PHYSICIAN-ASSISTED DYING
Integrative Seminar on Health
HSSP 110A – Section 2
Spring Semester 2016
Hours:Mon & Wed, 5:00-6:20pm Instructor:Dr. Anita Hannig
Location:Brown 115 Email:
Office Hours:Mon & Wed, 1:30-2:30pm (or by appointment) Office: Brown 209
Teaching Assistant: Jaqueline Gonzales Email:
Office Hours:Mon2:30-3:30pm (or by appointment) Office:Rabb 259
Course Description
Between 1997 and 2010, over 500 Oregonians who had been diagnosed with a terminal illness chose to end their life with the help of a self-administered lethal drug cocktail, prescribed by their local physician. Since the Death with Dignity Actpassed in Oregon, four other states (Washington, Montana, Vermont, and California) have followed suit and enacted similar laws that would make it legal for physicians to assist patients with a terminal diagnosis in dying. In 2012, 51.9% of Massachusetts’s residents checked “no” on question 2 of the general election ballot, thus narrowly defeating a measure to legalize physician-assisted dying in their state.
In this section, we will study physician-assisted dying from all its complicated medical, socio-cultural, ethical, religious, and political dimensions:What motivations underwrite patients’ desire to end their life on their own terms? How does the role and purpose of medicine change when physicians are asked to help people to die? Who are the strongest opponents and proponents of assisted dying in the United States? Students will not only identify key arguments and stakeholders on both sides of the debate, but also explore how aid-in-dying is changing the way Americans view and manage the process of dying. The overarching goal of the class is to help a (fictive)legislative assembly of the State of Massachusetts reach a decision about whether to legalize physician-assisted dying. Student teams of researchers will speak in front of the assembly, presenting all possible facets of the topic and shedding light on the concerns of various proponents or opponents of the law. At the end of the semester, students will vote as a class and each submit a detailed recommendation to the Massachusetts Attorney General.
The format of the course is based on a “problem-based learning” (PBL) format. This will require students to be active learners for the course. I will supply an initial list of background reading, after which the work will be student-directed. Students will decide (with guidance) how to tackle physician-assisted dying and learn about it in all its “science,” “society,” and “policy” aspects. Students will be responsible (again, with guidance) to generate readings and discussion materials for each class. With the PBL approach, students will use all resources available to obtain information about physician-assisted dying. This means exploring the social and natural sciences literature, contacting experts, evaluating stakeholders, and locating and evaluating advocacy or self-help groups. Students will be asked to developa group presentation on some significant aspect of physician-assisted dying and to conduct field interviews. In-class time will be made available for some of the group work.Based on these presentations, each student will develop his or her own position paper, making a concise argument for a specific solution.
COURSE OBJECTIVES
- To examine an important health topic in terms of “Science, Society, and Policy.”
- To bring together information and perspectives students learned in other HSSP courses.
- To learn to work together as teams to research and present information.
- To identify key issues, major debates, and leading figures in relation to the topic.
- To learn to use a range of resources to interrogate the issues around the topic.
- To present verbal and written findings to the class in a coherent and professional style.
Success in this four-credit course is based on the expectation that students will spend a minimum of 9 hours of study time per week in preparation for class.
COURSE Requirements & Evaluation
- Class Participation (25%)
Owing to its format as a discussion seminar, this course relies strongly on your informed and active participation,which hinges on your preparation of the readings prior to class and your thoughtful engagement during class discussions. In trying to create an academically productive space where everyone feels comfortable voicing their interpretation of the issues, I will encourage you to listen and respond to each other carefully and with generosity. During class, I will assess the quality of your contributions over their quantity. If you are speaking more than two or three times in a given class session, please hold back to give others room to speak. I expect each of you to come to class having read the assigned materials to be able to make a meaningful contribution to our collective conversation. Please bring hard copies of the readings with you to class (unless you are using an electronic tablet).
II.Assignments (75%)
a) Project Planning Document (10%)
Before splitting into subgroups, think about the ways in which one might approach learning about the stakes that surround physician-assisted dying. What specific questions does aid-in-dyingraise? Whose perspectives would a legislative assembly have to consider before coming to a decision about whether to legalize the practice in Massachusetts?Write a 2-page planning document (double-spaced, Times New Roman 12-point font, one-inch margins), suggesting 3-5 areas of research. These areas might include thinking about the issue 1) from a basic scientific perspective; 2) through the lens of the social, religious, and ethical dimensions of physician-assisted dying; 3) from a comparative policyangle(for instance by showcasing how aid-in-dying has been practiced in other countries); 4) from the point of view of those who would advocate for alternatives.Please write this document in the form of a paper (i.e. no bullet points/incomplete sentences/graphics).
b) Group Presentations andExecutive Summary (20%)
Students themselves will design and lead much of the class. In small groups of four, students will organize an entire class session on a specific subtopicand present their research as a panel in front of the legislative assembly (panelists should feel free to dress up professionally for this occasion!).The presentation should run for 45 minutes maximum, after which the floor will be opened to the assembly to address specific questions to the panel, who should strive to stay in character for the remainder of the session (one student will be appointed as the head of the legislative assembly for each day). Groups will be responsible for researching the topic, assigning background reading to their peers, presenting their findings, and leading class discussion. No specific recommendations need to be made at this point – the purpose of the panel of researchers is to present information, concerns, and diverse viewpoints (even those you do not share!) to the assembly.Background reading should not exceed 40 pages of text per class and should be forwarded to meat least one week prior to the presentation in order for it to be posted on LATTE in time for classmatesto prepare.
On the day of the presentation, each group will submit a 2-page executive summary (single-spaced, Times New Roman 12-point font, one-inch margins) to me and to each student in class. The executive summary should summarize the mainfindings of the research in digestible, abbreviated form (again, you do not need to make specific recommendations at this point). Each group’s grade will be based on a combination of preparation, presentation, and executive summary. The participation and input of audience members during the Q &A each day will be an important component of their overall participation grade.
Group presentations should focus on a critical aspect of the topic, but not attempt to cover all factual knowledge of that subgroup. They should not consist of45 minutes of PowerPoint slides, but aim at a more interactive way of learning. The Brandeis Experiential Learning staff has offered to consult with groups to generate ideas for their presentation and practice their delivery. I strongly recommend that you make use of this resource and schedule a time to consult with them prior to your presentation (
c) Field Interview and Reflection (20%)
The context and nuance of physician-assisted dying cannot merely be found in the published, peer-reviewed literature. It is important to extend our inquiry beyond the classroom and investigate the experiences of central figures in the field.Either individually or in pairs, students will be asked to interview a person with substantive knowledge in the course topic (note: you may not interview terminally ill patients themselves).Interviewees can includeadvocacy figuresfor or against physician-assisted dying, religious figures, physicians, politicians, hospice personnel, or other relevant practitioners.After conducting the interview, the student(s) will present their findings to the class.On the day of the presentation, each student is also expected to hand in an individual 2-3 page reflection (double-spaced, Times New Roman 12-point font, one-inch margins) of the interview, outlining important findings, key quotes (paraphrased is acceptable), and a discussion of how the interview fits within the larger themes of the course.An interview guide should be included as an addendum.Please obtain all appropriate permissions before conducting the interview.
d) Final Paper (25%)
Once all students have presented their group work and interviews, students will individually prepare a 6-page position paper (double-spaced, Times New Roman 12-point font, one-inch margins) to the Massachusetts Attorney Generalthat outlines recommendations they believe will best ameliorate the issues presented in class. These papers should be modeled on a policy brief; they should be written in a calm, factual, informed, and persuasive manner. Papers should make an overall recommendation either to legalize or to not legalize physician-assisted dying in Massachusetts, bringing in and citing supporting materials from the whole class semester. If an author argues in favor of legalizing physician-assisted dying, he or she should include at least one paragraph outlining how the practice should be implemented (what are the limitations, etc.). All papers will be graded on the ability to logically articulate an argument, the quality of evidence, appropriateness of conclusion, and clarity of writing. The papers will form the basis of the final debate of the assembly, culminating in a vote.
All assignments must be submitted on the dates and times indicated on the schedule above and below. If your assignment is late, I will deduct a third of a letter grade for every day (or fraction of a day) past the deadline. I will only grant an extension for an assignment under extraordinary circumstances and if you have approached me at least 24 hours before the due date.
ATTENDaNCE
In order to succeed in the course, your timely presence in the classroom is obligatory. If you are consistently late, your participation grade will take a toll. If, for any reason, you are unable to attend class on a given day, please contact me in advance to request an excused absence (otherwise your absence will count as unexcused). Two or more unexcused absences per semester will lower your participation grade by one third of a letter grade. Four or more unexcused absences will lower your participation grade by two thirds of a letter grade.
Computer and Cell Phone Use
In order to focus your full attention on the class and on each other, laptopsare not allowed during class time (except during lectures designed for the entire cohort and the two days of group work). Flat tablets (such as Ipads) are an exception, but may be used only to pull up the readings and not for typing. The use of cell phones is of course prohibited.
Disabilities
If you are a student with a documented disability on record at Brandeis University and wish to have a reasonable accommodation made for you in this class, please come and see me.
Academic Integrity
In all of your written assignments, please make sure to cite properly any sources that you consulted, whether or not you use direct quotes. You may not simply lift text from any source and incorporate it into your own work, nor can you just change a few words here and there and claim it as your own, even if you do cite the source. You must thoroughly and carefully paraphrase any information that you include. We will go over proper citation style in class.
You are expected to be familiar with and to follow the University’s policies on academic integrity and plagiarism (see Faculty may refer any suspected instances of alleged dishonesty to the Office of Student Development and Conduct. Instances of academic dishonesty may result in sanctions, including but not limited to failing grades being issued, educational programs, and other consequences.
Schedule of classes
Week One
1/13 (Wed)Introduction to the course
Massachusetts House Bill 1991 (Compassionate Care for the Terminally Ill Act)
Week Two
1/18 (Mon) No class (Martin Luther King Day)
1/20 (Wed)Marantz Henig, Robin. 2015. The Last Day of Her Life. The New York Times Magazine, May 14.
Lopes, Giza. 2015. Dying with Dignity: A Legal Approach to Assisted Death. Santa Barbara, CA: Praeger. Introduction [1-4]; Background [7-14]; In the Chambers [19-36].
Week Three
1/25 (Mon)Aviv, Rachel. 2015. Letter from Belgium: The Death Treatment. The New Yorker, June 22, 56-65.
Lopes, Giza. 2015. Dying with Dignity: A Legal Approach to Assisted Death. Santa Barbara, CA: Praeger. At the Bedside [45-67] & In the Courts [77-96]
1/27 (Wed)Brooke, Jarvis. 2016. When I Die: An End-of-Life Doctor Faces His Own End. Harper’s Magazine.
Lopes, Giza. 2015. Dying with Dignity: A Legal Approach to Assisted Death. Santa Barbara, CA: Praeger. On the Ballot [105-128].
In-class film excerpts: The Last Campaign of Booth Gardner
Week Four
2/1 (Mon)Marantz Henig, Robin. 2013. A Life-or-Death Situation. The New York Times Magazine, July 17.
Kaufman, Sharon. 2005. … and a time to die: How American Hospitals Shape the End of Life. Chicago: University of Chicago Press. Excerpts.
2/3 (Wed)Brainstorm topics and assign teams (six groups of four)
*** Project planning papersdueat 9am on 2/3***
Week Five
2/8 (Mon)Lecture on experiential learning by Daniel Langenthal and Alyssa Canelei(entire cohort; Golding 110)
6:30-7:30pm pizza time & lecture on effective group work with Thomas Bertorelli (option 1) Shiffman 219
2/10 (Wed)Lecture on interview methodsby Sara Shostak (entire cohort; Golding 110)
Hermanowicz, J. 2002. The Great Interview: 25 Strategies for Studying People in Bed.Qualitative Sociology 25(4): 479-499.
6:30-7:30pm pizza time & lecture on effective group work with Jaqueline Gonzales (option 2) Shiffman 219
Week Six
2/15 (Mon)No class
2/17 (Wed)No class
Week Seven
2/22 (Mon)In-class work in assigned groups (instructor rotates)
2/24 (Wed)In-class work in assigned groups (instructor rotates)
Week Eight
2/29 (Mon)Lecture on Op-Eds & policy briefsby Mike Doonan and Max Perlman(entire cohort; Golding 110)
3/2 (Wed)Speaker: Constance Putnam, author of Hospice or Hemlock? Searching for Heroic Compassion (Praeger, 2002)
Week Nine
3/7 (Mon)Group presentation 1
3/9 (Wed)Group presentation 2
Week Ten
3/14 (Mon)Group presentation 3
3/16 (Wed)Group presentation 4
Week Eleven
3/21 (Mon)Group presentation 5
3/23 (Wed)Group presentation 6
Week Twelve
3/28 (Mon)No class
3/30 (Wed)In-class film: How to Die in Oregon
Week Thirteen
4/4 (Mon)Interview presentations
4/6 (Wed)Interview presentations
Week Fourteen
4/11 (Mon)Interview presentations
4/13 (Wed)Interview presentations
Week Fifteen
4/18 (Mon)Death Cafe
*** Final paper dueat noonon Monday (4/18) ***
4/20 (Wed)In-class formal legislative debate & vote
Week Sixteen
4/25 (Mon)No class
4/27 (Wed)No class
Week Seventeen
5/2 (Mon)Capstone celebration (entire cohort)
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