Brad Stuart, MD
Coalition to Transform Advanced Care (C-TAC)
AAHPM reached out to the 2024 Visionaries to gain insight into what motivated them to pursue leadership positions and what they find more fulfilling in their experiences. Brad Stuart, MD has been recognized as one of the exceptional individuals chosen as a 2024 AAHPM Visionaries in Hospice and Palliative Care.
Who has most influenced your work and how have they shaped your contributions?
When I entered Stanford medical school in the 1970s, medical knowledge was exploding. But when I went on the wards in my 3rd year, the way we treated seriously ill patients horrified me. In 1978, I opened a solo practice in Internal Medicine. Hospice had just started in the US, palliative care didn’t exist, and there were no hospitalists. I learned how to save lives, but it was the patients I couldn’t save who taught me the most.
In the early 1990s, I went into hospice full-time. I tried to leverage my medical experience to promote healing, especially for patients who couldn’t be cured. I headed teams that developed national guidelines for hospice eligibility in non-cancer disease, then created Advanced Illness Management (AIM), the first large-scale home-based palliative care program in the US.
Looking back, what I really learned in medical training was that caring for people involved more than just know-how and techniques. I’m sure psychedelics played a role; I’d experienced them a few years before. Although I’d been raised with no religion, meeting with real suffering gave me my first hints about deep spirituality. I met my late father-in-law Willis Harman at Stanford. He was a proponent of LSD research before it was criminalized, and he also convinced me that large-scale system change was possible. Rachel Naomi Remen, MD was a mentor; she helped me learn how to become more present, to connect deeply with people who were frightened and in pain.
What is the significance to you of being recognized as a “Visionary” in Hospice and Palliative Medicine?
It’s an incredible honor. I was lucky to get into hospice on the ground floor. There was room to create then – and there’s still a need for visionaries today.
But this recognition is also about perseverance. System change takes one percent inspiration and 99 percent perspiration. It requires standing up to Chief Financial Officers who oppose new programs because they lose revenue by preventing hospital admissions – and also cost money to operate. But as payment models evolve, these programs make financial sense. And for deeper reasons, they’re the right thing to do.
Recognition as a visionary is really about the intangibles. What really matters in our work lies beneath and beyond the practical aspects. Our field lives in the borderland between the hard-science materialism of modern medicine and the transcendent mystery that lies at the end of life. Every person who’s drawn to work in hospice and palliative medicine senses the ineffable pull of that mystery. That’s what we need to bring down to earth today.
What is your aspiration for the evolution of Hospice and Palliative Medicine?
Hospice and palliative medicine need to generate more than perspiration – we have to get out front and create inspiration. We need to dig deep and expose the real needs we satisfy, the ones we never talk about.
One key factor drives scientific medicine and also obstructs hospice and palliative care: fear of dying. I believe the next major step in our evolution is to help our patients, families, and colleagues heal our collective fear of death. Medicine is already stepping up to deal with racial and gender dilemmas; fear of death is a reasonable next step. It’s so relevant to the dynamics and economics of healthcare today.
Last year I published my book, Facing Death: Spirituality, Science, and Surrender at the End of Life https://www.amazon.com/Facing-Death-Spirituality-Science-Surrender/dp/1954920652,to help heal our fear of death. During the pandemic, I started looking at the deeper issues that drew me to end-of-life work. They turned out to be spiritual, and I realized I’d never thought them through. The medical world rejects those spiritual principles, yet they’re the force that draws all clinicians into a life of service. We all come in devoted to healing, whether we know it or not. Then that idealism often gets trained out of us.
Baby Boomers are aging into mortality. That puts a new element in our job description. It’s time to sit down together and understand how to let go of the fear that stands between us and what’s ultimate and eternal.
Learn more about the AAHPM 2024 Visionaries in Hospice and Palliative Care and view a full list of all current and past Visionaries.