Stuff You Should Know: "Everyone Deserves A Good Death"
Date: October 9, 2025
Hosts: Josh Clark & Chuck Bryant
Podcast produced by: iHeartRadio
Brief Overview
In this episode, Josh and Chuck deeply explore the concept of a "good death" and the history, philosophy, and practice of hospice care. They unpack how hospice aims to ensure dignity, comfort, and meaning for everyone at the end of life and address the benefits, shortcomings, and recent controversies in the American hospice system. The hosts use their signature blend of empathy, humor, and clarity to demystify the process and encourage proactive thinking about end-of-life care.
Key Discussion Points & Insights
1. What is a "Good Death"? (02:26)
- Components frequently cited:
- Opportunity to say goodbye to loved ones.
- Freedom from pain and suffering.
- Having control over one’s final days.
- Being able to come to terms with mortality.
- Josh: “If you can't add more days to life, add more life to days.” (03:40)
- Hospices exist to provide these things to all, not just the wealthy or educated.
2. The History and Philosophy of Hospice (04:24)
- Hospice as we know it dates to the 1960s–70s.
- Old model: Medicine aimed at curing, not comforting; dying patients were often ignored in hospitals.
- Pain management: Previously, patients had to endure pain before receiving more relief, stemming from fears about opioid addiction.
- Josh: “You don't have to wait until one painkiller wears off to get another dose. You can…stay comfortable. That’s the point.” (06:55)
- Hospice philosophy: comfort and dignity at the end of life (palliative care).
3. Pioneers Who Changed End-of-Life Care (07:29)
- Elisabeth Kübler-Ross: Introduced the "five stages of grief" and called for compassion for the dying ("On Death and Dying," 1969).
- Ernest Becker: Wrote about death acceptance as he was dying ("Denial of Death," 1973).
- Cicely Saunders: Founded St. Christopher’s Hospice (London, 1967), blending medical expertise with holistic care.
- Noted for patient-focused pain and mood management which included “morphine and cocaine, plus their preferred liquor” but always shown with before-and-after photos to demonstrate patient improvement (11:08).
- Josh: “She went to medical school to make her voice a little more credible.” (10:11)
- In the U.S., Florence Wald established the first hospice in Connecticut (1973).
4. The Spread and Structure of Hospice (13:25)
- U.K. hospices were mostly inpatient; U.S. started as home-based due to cost and cultural preferences.
- Volunteering has been a backbone of hospice care.
- Acceptance by the U.S. government led to the Medicare Hospice Benefit (1982), integrating hospice into mainstream medical coverage.
5. Modern Hospice System: How It Works (20:19)
- Eligibility: Two doctors must certify a terminal illness with a prognosis of six months or less; patient must not seek curative treatments.
- Josh: “If you don’t check these boxes…you can’t be in hospice anymore.” (21:10)
- Daily payment model: Medicare pays a flat daily rate; there are four care levels:
- Routine home care: Regular check-ins at home.
- Continuous home care: 24/7 care for crises.
- Inpatient respite care: Short stays in hospice facilities to relieve caregivers.
- General inpatient care: Hospital-like setting for symptom management.
- Volunteering is required for 5% of patient hours by Medicare regulation.
6. The Full-Spectrum Support of Hospice (26:39)
- Beyond medicine: Volunteers and staff help with chores, personal care, errands, caregiving relief, pet care, and emotional support.
- Interdisciplinary teams: Physicians, nurses, social workers, aides, clergy, and bereavement counselors collaborate for "total pain" management (physical, emotional, social, and spiritual).
7. Hospice Utilization and Barriers (29:39)
- Massive growth: From 2,000 centers in 2001 to 5,700 in 2025; about half of Americans die in hospice care.
- Barriers: Misconceptions equate hospice to “giving up,” doctors may refer too late, and lack of awareness.
- Studies show entering hospice may even extend life due to comfort and holistic support.
- Josh shares a personal story: Yumi’s father left hospice “discharged alive, and went on to live for another three years.” (33:46)
8. Hospice, Palliative Care, and Right-to-Die (38:03)
- Palliative care: Symptom management, not exclusively end-of-life, can be applied alongside curative treatment.
- Assisted dying: Not the same as hospice. WHO and most hospices are explicit that hospice care "neither hastens nor postpones death." (39:10)
- Some staff are philosophically opposed to mixing palliative care with assisted dying; others see self-determination as paramount.
9. Problems in the Modern Hospice System (41:08)
- For-profit hospice boom: 25% owned by private equity (2024). Some maintain quality; others cut corners due to financial incentives of daily rate payment.
- Chains and corporate-owned hospices generally receive “the lowest ratings of care.”
- Payment model issues: No minimum visit frequency enforced federally, enabling some agencies to provide bare minimum care (43:57).
- Josh: "The system is just set up for abuse. Luckily, most...aren't in it to abuse the system, they're in it to help people." (44:00)
- Live discharge rules—patients may be kicked out if they stop declining on schedule, even if still terminally ill. Discharge disrupts care and removes resources.
- “Your death doesn’t have to cooperate with federal guidelines.” (47:19)
- At-home hospice is less supported financially, placing huge burdens on families and making dying at home hard for those without money or caregivers.
10. Advice: Planning and Advocacy (50:47)
- Josh: "Share your wishes with your family. Maybe even go so far as to create a living will...do, like, read reviews, find out who you would go to..." (50:47)
- Chuck: “A will and a living will are the two biggest gifts you can give your family as you grow old.” (51:12)
Memorable Quotes & Moments
- “If you can't add more days to life, add more life to days.” — Josh (03:40)
- “[Cicely Saunders] went to medical school to make her voice a little more credible.” — Josh (10:11)
- “Just being a human being who can drive a car over to someone’s house is essentially the qualifications.” — Josh (27:13)
- “Hospice in general gets good marks...but [chains and private equity] get the lowest ratings for care.” — Chuck (44:58)
- “Your death doesn’t have to cooperate with federal guidelines.” — Josh (47:19)
- “You can take my walker when you pry it from my cold dead hands.” — Chuck’s anecdote about his wife’s grandmother (49:55)
Timestamps for Important Segments
- Main Topic Introduction: 01:17
- Concept of a Good Death / Components: 02:26
- History of Hospice / Kubler-Ross & Saunders: 07:29–13:25
- Medicare Hospice Benefit & U.S. Expansion: 14:46–16:13
- How Modern Hospice Works (payment, eligibility, care levels): 20:19–25:35
- Full-Spectrum/Volunteer Support: 26:39–29:39
- Utilization, Barriers, & Impact: Personal story: 29:39–34:23
- Assisted Dying vs Hospice: 38:03–40:20
- For-Profit Concerns & System Loopholes: 41:08–44:58
- Discharge & Home Care Challenges: 45:43–49:55
- Planning / Living Will Advice: 50:47
Closing Thoughts
- Early, proactive planning is essential for a dignified end-of-life experience.
- Hospice care—while far from perfect—can bring immense comfort, dignity, and even unexpected time to those at life’s end, provided families are aware of the system's strengths and weaknesses.
- Empathy, community, and pragmatic preparation are at the heart of a "good death," echoed both in hospice’s philosophy and the hosts’ lively, sensitive discussion.
For listeners or loved ones considering hospice:
- Research local options and provider reputation.
- Communicate wishes and consider legal advance directives early.
- Remember: "Everyone deserves a good death."