In this course, designed for medical students, we plan to turn to a channel that is different from the usual one found in a medical school environment and begin (or continue) to explore the satisfaction and surprises that come from writing. We will “warm-up” with a poem, a (short) short story or article. Or, we might begin by talking about a personal experience. Then, we will write about what we just discussed or about our medical experiences, our patients, our work-induced emotional life, and more. The topic range is broad indeed, and the choices will be up to us all. We will then read and discuss the rich details of our writing with each other in a safe, non-judgmental setting.

Medical students and physicians are traditionally taught the need to be emotionally detached from patients – Osler called it “aequanimitas.” The reasons for this include protecting ourselves from being overwhelmed by patient suffering and protecting patients from physician loss of “objectivity.” The soundness of this rationale has been questioned; but, it is widely held. Regardless, being emotionally detached does not mean devoid of emotion. In preparation for, during, and after clinical encounters with patients, many feelings – both “positive” and “negative” – naturally arise in medical students. These have to do with seeing, touching, and learning from patients, and from making or the fear of making mistakes. (Nor are seasoned physicians immune to these feelings.)

What is a medical student/physician to do with his or her emotions? Many learn to “stuff” them, ignore them; some doctors do get good at denial. Would it not be better, at least some of the time, to acknowledge them, give them breathing room, think about them, even discuss them? This is a primary goal of the class. In addition, we will consider the value of regarding the medical history as a “text” which can be written and read from differing, equally valid points of view. To this end we may rewrite our traditional medical histories from the non-biomedical perspective of our patients or their loved ones, then compare and contrast the versions. Beyond all this, we will write to explore any issue of importance to us. And, of course, we may write just for the sheer enjoyment of it.

Course Requirements: To take the class for credit (one unit, pass/not pass or for a grade) requires attendance/participation at all meetings and writing at home each week. If a class must be missed, extra writing will be expected.

4 units

Thomas W. Laqueur
3221 Dwinelle

Guy Micco
537 University Hall

Ivana Mirkovic, GSI
Julia Wambach, GSI
Jenni Allen, GSR

This course is jointly offered by a physician and a historian. We will discuss contemporary questions of policy and practice: medical definitions of death; the “right to die;” how we die and how (we say) we want to die; the role of the hospital and the hospice; the functions of the State in mediating between various views about the end of life; the role of doctors, family, and others at the end of life, for example. We will also consider questions in the social and cultural history of death: how and in what numbers people have died before and after the demographic revolution; whether some cultures were more successful in assuaging the pain of death than others, whether there really has been a secularization of death; where bodies have gone and how they have been remembered; what the relationship is between the history of life and of death. One of the instructors, Guy Micco, MD, is a hospice/palliative care physician, was chair of the Alta Bates ethics committee for many years and regularly teaches medical humanities as well as clinical courses in the UC Berkeley-UCSF Joint Medical Program. The other instructor, Thomas Laqueur, has taught about the history of the body in various contexts and is completing a book on the history of death called The Work of the Dead.

The following books are required for the class:

Philippe Aries, Western Attitudes Toward Death; Johns Hopkins Univ. Press; ISBN:0801817625; August 1975

Margaret Edson, Wit; Dramatists Play Service, Acting edition; ISBN: 9780822217046;May 1999

Sherwin Nuland, How we Die: Reflections on Life’s Final Chapter; Vintage Books;ISBN: 9780679742449; January 1995

Leo Tolstoy, The Death of Ivan Ilych. Various additions, including online, available

Sharon Kaufman, And a Time to Die: How American Hospitals Shape the End of Life; U Chicago Press, (paperback) 2006

Drew Faust, The Republic of Suffering: Death and the American Civil War; Vintage Books; ISBN 9780375703836; 2009

David Rieff, Swimming in a Sea of Death: A son’s memoir, Simon and Schuster; ISBN: 9780743299473; 2008

Highly recommended: Joanne Lynn and Joan Harrold, Handbook for Mortals: Guidance for
People Facing serious Illness; Oxford U. Press, ISBN 0195116623; 1999

The course “Reader” will be available on bspace. Information on how to access it will be given in class.

Course Requirements:

1. Class/section participation – 20%. Section attendance is required; more than 3 unexcused absences is grounds for failing the course.

2. One page response paper to readings every week placed into Drop Box on the course site in bspace; due the night before your section meeting. (Exception: no response paper for the first week or Thanksgiving week) – 25%

3. An in-class midterm exam – 25%

4. Final paper – 12 to 15 pages – due the last class meeting (In cases of collaborative research, each person must be responsible for a part of the project equivalent to a paper) – 30%

CLASS SCHEDULE

Week 1 (Thursday) August 29: Introduction

What is the history of death?
Begin Reading Aries—Western Attitudes…

Week 2 September 3, 5: Attitudes toward Death through the Ages

1. Do attitudes toward death change?
2. Is death a good or a bad thing?

• Finish Aries, Western Attitudes…Thomas Nagel, “Death”
• Bernard Williams, “The Makropulos Case: Reflections on the Tedium of Immortality”
• Seneca, Letters XII and LXIII from Letters From a Stoic
• “The Dart,” from the Salla Sutta
• Wm Shakespeare, from Measure for Measure
• Anon, “What If It Works?”

Week 3 September 10, 12: What is Death? History, Definition, Diagnosis

1. How could you tell if someone was dead in the past?
2. Contemporary debates about defining and diagnosing death

• Shakespeare, excerpt from The Tragedy of King Lear
• Caroline Bynum, excerpts from Resurrection of the Body in Western Christianity, 200-1336.
• “Death,” from Encyclopédie, 1751 < http://quod.lib.umich.edu/cgi/t/text/text-idx?c=did;cc=did;rgn=main;view=text;idno=did2222.0000.836>
• Joseph Fletcher, “Indicators of Humanhood: A Tentative Profile of Man,”
• Hastings Center Report 2(5), 1-4, 1972. “Four Indicators of Humanhood, The Inquiry Matures,” Hastings Center Report, 4(6), 4-7, 1974
• M.L. Tina Stevens, “Redefining Death in America, 1968” Chapter 3 of Bioethics
• in America: Origins and Cultural Politics
• “A definition of Irreversible Coma: Report of the Ad Hoc Committee of the Harvard
• Medical School to Examine the Definition of Brain Death,” JAMA 205, 85-88, 1968
• Alexander Morgan Capron, “Brain Death – Well-settled, but still unresolved,” NEJM 344(16), 1244-1246, 2001
• E. Christian Brugger, “D. Alan Shewmon and the PCBE’s White Paper on Brain Death:
• Are Brain-Dead Patients Dead?” J Med Philosophy, 38, 205-218, 2013.
• State of California, “Death Certificate”
• Brendon Reilly, “Pronouncing,” Annals of Internal Medicine, 135(6), 467-470, 2001.
• Begin reading Nuland (see below)

Week 4 September 17, 19: How We Die I – Medicine

1. What is it to be dead (continued)
2. Does nature make a bad death inevitable?

• Sherwin Nuland, How We Die: Reflections on Life’s Final Chapter
• Thomas Laqueur, “Closing Time” [review essay of Nuland] London Review of Books
• August 18, 1994
• Joanne Lynn and Joan Harrold, “Learning about specific illnesses,” Chapter 9 in
• Handbook for Mortals …

Week 5 September 24, 26: How We Die II – Dying well

1. Why does how we die matter?
2. Death as redemption – the case of Ivan Ilych

• Adam Smith, from Book I, Chapter 1 of The Theory of Moral Sentiments, 1759
• Death bed scenes: “Death of Socrates” in Plato’s Phaedo, 115b-118b; “Death of Jesus,”
• in Mark 14- and Luke 22-; Stephen Mitchell, “Trial before Pilate and the Crucifixion,” in The Gospel According to Jesus; Stephen Miller, “The Death of Hume,” Wilson Quarterly, Summer 1995, 30-39; Charles Dickens, from The Old Curiosity Shop, Chapter 72.
• Leo Tolstoy The Death of Ivan Ilych
• Guy Micco, et al., “The Death of Ivan Ilyich and pain relief at the end of life,” The
• Lancet, 374, 872-873, 2009.
• Everyman, the medieval morality play (online)

Week 6 October 1, 3: Dead Bodies

1. Are dead bodies dangerous?
2. The Republic of Suffering

• Drew Faust, The Republic of Suffering: Death and the American Civil War

Week 7 October 8, 10

1. Death in the hospital I
2. The dead come back: ghosts and spirits

• The SUPPORT Principal Investigators, “A Controlled Trial to Improve Care for
• Seriously Ill Hospitalized Patients: The Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT),” JAMA 274, 1591-1598, 11/22-29/95
• Sharon Kaufman, And a Time to Die … – read especially the Introduction, Chapter 4
• (“Moving Things Along”), and Chapter 7 (“Life Support”)

Guest (October 8): Sharon Kaufman, Professor and Chair, Department of Anthropology, History and Social Medicine, UCSF
___________

• Alex Owen, “Women, Power, and Spiritualism in Late Victorian England,” from The
• Darkened Room, University of Chicago Press, 2004 ed.
• Arthur Conan Doyle, Chapters 7 and 11 from The Edge of the Unknown, GP Putnam’s
• Sons, 1930. Online at: <http://gutenberg.net.au/ebooks05/0500151.txt>
• Sam Parnia, excerpts from Erasing Death
• Burch, et al., “What death is like,” American Heart Journal, September 1968
• Nuland, Hopko, and Thurman, “What happens after you die?” Shambala Sun, March 1995
• Mobbs and Watt, “There is nothing paranormal about near-death experiences: how neuro-
• science can explain seeing bright lights, meeting the dead, or being convinced you are
• one of them,” Trends in Cognitive Sciences, 15(10), 447-9, October 2011. (Plus letter to
• to the editor and authors’ response).

Week 8 October 15: Death in the Hospital II

Margaret Edson, W;t (movie viewing to be arranged)
[Arthur Kleinman, “Illness unto Death,” from Kleinman, The Illness Narratives (Basic
Books, division of Harper Collins) pp. 148-157, 1988]

October 17: Midterm Exam in class

Week 9 October 22, 24

1. Imaging death
Guest October 22: Beth Dungan, PhD (History of Art)
__________________
2. Hospice and its alternatives
Guest October 24: Alex Smith, Assistant Professor of Medicine, Division of Geriatrics, UCSF
David Rieff, Swimming in a Sea of Death: A son’s memoir

Week 10 October 29, 31: Truth-Telling, Hope, and the Bad News

• Hippocratic Corpus, “Decorum,” XVI.
• Thomas Percival, “A Physician Should be the Minister of Hope and Comfort to
• the Sick,” from Percival’s Medical Ethics, 1803.
• Thomas Addis, excerpt from Glomerular Nephritis, 1948.
• Kelly and Friesen, “Do Cancer Patients Want to Be Told?” Surgery 27, 822-826, 1950.
• Donald Oken, “What to Tell Cancer Patients: A study of medical attitudes,” JAMA
• 175(13), 86-94, April 1, 1961.
• Simon de Beauvoir, A Very Easy Death, 62-106, 1964.
• Novack, et al, “Changes in Physicians’ Attitudes Toward Telling the Cancer Patient,”
• JAMA 241, 897-900, 1979.
• Norman Cousins, “A Layman Looks at Truth Telling in Medicine,” JAMA 244, 1929-
• 1930, 1980.
• Judge Jacob Turkel, “Remarks on Telling the Truth or Lying,” Medicine and Law 4,
• 91-93, 1985.
• Antonella Surbone, “Letter from Italy: Truth Telling to the Patient,” JAMA 268, 1661-
• 1662, 1992.
• Edmund Pellegrino, “Is Truth Telling to the Patient a Cultural Artifact?” JAMA 268,
• 1734-1735, 1992.
• E.R.W. Fox, “A Dream Trip to Australia,” West J Med 145, 555, 1986.
• Lawrence Grouse, “The Lie,” JAMA 45(2), 173, January 9, 1981.
• Pauline Chen, “When Doctors Don’t Tell the Truth,” New York Times, March 1, 2012.
• Smith and Longo, “Talking with Patients about Dying,” NEJM, October 25, 2012.
• Rebecca Dresser, “A Terrifying Truth,” Narrative Inquiry in Bioethics 3(1), 10-12,
• Spring, 2013.
• ______________
• Jerome Groopman, “Dying Words: How Should Doctors Deliver Bad News?” The
• New Yorker, October 28, 2002.
• Miriam Arato, et al. v. Melvin Avedon, Supreme Court of California, 1993
• Four poems on telling ‘bad news’
• John Stone, “Talking to the Family”
• Raymond Carver, “What the Doctor Said”
• Donald Hall, from Without
• Douglas Dunn, “Second Opinion”

Week 11 November 5, 7

1. Death’s demography
Guest November 5: Ron Lee, Professor of Economics and Demography and Director, UC Berkeley Center for the Demography and Economics of Aging
Marilyn J. Field and Christine K. Cassel, “A Profile of Death and Dying in America,”
Chapter 2 in Approaching Death (Washington: National Academy Press) 1997
Other readings on demography to follow

2. Ritual care of the dead body: Why the dead body matters; Putting the dead to rest
Claudio Lomnitz, excerpts from Death in Mexico
Thomas Lynch, pp. xiii-xx, 3-26, and 179-199 from The Undertaking: Life Studies from the Dismal Trade, Norton, 1997

Week 12 November 12, 14

1. Why the dead body matters; Putting the dead to rest (continued)
__________________
2. Psychoanalysis and Death; mourning
Guest November 14: Sara Hartley, MD, Psychotherapist and Clinical Professor, UCB-UCSF Joint Medical Program
Thomas H. Ogden, “An Elegy, a Love Song, and a Lullaby,” Psychoanalytic Dialogues,
11(2), 293-311, 2001.
Thomas H. Ogden, “Freud’s ‘Mourning and Melancholia’ and the origins of object
relations theory,” from Creative Readings: Essays on Seminal Analytic Works,
Routledge, 2012.
Nina Coltart, “Endings,” from The Baby and the Bathwater, International Universities
Press, 1996.
Sigmund Freud, “Mourning and Melancholia” – FYI!

Week 13 November 19, 21: Current Debates about the End of Life

1. The question of suicide in historical perspective
Plato, excerpt from “Phaedo” on suicide
Seneca, Epistulae Morales, LXXVII, on suicide
Hume, “Of Suicide.”
Schopenhauer, “On Suicide,” from The Complete Essays of Schopenhauer, T Bailey
Saunders, transl.
Kant, “Duties Towards the Body in Regard to Life” and “Suicide”
Lionel Tollemache, “The New Cure for Incurables” Fortnightly Review, xiii, 1873, 218-2
[Pope Pius XII, “The Prolongation of Life,” in The Pope Speaks 4, 393-398, 1958] Pope John Paul II (approved), “Declaration on Euthanasia” 1980
________________
2. Doctors and the decision to die
James Rachels, “Active and Passive Euthanasia” and Beauchamp and Childress, “Killing
and Letting Die,” in Ethical Issues in Death and Dying, Robert Weir, ed., 249-274 (Columbia University Press) 1986
Anon, “It’s Over Debbie” and editorials, JAMA 259, 272, 1988. Letters to editor, JAMA
259, 2094-2098, 1988
Timothy Quill, “Death and Dignity: A Case of Individualized Decision Making,” NEJM
324, 691-694, 1991. Letters to editor, NEJM 325, 658-660, 1991
Edmund Pellegrino, “Compassion Needs Reason Too,” JAMA 270, 874-875, 1993

Week 14 November 26: The law and the decision to die
(November 28 is Thanksgiving)

1. The “right-to-die”
2. Euthanasia and disability

Kathleen Foley, “Competent Care for the Dying Instead of Physician-Assisted Suicide,”
New England Journal of Medicine 336, 54-58, 1997
Marcia Angell, “No One Trusts the Dying,” The Washington Post, July 7, 1997
Roberts and Kjellstrand, “Jack Kevorkian: a medical hero,” British Medical Journal
312, 1434, 1996
Joanne Lynn, “Where’s the Outrage?” in The Exchange, a publication of Americans for
Better Care of the Dying
U.S. Supreme Court decisions NY vs. Quill and Washington vs. Glucksberg
California Assembly Committee on Judiciary, “Bill Analysis, AB 654,” (The California
Compassionate Choices Act), April 12, 2005
Lonny Shavelson, “The Slippery Slope: Euthanasia for the Disabled,” Chapter 4 (pp.105-
157) from A Chosen Death, Simon and Shuster, 1995
_______
Terri Schiavo readings:
George Annas, “”Culture of Life” Politics at the Bedside – The Case of Terri Schiavo,”
NEJM 352, 1710-1715, 2005
Timothy Quill, “Terri Schiavo – A Tragedy Compounded,” NEJM 352, 1630-1633, 2005
Pope John Paul II, “Address to the participants in the international congress on ‘Life-
Sustaining Treatments and Vegetative State: Scientific Advances and Ethical
Dilemmas,’” March 20, 2004
United States Council of Catholic Bishops, “Cardinal Keeler Issues Statement on Florida
Schiavo case; Stresses Church Teaching on Feeding, Hydration,” March 9, 2005
Harriet McBryde Johnson, “Hey, Wait a Minute: Not Dead at All. Why Congress was
Right to stick up for Terri Schiavo,” Slate, March 23, 2005

Week 15 December 3: Physician-Assisted Suicide and Euthanasia (continued)
December 5: Conclusion (last day of class)

Introduction

“Memory is everything. Without it we are nothing,” -Eric Kandel, Nobel laureate

Memory is thought by some (with John Locke) to be a sine qua non of the self; lose it and autonomous agency and personhood are lost. Today, the neurosciences are suggesting something similar: dementia (aka “major neurocognitive disorder”) is the progressive loss of neurons and their function; with this loss comes loss of memory and, hence, loss of the self and personhood. When personhood is lost, all is lost. Others believe that the “self” is relational and that dementia may be perceived (and treated) in a more benign fashion. This course will help students and faculty from diverse backgrounds explore these vastly different views from a number of perspectives across the sciences and humanities. In class, we will engage invited guests with expertise in religious studies, anthropology, history, geriatrics, social welfare, English literature, and the neurosciences.

Readings and in-class discussion will be supplemented by fieldwork meant to expose students to programs that employ novel communication and therapeutic methods for elders with serious memory loss. Students will be able to pair with such elders, and perhaps their caregivers, to learn directly about their lives and elicit their psychosocial histories. Another potential fieldwork experience – patient encounters in the geriatric clinic and/or the newly proposed interdisciplinary memory clinic at Alameda County Medical Center (Highland Hospital) – would allow for student learning of how to assess cognitive function.

Course Goals and Objectives:
1. Explore various understandings of the ‘self’ from biological, psychological, religious, historical, social and cultural points-of-view
2. Consider what it is to be a ‘person,’ and how memory plays into our conceptions of the ‘self’
3. Consider whether memory loss as we age is pathological
4. Consider whether memory loss in dementia means loss of the ‘self’ and one’s personhood
5. Experiential component – have first-hand experience with someone labeled as having a dementia and their caregivers

Class Requirements and Expectations
1. All students are expected to come to each class prepared to discuss the readings of the week. In preparation for these discussions, two students each week will submit a brief reflection on these readings. These reflections are to be uploaded to bspace and emailed to our course listserv <theself@berkeley.edu> by the day before class, latest. An optional email conversation may or may not transpire.
2. Students are expected to complete at least 15 hours of fieldwork. An orientation to each potential fieldwork site will occur during the first class meeting. Each student will choose their top three site choices by week two of class (February 4), and assignments will be made based on this information. Fieldwork activities could include pairing with a client or resident with memory loss, spending time with them and their caregivers; shadowing staff members as they interact with clients/residents; and sitting in on group interactions/activities and interprofessional team meetings, if/when possible.
3. Each student will give a brief presentation at the end of the semester on his/her fieldwork experience. To facilitate this, students may wish to journal about these experiences.
4. Student will submit a final 8-10 page paper on a topic of their choice related to the subjects of the course – memory, aging, the self. This paper will be due by no later than the last class of the semester.
If a class must be missed, Guy Micco should be contacted as soon as possible. A make-up assignment will be given; this will likely be an extended (3-4 page) reflection on the week’s readings.

List of fieldwork locations:
– Alzheimer’s Services of the East Bay (ASEB)
– Salem Lutheran Home memory unit (The Terrace)
– Mercy Retirement and Care Center, Oakland
– Lakeside Park, Oakland <http://lakesideparksenior.com>
– Bayside Park, Emeryville <http://baysideparksenior.com>
– AgeSong, Hayes Valley, San Francisco
– Piedmont Gardens’ memory unit (The Grove), Oakland <piedmontgardens.com/services/memory_support> – Chaparral House, Berkeley

Grading:
1. Participation (40%)
a. In class discussion
b. Reading reflections
2. Fieldwork (40%)
a. 15 hours
b. End of semester presentation
3. Final Paper (20%)

 

Memory, Aging, and the Self
Class Schedule

January 28
Topic: Course overview, introductions, fieldwork orientation
Guests: from various field experience sites

February 4
Topic: Historical view of memory and the self
Guest: Thomas Laqueur, UCB Professor of History
Readings: John Locke on ‘the self’

February 11
Topic: A Christian and a Buddhist look at the ‘self’
Guests: The Rev. Peter Yuichi Clark, Ph.D., BCC, ACPE Supervisor, Professor of Pastoral Care at the American Baptist Seminary of the West and Manager of Spiritual Care Services at UCSF Medical Center.
Hozan Alan Senauke, Vice-Abbot of Berkeley Zen Center, founder of the Clear View Project (developing Buddhist-based resources for relief and social change), and Senior Advisor to Buddhist Peace Fellowship.
Readings: tba

February 18 Presidents’ Holiday

February 25
Topic: A philosopher looks at the self
Guest: John Perry, Professor of Philosophy, Stanford
Readings: tba

March 4
Topic: Biological perspective on memory and the self
Guest: William Jagust, UCB Professor of Public Health and Neuroscience
Readings: tba

March 11
Topic: Biomedical and clinical aspects of the disease of dementia
Guests: Claudia Landau, Director, Geriatrics and Palliative Care, Highland Hospital
Bruce Reed, Neuropsychologist and Associate Director of the UC Davis Alzheimer’s Disease Research Center
Drew Thompson, UCB–UCSF Joint Medical Program student
Readings: tba

March 18
Topic: Social constructions of aging, self, and dementia
Guest: ?Lawrence Cohen, UCB Professor of Anthropology
Readings: tba

March 25 Spring Break

April 1
Topic: A non-biomedical view of “dementia”
Guests: Patrick Fox, UCSF Professor of Sociology, Department of Social and Behavioral Sciences,
Co-Director, Institute for Health and Aging
Nader Shabahangi, Founder and CEO, AgeSong
Readings: tba

April 8
Topic: Memory and poetry
Guest: Marilyn McEntyre, Professor of Medical Humanities, UC Berkeley-UCSF Joint Medical Program
Readings: tba

April 15
Topic: Meaningful interactions/connections in the context of ‘dementia’
Guests: Desi Owens, Academic Coordinator and Campus Planner, UC Berkeley Academic Geriatric Resource Center
Linda Spector, Co-Founder Stagebridge
Readings: tba

April 22 Fieldwork presentations

April 29 Fieldwork presentations

May 6 Fieldwork presentations. Class Evaluations

Readings will be posted to our bspace site at least one week prior to each class.

Other potential topics: firsthand accounts of memory loss and the self (an evening viewing of “Complaints of a Dutiful Daughter” or the Alzheimer’s Project) – or – Music and memory Readings: Memoirs of persons with Alzheimer disease, blog posts

Units: 1 (2nd unit for independent study possible)
Maximum class size: 8 students, graduate level (upper division undergraduate by permission of instructor)
Course number: HMS 210 (HMS 298 for 2nd unit, discuss with Guy Micco)
Room: 574 University Hall and Salem Lutheran Home (see class schedule)
Course Meetings: Wednesdays, 5:30 to 8:30 PM, from August 29 thru November 14, including two “performances” toward the end of the course.

Live performances help bring new interpretations and new meanings to the written word. Readers’ theater is a technique used in the performance of literature in which texts are staged with minimal production values and scripts are not fully memorized. Plays are not the only form of literature that can be “performed.” Poems and short stories, even novels and memoirs (and many other forms of fiction and nonfiction) have been successfully adapted for the stage. With Readers’ Theater, rehearsal and preparation time are significantly reduced so that non-professional performers, who cannot commit to the six to eight weeks of nightly rehearsal traditionally necessary for a fully staged production, can participate; and, performances can be made available to communities with fewer resources.

In this course, we will choose stories, plays, and poems that have to do with aging and old age; we hope they will deal with the pleasures as well as the problems and concerns brought to us by aging in our society. We anticipate a lively intergenerational and interdisciplinary dialogue among UC Berkeley students in healthcare professions, humanities, and social sciences, and a group of elders at Salem Lutheran Home, a continuing care retirement community in Oakland. Our course will begin on the Berkeley campus, but many of the class meetings will be at Salem Lutheran with interested elders who reside there. To spark discussion, we will engage in a variety of theater and intergenerational role-playing activities in which the topics will pertain to old age and aging. We will also practice dramatic exercises and techniques that focus on voice, body and presentation; and, for those who are interested, there may be opportunities to visit and participate in Linda Spector’s “Imagination Workshop” at a skilled nursing elder care community (see below).

We will have the time to prepare and perform only a few texts; though we will read and discuss many others together. At the end of the course, we will all ‘perform’ together at Salem Lutheran and on the Berkeley campus, for a wider audience from both sites. After each performance, we will engage in a discussion with our audience. This is perhaps the richest aspect of Readers’ Theater. We look forward to an exciting and fun class!

Small print: Some of our rehearsals, performances and/or after-show discussions may be recorded (audio and/or video) to be used later as teaching tools. A dvd comprised of a performance and comments by members of a former class and audience is available for your viewing pleasure.

Course Objectives

By the end of this course, students will:

• have discussed and learned from examples of the vast literature (poetry, novels, plays, essays, stories, myths) devoted to aging and end-of-life matters in various societies.

• have successfully performed (with the Readers’ Theater technique) several types of “aging” literature before audiences of elders and of their (student) peers.

• have practiced and employed presentational skills such as vocal expression and proper posture while performing.

• better understand the relationship between old and young in our time and place and how that relationship is changing as we are living longer.

• begin to recognize the contributions of wisdom and experience that older people make to all societies.

• have learned more on how to communicate with elders in a positive and relaxed manner.

• understand how theater may be used to provoke action, changes in relationships, and comprehension of ideas.

• understand the potential of dramatic improvisation to enhance communication and comprehension of ideas.

Course Requirements:

1. Attend and participate in all class meetings. Assignments, including readings and writing, are to be completed prior to each class. If a class must be missed, a 3-page paper, discussing the reading for the week, or another topic agreed upon with instructors, will be due the following week. (This will be in addition to any written assignment for the week.)

2. The first 15 (or so) minutes of most classes will be reserved for a student presentation on our topic (“aging”!). This could be a poem, story, or essay; a film clip, a newspaper or magazine article, a cartoon, TV program, internet site, or personal experience (or other).

3. Participate in the two Readers’ Theater presentations near the end of course – one at Salem Lutheran Home, the other at UC Berkeley (These will occur on October 31 and November 7, during usual class time.

Readings: some will be posted on the course’s bspace site, others will be brought to class by instructors and students.

COURSE SYLLABUS

1. August 29 (574 University Hall)
– Introductions
– Guy on aging, Linda on performance, discussion of syllabus
– Discuss our goals/hopes/reasons/anxieties re being here
– Read aloud and discuss selected performance texts
Assignment for September 5:
– Find at least one new reading, write a précis and email to the class by next Wednesday; be prepared to direct a Readers’ Theater adaptation of it.

2. September 5 (574 University Hall)
– Student presentation
– Warm-ups
– Discuss assigned readings
– Try out new adaptations, discuss new readings, make preliminary decisions
Assignment for September 12:
– Read for next week from Savitt Medical Readers Theater
– Find at least one new reading, write a précis and email to the class by next Wednesday; be prepared to direct an adaptation of it.

3. September 12 (Salem Lutheran – meet at University and Oxford to car pool)
– Introductions
– Discuss reader’s theater, performance possibilities, discuss intergenerational exchange, discuss goals for session (process goals and product goals)
– Introduce warm-up exercises and why they are important
– Consider some texts that have already been adapted – read and discuss, including how they change when different voices read/speak them
– Try texts that Berkeley students bring in, play with how they are read
Assignment for September 19:
– Find at least one new reading, write a précis and email to the class by next Wednesday; be prepared to direct an adaptation of it.

4. September 19 (574 University Hall)
– Student presentation
– Discuss last week – What worked? What didn’t? Surprises? Delights? Disappointments? What do we need to be prepared for?
Assignment for September 26:
– Find at least one new reading, write a précis and email to the class by next Wednesday; be prepared to direct an adaptation of it.

5. September 26 (Salem Lutheran)
– Student presentation
– Warm-ups
– Role-playing/improv games
– Discuss what comes up, both in terms of form and content; talk about whether any of this can work in performance contexts, and why; how could (or couldn’t) the audience be introduced into this process
Assignment for October 3:
– Find at least one new reading, write a précis and email to the class by next Wednesday; be prepared to direct an adaptation of it.

6. October 3 (Salem Lutheran)
– Student presentation
– Warm-ups
– Continue trying out and discussing texts

7. October 10 (Salem Lutheran)
– Student presentation
– Warm-ups
– Re-reading texts and final selections for performances

Assignment for October 17:
– Consider stereotypes of aging in our society – in literature, the media, advertising, cartoons. Bring examples and be prepared to present them in class. Why and how do we stereotype groups of people? Where do stereotypes come from? Do elders stereotype younger people? How do stereotypes hinder/help intergenerational communication?

8. October 17 (Salem Lutheran)
– Student presentation
– Warm-ups
– Role playing. Improv/drama games and discussion of stereotypes

9. October 24 (Salem Lutheran)
Student presentation
– Warm-ups
– Rehearsal

10. October 31 (Salem Lutheran)
– Performance! (Halloween!)

11. November 7 (UCB campus)
– Performance!

12. November 14 – Final class (574, University Hall)
– Wrap-up, course evaluation

Note: Per above, the Salem performance will be on Wednesday, October 31; UCB’s will be on Wednesday, November 7, from 5:15 to 6:30, followed by the cast dinner!

Though hardly new, Death is in the news over the past several years. It seems we have rediscovered or uncovered this bare-essential fact of life. While Philippe Aries could state as late as the 1970’s that ours was a time in which death had become “shameful and forbidden,” this order has been rapidly changing. Now governmental agencies and private foundations are spending hundreds of millions to study it. The medical literature is brimming with articles on the discontents of the hospital death and the goodness of the hospice or home death. Near-daily newspaper and popular magazine accounts bring this view to an ever-increasing audience. We listen to NPR radio programs on death and watched Bill Moyers, among others, present it to the mass television audience. Parents and children, husbands and wives, doctors and patients are speaking of the ‘great matter’ in a more candid fashion than anyone can remember.
This all speaks to a major change of attitudes in our culture. The course we are about to take reflects this change; it will give us the time and place to think critically about what is going on. In so doing we will look at current and past representations of death, we will consider such questions as what constitutes a ‘good death’ and what makes a hospital death problematic. We will spend time discussing death in and through medical literature, fiction and poetry; visual representations and music. And, if you are willing, we will share personal stories of loss. All of this is a reflection of the notion that the better we know ourselves, specifically our attitudes concerning death and dying, the better we will be able to understand and help others – and ourselves – in times of crisis surrounding the death of a patient or loved one.

Course Requirements:

• Weekly readings and discussions based on these readings. In addition, each student will be expected to write a one-half to one-page *reflection* on each week’s reading – or some personal reflection on suffering/death stimulated by the reading – prior to that week’s class time. This will be collected each week. (Note that a *reflection* is not meant to be a polished piece of writing; rather, it may be written within 10 to 15 minutes of concentrated effort.)

• The first 20 to 30 minutes of each class will be devoted to a student presentation/ discussion of a short reading – from any source – on our topic. (Three possible sources, Kitchen Table Wisdom, How Can I Help?, and The Oxford Book of Death, are listed below.)

• For a letter grade there will be a 10-15 page paper or a class-related project approved by course instructor due by the last day of class.

Any student who so desires will be paired with a hospital chaplaincy resident, and provisions will be made for visiting patients in the hospital together. The time commitment to, and depth of, this experience is left to each student.

The Retreat: On the weekend of April 10-12, a two-day retreat will be held at Green Gulch Zen Center, beginning with dinner Friday evening, ending with lunch on Sunday. We will engage in discussions and practices designed to give us a more keen awareness of our sense of life and death and how we deal with our own and others’ suffering and mortality. The goal is to provide a structured opportunity to explore, integrate, and deepen individual learning from the class. Attendance cannot be mandatory but is strongly requested.

_____________

Look
Look me in the eye –

Most of
I mean all of –

Why make such a fuss

Are going to –

I mean
Look me in the eye.

-Rick Fields
SCHEDULE
Note: All classes will be held on Wednesdays from 5:30-7:30PM (or 6 to 8:00) in
104 Dwinelle
The retreat will be the weekend of April 10-12

January 21 Introduction – discuss themes, writing exercise, part of Marin Monsen’s film

January 28 What is Death?
In class: film excerpts from Wiseman’s “Near Death,” “King Lear,” and “Stand By Me”
Reading: Joseph Fletcher, “Indicators of Humanhood: A Tentative Profile of Man,” Hastings Center Report 2, 1-4, 1972.
Joseph Fletcher, “Indicators of Humanhood: The Enquiry Matures,”
Hastings Center Report 4, 4-7, 1974.
“Controversies in the Determination of Death: A White Paper by the President’s Council on Bioethics,” December 2008.
[“A definition of Irreversible Coma: Report of the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death,” JAMA 205, 85-88, 1968.
Robert Veatch, “The Impending Collapse of the Whole-Brain Definition of Death,” Hastings Center Report 4, 18-24, July-August, 1993.
James Bernat, “A Defense of the Whole-Brain Concept of Death,” Hastings Center Report 28, 14-23, March-April, 1998.
Youngner, Arnold, and DeVita,”When is Dead?” Hastings Center Report 29, 14-21, Nov-Dec, 1999.
Ronald Cranford, “Even the Dead are not terminally ill anymore,” Neurology 51, 1530-1531, 1998.
Alexander Morgan Capron, “Brain Death – Well Settled yet Still Unresolved,” NEJM, 344, 1244-1246, 2001.
“Pronouncing” (from “On being a doctor”)]

February 4 How We Die I
Reading: Sherwin Nuland, How We Die
Thomas Laqueur, “Closing Time” [review essay of Nuland] London Review of Books, August 18, 1994
Joanne Lynn and Joan Harrold, “Learning about specific illnesses,” Chapter 9 in Handbook for Mortals

February 11 The Hospital Chaplaincy and Hospice
Guest: Rev. Peter Yuichi Clark, Chaplain, Alta Bates-Summit Medical Center
Reading: on chaplaincy and hospice
Margaret Edson, W;t [may hold for future meeting] Arthur Kleinman, “Illness unto Death,” from Kleinman, The Illness Narratives (Basic Books, division of Harper Collins) pp. 148-157, 1988.
*James Wagner and Tami Hidgon, “Spiritual Issues and Bioethics in the Intensive Care Unit: The Role of the Chaplain,” Critical Care Clinics 12(1), January, 1996.
*Nancy Chambers and J Randall Curtis, “The Interface of Technology and Spirituality in the ICU,” Chapter 15 in Managing Death in the ICU: The Transition from Cure to Comfort, ed by Curtis and Rubenfeld. Oxford U Press. 2001.
*Bernard Lo, et.al., “Discussing Religious and Spiritual Issues at the End of Life: A Practical Guide for Physicians.” JAMA 287, 749-754, 2005.
*Edwin DuBose, “A Special Report: Spiritual Care at the End of Life.” Second Opinion 10, 4-74, 2002. The Park Ridge Center for Health, Faith, and Ethics.

February 18 Suffering and Dying
Reading: Leo Tolstoy, “The Death of Ivan Ilych” and “Three Deaths”; David Rieff, Swimming in a Sea of Death
Stephen Mitchell, “Trial before Pilate and the Crucifixion,” in The Gospel According to Jesus
“The Dart,” from the Salla Sutta
“Death of Socrates” in Plato’s “Phaedo,” 115b-118b
Letters of Seneca, from Letters from a Stoic, selected by Robin Campbell. Penguin Books. 1969.
“The Death of Hume,” Wilson Quarterly, Summer 1995, 30-39
Shakespeare, Measure for Measure, film clip to be shown in class

February 25 The “Good Death” I – Physician-assisted suicide (PAS), euthanasia
Reading: Anon, “It’s Over Debbie” and editorials, JAMA 259, 272, 1988. Letters to editor, JAMA 259, 2094-2098, 1988
Timothy Quill, “Death and Dignity: A Case of Individualized Decision Making,” NEJM 324, 691-694, 1991. Letters to editor, NEJM 325, 658-660, 1991
Kathleen Foley, “Competent Care for the Dying Instead of Physician-Assisted Suicide,” New England Journal of Medicine 336, 54-58, 1997
Marcia Angell, “No One Trusts the Dying,” The Washington Post, July 7, 1997
Roberts and Kjellstrand, “Jack Kevorkian: a medical hero,” British Medical Journal 312, 1434, 1996
Joanne Lynn, “Where’s the Outrage?” in The Exchange, a publication of Americans for Better Care of the Dying
U.S. Supreme Court decisions NY vs. Quill and Washington vs. Glucksberg
“California Compassionate Choices Act” – news reports.
The Oregon experience.
Daisy J A Janssen, et.al., “The last wish of a patient with end stage

chronic obstructive pulmonary disease,” BMJ 337, December 8, 2008. [Euthanasia in the Netherlands] The Field Poll on physician assisted suicide – 2006

Richard Selzer’s, “Mercy” [A “readers’ theater” performance in class]

March 4 The History of Death
Reading: tba
Guest: Thomas Laqueur, Professor of History, UCB

March 11 How We Die II – of various causes, end-of-life symptoms and management of these with palliative care
Guests: Claudia Landau, MD, PhD and Sheira Freedman, MD
Reading: *Joanne Lynn and Joan Harrold, Handbook for Mortals
*Joanne Lynn, “An 88-Year-Old Woman Facing the End of Life.” JAMA 277, 1633-1640, 1997.
Marcia Lattanzi-Licht and Stephen Connor, “Care of the Dying: The Hospice Approach,” Chapter 6 from Dying: Facing the Facts, ed by Wass and Neimeyer, Taylor and Francis, Publishers, 3rd ed. 1995.
*Gautam Naik, “Unlikely Way to Cut Hospital Costs: Comfort the Dying,” The Wall Street Journal, March 10, 2004.
*Teno and Connor, “Referring a Patient and Family to High Quality Care at the Close of Life: ‘We Met a New Personality … With This Level of Compassion and Empathy.'” JAMA 301, 651-9, 2009.

March 18 The “Good Death” II – Disability and “quality” of life; “futility”
Reading: Lonny Shavelson, “The Slippery Slope: Euthanasia for the Disabled” from A Chosen Death, Chapter 4 (pp.105-157), Simon and Shuster, 1995
The cases of Elizabeth Bouvia and Mark O’Brien
Terry Schiavo articles:
George Annas, “”Culture of Life” Politics at the Bedside – The Case of Terri Schiavo,” NEJM 352, 1710-1715, 2005.
Timothy Quill, “Terri Schiavo – A Tragedy Compounded,” NEJM 352, 1630-1633, 2005.
Pope John Paul II, “Address to the participants in the international congress on ‘Life-Sustaining Treatments and Vegetative State: Scientific Advances and Ethical Dilemmas,’” March 20, 2004.
United States Council of Catholic Bishops, “Cardinal Keeler Issues Statement on Florida Schiavo case; Stresses Church Teaching on Feeding, Hydration,” March 9, 2005.
Harriet McBryde Johnson, “Hey, Wait a Minute: Not Dead at All. Why Congress was Right to stick up for Terri Schiavo,” Slate, March 23, 2005.

March 25 Spring Break

April 1 Where We Die: Death in the Hospital
Guest: Sharon Kaufman
Reading: Sharon Kaufman, And a Time to Die: How American Hospitals Shape the End of Life, Chapter 1, Death and Hospital Culture, pp. 25–60 and Chapter 4, Moving Things Along, pp. 95–146.
Sharon Kaufman and Lakshmi Fjord, “Life Extension in an Aging Society: Medical Treatment and the Ethical Field,” submitted for publication to The Gerontologist, January 2009.

April 8 Truth-telling and Hope; Telling the “Bad News”
Reading: Hippocratic Corpus, “Decorum,” XVI.
Thomas Percival, “A Physician Should be the Minister of Hope and Comfort to the Sick,” from Percival’s Medical Ethics 1803
Thomas Addison, excerpt from Glomerular Nephritis, 1948
Kelly and Friesen, “Do Cancer Patients Want to Be Told?” Surgery 27, 822-826, 1950
Simon de Beauvoir, A Very Easy Death, 62-106, 1964
Novack, et al, “Changes in Physicians’ Attitudes Toward Telling the Cancer Patient,” JAMA 241, 897-900, 1979
Norman Cousins, “A Layman Looks at Truth Telling in Medicine,” JAMA 244, 1929-1930, 1980
Judge Jacob Turkel, “Remarks on Telling the Truth or Lying,” Medicine and Law 4, 91-93, 1985
Antonella Surbone, “Letter from Italy: Truth Telling to the Patient,” JAMA 268, 1661-1662, 1992
Edmund Pellegrino, “Is Truth Telling to the Patient a Cultural Artifact?” JAMA 268, 1734-1735, 1992
E.R.W. Fox, “A Dream Trip to Australia,” West J Med 145, 555, 1986
Lawrence Grouse, “The Lie,” Arch Intern Med 157, 2153, 1997
_____
Jerome Groopman, “Dying Words: How Should Doctors Deliver Bad News?” The New Yorker, October 28, 2002
Daniel Sulmasy, “Hope and the Care of the Dying Patient: A Catholic, Christian Perspective,” The Yale Journal for Humanities in Medicine, May 10, 2002.
Arato, et al. v. Avedon, Supreme Court of California, 1993
John Stone, “Talking to the Family”
Raymond Carver, “What the Doctor Said”
Donald Hall, from Without
Rick Fields, from Fuck You, Cancer

April 10-12 RETREAT at Green Gulch Farm
The retreat begins at dinnertime Friday, April 10 and ends with lunch on Sunday, April 12

April 15 Cultural differences in End-of-Life Care
Guest: LaVera Crawley, Research Associate, Stanford University Center for Biomedical Ethics
Reading: tba

April 22 and 29 Student presentations
or
Imaging Death
Guest: Beth Dungan, Art Historian, Director of Adult Education, SFMOMA
or –
On Suicide
or –
Aging/Old Age and Death; How long do you want to live? – Alcestis; “Fortitude;” Saramago, Death With Interruptions; Thomas Nagel, “Death;” Ionesco, Exit the King; Bernard Williams, “The Makropulos Case: Reflections on the Tedium of Immortality;” “What if it works?

May 6 Student presentations and Wrap-up
________

Required Reading:

The Course Reader

Sharon Kaufman, And a Time to Die: How American Hospitals Shape the End of Life
David Rieff, Swimming in a Sea of Death
Sherwin Nuland, How We Die
Leo Tolstoy, “The Death of Ivan Ilych”
Margaret Edson, W;t
Joanne Lynn and Joan Harrold, Handbook for Mortals: Guidance for People Facing
Serious Illness
Euripides, Alcestis
Ionesco, Exit the King

Recommended Reading:

Ram Dass, How Can I Help
Rachel Remen’s Kitchen Table Wisdom
Sandra Gilbert, Wrongful Death

Films: Moyers on Death; Notes from the Edge; Wiseman’s Near Death; Cancer in Two Voices; Wild Strawberries; The Dead; W;t; Flatliners; Ikuru; Steambath; The Deep Sea; The Diving Bell and the Butterfly; The Self-Made Man; Dying Wish; The Bridge; Fortitude