TED Talk Analysis: BJ Miller on palliative care and reform of our "experience of dying"

"My purpose is to bring intention and creativity to the experience of dying."

BJ Miller, a doctor of palliative care at the Zen Hospice Project (ZHP), led into the body of his TED talk with this surprising statement.  His TED talk, which is eclipsing 1.8 million views, was given at the annual TED conference in 2015, which was held in Vancouver, Canada.  The speech was given to wrap up the event, as it was the penultimate speech given at the conference.

The forgoing words blindsided the audience.  He invoked the audience by making special mention that they were somewhat familiar with death.  However, his main assertion that he espoused was that "dying with dignity" is somewhat of an enigma in the medical and civilian world.  His novel assertion of bringing in “creativity and intention” to death, and even to express death in such a novel way as to call it an “experience” shocked the audience.  Nonetheless, it made them listen to his story, his idea, and his vision.

He began with a story, as all TED talks do: he told of his personal experience with death.  This established his specific connection with his subject, and such was maintained throughout, as his prosthetic legs were a prevailing manifestation of his near-death experience.

BJ Miller explaining the story behind his prosthetic legs.

He then launched into three talking points regarding his idea for reform regarding palliative care in US medicine.  Seeing as medically insulting end-of-life treatments are often repugnant stigmas associated with death, his first idea was that palliative care needs to have a focus on simply relieving suffering rather than adding to it. Secondarily, he emphasized that such suffering near death needs to be mitigated by aesthetic treatment rather than strictly medical treatment.  Surprisingly, he claimed that in his personal experience through ZHP, such aesthetic treatment arose by simply giving patients a feeling of purpose and a connection/familiarity with their old lives (he humorously declared that they often do this by simply making cookies and letting the smell permeate the halls and rooms of patients at ZHP).  Lastly, he concluded his reformative plan by stating that “healthcare can become about making life (you have left) more wonderful, not just less horrible.”

BJ Miller presenting at TED2015 in Vancouver.

Regarding his delivery, there are few valid critiques that can be assessed towards his speech.  The only thing that could have bolstered his connection with the audience is an insertion of more humor, as he only made a few humorous statements in his whole speech.  However, considering that he spoke for 18 minutes on death, perhaps it was helpful to not overuse humor. Also, though he chose to use no visuals, this was easily made up for by his well-spoken, intelligent, and conversational delivery. Furthermore, while one would think that sitting down the entire speech (he did not have much of a choice as he had two prosthetic legs) would be a hindrance to his connection with the audience, it instead enhanced his delivery drastically.  It created an intimate effect, wherein it felt as if he was simply sitting down to have an earnest, warm conversation with the audience rather than giving a formal speech.  In all, his delivery was spot-on: his use of body language, the passion with which he presented his topic, his use of personal narratives and experiences, his constant maintaining of eye contact, and the strategic placement of pauses in his speech made for an intimate and touching message.

Frankly, the audience expected such a novel idea.  Though the initial point of his assertion may have been surprising, the audience anticipated this, as unique ideas are often presented on the TED stage (thus the mission statement of TED, “ideas worth spreading”). 

This talk had a direct connection with my service-learning group as the main beneficiaries of our service are receiving hospice/palliative care.