative care truly a significant need? Are there really that many children who need it?

The answer is absolutely yes.

I have traveled around the world and witnessed that need firsthand. Twenty-one million children worldwide need pediatric palliative care.

Twenty-one million.

When people understand the scale of the need and what pediatric palliative care involves, they often ask the same question you may be thinking:

How do you do this work?

I have already told you that I believe God put me here to do it. I have also told you what a joy and privilege it is to work with these precious children.

But I want you to understand something else.

Pediatric palliative care is the most beautiful, bold, and brave field in medicine.

Children are incredible. They continue growing while fighting disease. They say and do the funniest things. And, one of my favorite parts, they love my koala.

That may make me a little biased.

We also have the privilege of watching them do the work of childhood.

The work of childhood is going to school. It is playing without a care in the world.

Our patients are living. They are not simply waiting to die.

Our job in pediatric palliative care is to fill every day and every moment with as much joy as possible.

Pediatric palliative care is radical, and these children are extraordinarily brave.

It is also rebellious.

You can probably tell that I have a bit of a rebellious spirit. Pediatric palliative care is a true rebellion. It is disruptive.

Think about healthcare.

The system is broken.

Medicine has become a business. It worships innovation, chases metrics, and celebrates procedures. Hospitals compete for the newest tools, the most advanced scanners, and the most cutting-edge treatments.

In the middle of all that noise, the human beings get lost.

Where are the precious children?

Pediatric palliative care is an antidote.

We are not focused solely on the newest medication or the fanciest technology. What we use most often is the oldest medicine in history:

Presence and human connection.

That is something every one of us can offer.

We can be present with the person in front of us. We can hold someone’s hand, look them in the eye, and say:

“You are not alone. I am here with you. What are you hoping for, and how can I help?”

When we strip away all the noise and complexity, medicine comes down to something astonishingly simple.

Love.

In a healthcare system that has lost much of its humanity, love is revolutionary.

I call this courageous compassion because compassion is my favorite word.

It comes from the Latin com, meaning “with,” and pati, meaning “to suffer.”

Compassion literally means to suffer with.

It means turning toward suffering.

But compassion alone is not enough. We must also be courageous.

We must be willing to lean into suffering, say difficult things, and turn toward pain rather than running from it.

To do that repeatedly, we need something else.

We need grit.

Grit brings us back again and again. It is the quiet, persistent, passionate perseverance that helps us endure and continue leaning in.

We need grit and courageous compassion, and we need to practice them together.

That requires everyone in this room.

I am grateful for End Well 2025 and its theme of Radical Bravery because care like Jake received is about more than improving what happens inside a hospital.

It is about community-based compassion.

It requires all of us. It requires every one of you.

The Quality of Life for All initiative is built on community-based courageous compassion.

This is bigger than a Stanford program. It is a movement.

It is a movement to take the principles of palliative care, including what you will learn today, and bring them into communities so they can support children and families like Jake’s.

I urge you to be courageous enough to face suffering.

Be compassionate enough to open your heart and connect.

Be gritty enough to keep showing up, again and again, as we pursue quality of life for every precious child and family.

Join me in leaning into suffering.

When we lean into suffering together, we do more than help others end well.

We help the whole world live well.

Thank you.

One last koala.