When The Pitt first hit the airwaves last winter, it started a lot of conversations among clinical professionals, including the show’s clinically accurate and emotionally nuanced portrayal of the death.
In particular it was the death of the character known as Mr. Hayes, whose adult children wrestled with whether or not to intubate him over the course of several episodes. The interaction among and between the fictional family and Noah Wyle’s character, Dr. Michael “Robby” Robinavitch, are unflinching and honest — and they were informed by, among other things, resources developed by Shoshana Ungerleider, MD, and the End Well Project.
Ungerleider, an internal medicine physician and the host and producer of the podcast Before We Go and the TED Health Podcasts, founded End Well in 2017 with the mission of making the end of life more dignified and human centered. When considering how death is portrayed in the media — on television, at least — Ungerleider and her team discovered that it is anything but: more than 80% of the deaths we see on the small screen are the result of violence, and that trend is only increasing. Depictions of gun violence on popular primetime dramas doubled from 2000 to 2018, while illness accounted for only 4.3% of deaths shown.
“We looked at over 141,000 scripted TV episodes from 2010 to 2020 and found that what’s shown on screen rarely reflects how most people actually die,” Ungerleider said. “Most people will actually die in hospitals or other healthcare facilities or other institutions, isolated. But you wouldn’t know that from watching TV.”
Not only is this overly violent TV landscape unrealistic but also it leaves audiences in the dark about what they themselves may encounter when met with the eventual decline of a loved one, Ungerleider said.
“When we overrepresent violent deaths and really inaccurately portray the end of life experience, I think that this leaves audiences really of all ages unprepared for some of the decisions that they may one day face for themselves and the people that they love,” she said.
“Shows like The Pitt, who really get it right with all the urgency that you see in a hospital setting, but also nuance and ethical complexity, helps close the gap between kind of the fiction of television and real life.”
The team at End Well worked with the Hollywood, Health & Society program at the Norman Lear Center, USC Annenberg, Los Angeles, for more than 3 years to produce the report and accompanying guidelines for the media to assist in portraying natural death accurately. Kate Langrall Folb, program director for Hollywood, Health & Society, said that while the program has been consulting on TV shows and movies since 2001 on “everything from diabetes to HIV to cancer and beyond,” they had never worked with shows on how to depict the end of life.
“We were delighted to partner with End Well to develop tools and resources for writers on that topic,” Langrall Folb said. “Hollywood was not asking for these tools, but I believe that is mainly because they didn’t know they needed them. Now that we have brought this topic to their attention, they’re all in.”
Langrall Folb highlighted a second storyline from The Pitt for its relevance and realistic portrayal, driven by the tools developed by End Well and the Norman Lear Center group — an arc about a patient who is brain dead due to an overdose. She learned that, thanks in part to the contributions the Norman Lear Center and End Well made, at least one family was able to better process and make decisions during a tragedy.
“There was an ER [emergency room] doc who wrote to the show saying that he was in a similar situation in real life with a brain-dead patient. He was preparing himself to speak to the family to discuss what they wanted to do, bracing himself because those conversations are usually so difficult — people not wanting to accept, etc.,” Langrall Folb said. “But when he entered the room to talk to the family, they told him not to worry, that they had watched The Pitt and already decided that they didn’t want to keep their loved one on life support any longer. It’s amazing to see this kind of real-world impact come from our work behind the scenes.”
Langrall Folb believes that this impact will spread as more producers and writers pick up the guidelines and incorporate them into their work.
“Audiences are affected by what they see on their favorite shows,” she said. “Accurately showing the myriad ways in which people’s lives come to an end will help them when they or a loved one are facing the end of their own lives.”
Ungerleider is hoping that more, and more accurate, portrayals of natural death will help people understand the end of life better and be better prepared as individuals and as caregivers.
“Media has the power to normalize what we so often avoid talking about — like grief, caregiving, and mortality. And when that’s done thoughtfully, it doesn’t just educate — it empowers,” Ungerleider said.
Ungerleider pointed out that what the End Well team and the people at the Norman Lear Center have developed is not just a clinical resource, it opens up space for the emotions involved in death.
“This isn’t just about getting the medical details right — it’s about honoring the human experience. When stories reflect the complexity of serious illness, families, caregivers, and patients at home feel seen,” Ungerleider said. “When a character on TV gets support from a palliative care team, it gives viewers permission to ask for the same in their real lives.”
The Executive Director of End Well, Tracy Wheeler, who was also integral to the development of the report and the tools, framed the resources like a map to this fairly unexplored territory.
“By helping Hollywood portray serious illness and death more accurately, we’re not just improving representation — we’re giving people the language and perspective to better navigate these experiences in real life,” Wheeler said. “This work reflects our shared belief that storytelling has the power to shift culture.”