Issues in Death & Dying
BIOE 630.01
Session 1 - CRN 11633
3 units
Spring, 2010
W 4:30 -7:00 PM
Instructor: Miriam Piven Cotler, Ph.D
Office: University Hall # 4512
Email:
mpcotler@lmu.edu
Mobile phone: 818-613-3862.
Office phone:
310-568-6159
Office Hours: By appointment
PRINCIPAL TOPICS
This seminar focuses on the ethics and ethical dilemmas surrounding death and
dying. The definition and determination of death are controversial, as are means
by which it may occur. We briefly review how patients, families, communities,
the health care system, and organized religions respond to end of life, dying, and
bereavement. As technology has provided more control over how and when we
die, personal, social, religious, cultural, structural, and financial concerns are
some of the factors impacting decisions made by patients, families,
administrators, and healthcare professionals. The course will include lecture,
discussion, and case review. Students are encouraged to provide and present
relevant cases.
STUDENT LEARNING OUTCOMES
Students should be able to discuss, describe and or/identify:
Ethical issues related death, dying and bereavement
Definitions of death.
Death as a process
Particular ethical challenges in making decisions at the end of life posed by clinical
uncertainty, technology, and the courts.
Cultural, historical, legal, psychosocial, and religious perspective related to death,
dying, and bereavement.
Suicide
Euthanasia
The management of dying and death.
Decisions for patients who are not competent
The organization and delivery of services to the dying.
The history, rationale and structure of hospice and palliative care.
.
PREREQUISITES/RECOMMENDED BACKGROUND
An undergraduate degree or its equivalent. Completion, or concurrent enrollment,
in an introductory bioethics graduate course.
REQUIRED TEXTS
Beachamp, Tom and Robert Veatch. Ethical Issues in Death and Dying, 2nd
Edition. Prentice Hall, 1996
Thomas Shannon, Editor, Death and Dying; A Reader. Sheed and Ward, 2004
COURSE WORK/EXPECTATIONS1
Students are expected to read assignments prior to the date for which they have been
assigned. Participation in class discussion is encouraged and is considered essential
to the conduct of this course.
The examination format is blue book, brief essay. It will assess identification and
understanding of key concepts and relationships. A study guide will be provided.
Assignments:
 Report on a work (preferably of fiction) dealing with death and dying. (due
April 7). Students will provide a summary and lead a discussion of the work,
with emphasis on ethical implications.
Suggested readings:
Fiction
The Year of Magical Thinking, Joan Didion
Paula-- Isabel Allende
Refuge-- Terry Tempest Williams
Grief, Andrew Holleran
The Mercy Papers: A Memoir of Three Weeks—Robin
Romm
The Book Of Jesse
Another novel Preapproved by the professor
Non fiction
Death’s Door, Sandra M. Gilbert
Ending Life: Ethics and the Way We Die, Margaret Pabst
Battin
The Final Gifts, Callanan and Kelley
Lizza, John P., Persons, Humanity, and the Definition of
Death,
Gilpin-Faust, Ruth The Republic of Suffering
Pausch, Randy, The Last Lecture, New York: Hyperion
Press, 2008
Other, pre-approved text
 Review and summarize one article on ethical issues in death, dying, afterlife,
or bereavement. (due March 3)
METHODS OF EVALUATION
Due to grading deadlines, and in the interest of fairness, there will be no
extension for assignments. Exam makeup will be granted only for verifiable
1
This syllabus and schedule are subject to change in the event of extenuating
circumstances. If you are absent from class, it is your responsibility to check on
announcements made while you were absent
emergency or upon prearranged agreement with the instructor. Unannounced
quizzes on the readings may be given.
NOTE THE UNIVERSITY POLICY ON CHEATING AND PLAGUARISM. And
THE BIOETHICS INSTITUTE POLICY ON CLASS ATTENDANCE
STUDENTS ARE EXPECTED AND REQUIRED TO HONOR THE RULES.
Grading Policy
Class Participation
Exam
Article Critique
Book Report and Presentation
Total
= 100 points
= 100 points
= 50 points
= 150 points
= 400 points averaged
Semester grades will be determined on the total percentage of points earned.
Grading will employ the +/- system:
97 + = A+ 89 - 87 = B+ 79 - 77 = C+ 69 - 67 = D+
96 - 93 = A 86 - 83 = B 76 - 73 = C 66 - 63 = D
92 - 90 = A- 82 - 80 = B- 72 - 70 = C- 62 - 60 = D59 or below = F.
Tentative Schedule
Date
Topic
Jan 20 - 27
Feb 3
Feb 10
Feb 17
Feb 24
March 3
March 10
March 17
March 24
March 31
April 7
April 14
April 21
April 28
Readings
(additional readings as appropriate)
What Is Death?
Dying today
B&V I, pp1 – 64; S pp1- 9
Legal, historical, religious
S 9 -31, handout
Views of death and dying
Truthtelling
B&V II, pp64-98
Suicide
B&V III, pp106-148
Euthanasia
B&V 211- 248
Physician Assisted Suicide
B&V IV, pp161 - 206
Article summary due
S pp 63 - 131
Advance Directives and POLST
Decisions by competent adults
B&V 257- 283
Deciding for those who were competent;
S 31 – 45
for children
B&V 286- 325; 331 – 349
Deciding for those who were competent; adults (contin. Readings)
no class; spring break
The concept of futility
B&V 349 – 385
Book report due; begin class discussions
Healthcare Services for the terminally
Ill; hospice, palliative care, home care
S 45- 63
Book discussions continue
Hospice and Palliative care continued
Socio-economics and Limiting Care
B&V 407 – 457
May 5
Exam
Bibliography (partial)
Lizza, John P., Persons, Humanity, and the Definition of Death, Baltimore, Johns
Hopkins University Press, 2006. strongly recommended
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_________________Approaching Death; Improving Care at the End of Life,
Washington, D.C., National Academy Press, 1997.
_________Forgoing Life-Sustaining Treatment for Minor Patients, Los Angeles
County Bar Association, 1996.
AMA Council on Scientific Affairs, “Good Care of the Dying Patient”, Journal of
The American Medical Association, Vol. 275, No. 6, February 14, 1996, pp. 474-478
Appleton, Michael, Good End; end of Life concerns and conversations about Hospice
and Palliative Care, 2005.
Battin, Margaret Pabst, Ending Life: Ethcs and the Way We Die,, Oxford, 2005
Becker, Ernest, The Denial of Death,, New York, Free Press, 1973.
Brock, Dan, Life and Death: Philosophical Essays in Biomedical Ethics. Cambridge
University Press, 1994.
Brown, Norman O., Life Against Death: The Psychoanalytic Meaning of History.2nd
Ed.. Hanover, Hew Hampshire: Wesley University Press, 1985.
Byock, Ira, Dying Well; Peace and Possibilities at the End of Life, Riverhead Books,
1997.
Callahan, D, Setting Limits: Medical Goals in an Aging Society. New York: Simon &
Schuster, 1987.
Callahan, Daniel, "Pursuing a Peaceful Death", Hastings Center Report (JulAug1993), pp33-38.
Callanan, Maggie and Patricia Kelley, Final Gifts:Understanding the Special
Awareness, Needs and Communications of the dying Bantam Books, 1997
Coberly, Margaret, Sacred Passage: How to Provide Fearless, compassionate Care for
the Dying, Shambala, 2003
Cotler, Miriam Piven and Gregory, Dorothy Rasinski, "Futility: Is Definition the
Problem? Parts I; II and III", Cambridge Quarterly of Healthcare Ethics (1993),
Cotler, Miriam Piven, “’The Do Not resuscitate Order: Clinical and Ethical Rationale
and Implications’”, Medicine and Law, 19:3, 2000.
Curtis, J. Randall, Rubenfeld, Gordon, D. (2001). Managing Death in the Intensive
Care Unit: A Transition from Cure to Comfort. Oxford University Press Inc.
Dickinson, George, Death, Dying and Bereavement, 8th Ed. Conn.: McGraw Hill,
2006.
Doka, Kenneth, Editor, Living with Grief; Loss in Later Life, Hospice Fdn of
America, 2002
Durkheim, Emile, Suicide, New York: Free Press, 1951.
Faust, Drew Gilpin (2008). The Republic Of Suffering: Death and the American Civil
War. Random House, Inc, New York.
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Feifel, Herman. (1959). The Meaning of Death. The Blakiston Division, McGraw Hill
Book Company, Inc. New York.
Field, Marilyn J. & Cassel, Christine K (1997). Approaching Death: Improving Care
At The End Of Life. Division of Health Care Services, Institute of Medicine.
Fins, Joseph J., A Palliative Ethics of Care; Clinical Widsom at Life’s End. Boston:
Jones and Bartlett, 2006
Gilbert, Sandra M., Death’s Door: Modern dying and the Way We Grieve, Norton,
2006
Groopman, Jerome, How Doctors Think. Boston: Houghton Mifflin, 2007,
Himelstein, Bruce, Joanne Hilden, Ann Morstad Boldt and David Weissman,
“Pediatric Palliative Care”, New England Journal of Medicine, m 350:17, April 22,
2004.
Holleran, James, Grief, A Novel, Hyperion, 2006.
James, John and Russell Friedman, The Grief Recovery Handbook, New York:
Harper Perennial, 1998.
James, John and Russell Friedman, When Children Grieve, New York: Quill, 2001
Jennings, Bruce, Editor with Gregory Kaebnick and Thomas Murray, Improving End
of Life Care; Why Has It Been so difficult?. The Hastings Center, special report,
2004.
Kane, Robert and Joan West, It shouldn’t Be This Way; The Failure of Long Term
Care, Nashville: Vanderbuilt University Press, 2005.
Kastenbaum, Robert J., Death, Society, and Human Experience, 7th Ed. Boston, Ally
and Bacon, 2001.
Kleespies, Phillip M., Life and Death Decisions; Psychological and Ethical
considerations in End-of-Life Care”, Washington, D.C., American Psychological
Association, 2004.
Kubler-Ross, Elizabeth, Death: The Final Stage of Growth, Englewood Cliffs, New
Jersey, Prentiss Heall, 1975.
Lynn, Joanne, “Learning to Care for People with Chronic Illness Facing the End of
Life”. JAMA, 284:19, November 15, 2000.
Lynn, Joanne, Editor By No Extraordinary Means: The Choice to Forgo Life
Sustaining Food and Water. Bloomington: Indian Press, 1989
McMahon, Jeff, The Ethics of Killing: Problems at the Margins of Life , New York:
Oxford University Press, 2002.
Meier, Diane E. and R. Sean Morrison, “Autonomy Reconsidered”, NEJM, 346:14,
April 4, 2002.
Morrison Diane and R. Sean Meier, “Palliative Care” NEJM, 350:2582-2590, #25,
June 17, 2004
Nuland, Sherwin, How We Die: Reflections on Life’s Final Chapter, New York,
Alfred Knopf, 1994.
Pausch, Randy, The Last Lecture, New York: Hyperion Press, 2008
Quill, Timothy E., A Midwife Through the Dying Process: Stories of Health and Hard
choices at the End of Life., Baltimore, Md, Johns Hopkins Press, 1996.
Quill, Timothy, M.D., "Death and Dignity", NEJM, Mar 7, 1991, 324:10.
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Richardson, Ruth, Death, Dissection, and the Destitute, 2nd. Ed., Chicago: University of
Chicago Press, 2000.
 Riley, G., Lubitz, J., Eggers, P., Gilden, D. M., Valentine, D. P., Lynn, J., Mendelson,
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(1998). Potentially Ineffective Care in Intensive Care. JAMA 279: 651-654 [Full Text]
 Scitovsky, Anne and Alex Capron, "Medical Care At the End of Life: The Interaction of
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 Spitz, Rabbi Elie Kaplan, Does the Soul Survive? A Jewish Journey to Belief in
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 Sullivan, Amy, Mathew Lakoma and Susan Block, “The Status of Medical Education
in End-of-Life Care; A National Report”, Journal of General Internal Medicine, 18,
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 Wanzer, Sidney, H., M.D., et al. “The Physician Responsibility toward Hopelessly Ill
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 Wanzer, Sydney H, MD, Glenmullen, Joseph, MD (2007). To Die Well: Your Right
To Comfort, Calm, and Choice in the Last Days of Life. Da Capo Press.
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