MEDICAL AID-IN-DYING
Integrative Seminar on Health
HSSP 110A – Section 2
Fall Semester 2017
Instructor: Dr. Anita HannigEmail:
Course Hours: Mon & Wed, 5:00-6:20pmCourseLocation:Schwartz 103
Office Hours:Mon & Wed, 2:00-3:00pm (or by appoint.)Office: Brown 209
Teaching Assistant: Alysa Hodgson Email:
Office Hours: Mon, 6:30-7:30pmOffice:Rabb 259
Course Description
In 1997, Oregon became the first state to legalize medical aid-in-dying,enabling terminally ill, mentally competent adults to end their own life by ingesting a lethal dose of a physician-prescribed drug cocktail.Since then, Washington, Vermont, California, Colorado, and the District of Columbia 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 medically-assisted dying in their state. Currently, two Massachusetts physicians—one of whom is suffering from prostate cancer—are suing the Attorney General for the right to hasten the deaths of terminally ill patients. Meanwhile, a new End of Life Options bill is being debated on Beacon Hill. This shifting legal climate raises urgent questions about the implementation, routinization, and desirability of medically-assisted death as an end-of-life practice that are now—more than ever—critical to address.
In this section, we will study medical aid-in-dying from all its complicated medical, socio-cultural, ethical, religious, economic, 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 will also explore how aid-in-dying is changing the way North Americans view and manage the process of dying. We will host a variety of guest speakers who are experts in the field of aid-in-dying and hold an in-class Death Café. 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 aid-in-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 and opponents of the law. At the end of the semester, students will vote as a class on whether to pass aid-in-dying in Massachusetts.
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 aid-in-dying and learn about it in all its “science,” “society,” and “policy” aspects. This means exploring the social and natural sciences literature, contacting experts, evaluating stakeholders, and locating and evaluating advocacy groups. Students will be asked to developa group presentation on some significant aspect of assisted dying and to conduct field interviews. In-class time will be made available for some of the group work.Based on their entire work this semester, each student will develop their own position in the form of an op-ed, 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 one might approach learning about the stakes that surround medically-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 3-page planning document (double-spaced, Times New Roman 12-point font, one-inch margins), suggesting 3-5 areas of research, citing at least three readings from the previous month. 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 aid-in-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 (25%)
In small groups of four, students will organize an entire class session on a specific subtopicand present their research as a panelin front of the legislative assembly (panelists should feel free to dress up professionally for this occasion!).The presentation should run for 50 minutes maximum, after which the floor will be opened to the assembly to ask questions to the panel, which 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). 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.
On the day of the presentation, each group will submit a3-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) and include a bibliography. 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 of50 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 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.Students will be asked to interview a person with substantive knowledge on the course topic (note: you may not interview terminally ill patients).Interviewees can includeadvocacy figuresfor or against assisteddying, religious figures, physicians, politicians, hospice personnel, or other relevant practitioners.Each student willhand ina4-page reflection of the interview(double-spaced, Times New Roman 12-point font, one-inch margins), outlining important findings, key quotes (paraphrased is acceptable), and a discussion of how the interview fits within the larger themes of the course.
d) Final Paper (20%)
Once all students have presented their group work and completed their interviews, students will individually prepare an 800-word op-ed that outlines recommendations they believe will best ameliorate the issues presented in class.Op-eds should make an overall recommendation either to legalize or to not legalize aid-in-dyingdying in Massachusetts, bringing in and citing supporting materials from the whole class semester. If an author argues in favor of legalizing aid-in-dying, they 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 significant toll. Starting in the second class, attendance will be taken at the beginning of each class. Each class builds on the next, and full attendance is essential for establishing a productive learning community and healthy class dynamic. However, I understand that things come up during the semester that can prevent you from coming to class. As a result, you may miss two classes total—no questions asked—without it affecting your grade. For each additional class that you miss, your participation grade will be reduced by five points. **Please note: since we give you two freebies, this class does not have a system of “excused” or “unexcused” absences, so please refrain from contacting the instructor or your TA about reasons for missing class (other than a major, documented medical emergency requiring an extended absence from the university).** If you are an athlete and must miss more than one class for an event, you will only get one extra freebie for the semester.
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 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
8/30 (Wed)Introduction to the course
Week Two
9/4 (Mon) No class (Labor Day)
9/6 (Wed)Oregon Death with Dignity Act
Oregon Death with Dignity Act Data Summary 2016
Marantz Henig, Robin. 2015. The Last Day of Her Life. The New York Times Magazine, May 14.
Week Three
9/11 (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. Introduction [1-4]; Background [7-14]; In the Chambers [19-36].
9/13 (Wed)Lepore, Jill. 2009. “The Politics of Death.” The New Yorker, November 30.
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].
Week Four
9/18 (Mon)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
9/20 (Wed)Film: How to Die in Oregon
Week Five
9/25 (Mon)Marantz Henig, Robin. 2013. A Life-or-Death Situation. The New York Times Magazine, July 17.
Gandsman, Ari. 2016. “A Recipe for Elder Abuse:” From Sin to Risk in Anti-Euthanasia Activism. Death Studies:578-588.
[9/26 (Tues)Legislative Hearing at Massachusetts State House]
9/27 (Wed)Boodman, Eric. 2017. A murder case over assisted dying divides Quebec. Should the law be changed?STAT, July 28.
Gawande, Atul. 2010. Letting Go: What should medicine do if it can’t save your life? The New Yorker, August 2.
Week Six
10/2 (Mon)Brainstorm topics and assign teams
*** Project planning paperdueat noon on 10/2 ***
10/4 (Wed)Lecture on effective group presentations by Alyssa Canelli
Week Seven
10/9 (Mon)In-class work in assigned groups (instructor rotates)
10/11 (Wed)No class
Week Eight
10/16 (Mon)Guest Speaker: John Kelly
10/18 (Wed)In-class work in assigned groups (instructor rotates)
Week Nine
10/23 (Mon)Session on qualitative interview methods
Hermanowicz, J. 2002. The Great Interview: 25 Strategies for Studying People in Bed.Qualitative Sociology 25(4): 479-499.
10/25 (Wed)Guest Speaker: Dr. Roger Kligler
Kligler, Roger. 2017. The Death I Want: Why I’m suing Massachusetts for the right to die on my own terms. Boston Magazine, January 15.
Week Ten
10/30 (Mon)Group one presentation
11/1 (Wed)Group two presentation
Week Eleven
11/6 (Mon)Group three presentation
11/8 (Wed)Film: Final Exit Network
*** Interview Reflection due at noon on Wednesday (11/8) ***
Week Twelve
11/13 (Mon)Session on how to write an op-ed
Read folder of sample op-eds on LATTE
11/15 (Wed)Group four presentation
Week Thirteen
11/20 (Mon)Group five presentation
11/22 (Wed)No class (Happy Thanksgiving!)
Week Fourteen
11/27 (Mon)Death Café
11/29 (Wed)Formal legislative debate (part I)
Week Fifteen
12/04 (Mon)Formal legislative debate (part II) & vote
*** Final paper dueat noon on Monday (12/04) ***
12/6 (Wed)Capstone Celebration
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