Health and Society

How We Die

HOW WE DIE

Until recent decades among the most taboo areas of discussion, issues about how we die are moving into center stage among the century’s most challenging social issues.   We no longer die primarily of infectious and parasitic disease, as was true worldwide up through about the middle of the 19th century and is still true in some parts of the developing world; now the great majority of people in the developed world with advanced health care systems die slow deaths, of degenerative diseases typically diagnosed long in advance and exhibiting long downhill courses, made possible in part by modern medical science—cancer, heart and other types of organ failure, the dementias.

This is how we die. But is it how we wish our dying to go, either for ourselves or for those we love? Current political ferment over end-of-life medical practice and right-to-die legislation is exploding into the public arena: it is these issues we wish to explore and, in doing so, construct more sensitive and effective ways of responding to them.

*Please note this Praxis Lab is offered off-cycle and will be taught Spring 2016 and Fall 2016. We are no longer taking applications for this Lab.

In the first semester, we will consider, among other things, the background epidemiology of how we die, including developed and developing-world mortality patterns; strategies for “negotiating” death, including do-not-resuscitate orders, withholding and withdrawal of care, the (over)use of opioids and other medications foreseeing though not intending that death with occur; palliative care and terminal sedation; and physician-assisted dying, called death with dignity, as is legal in Oregon, Washington, Vermont and a number of European countries. What about dying in homicides, suicides, high-risk sports and exploration, dying in self-sacrifice, religious martyrdom, or kamikazi, jihad, and military situations? What about suicides of social protest? What mechanisms are available, such as Living Wills and durable powers of attorney, to protect patients’ wishes about how they die? What difference do institutional settings make, like ICUs and long-term nursing facilities? What about media portrayals of death and dying, from classics like E.R. to fantasy and science fiction—what role do these play in how we think about death? What about gender issues, age issues, racial and economic disparities, and so forth? What about the costs of health care?   How do beliefs about the value of life and the possibility of immortality play a role in how we die? During this semester, participants in the Praxis Lab will compile short research reports on such topics and others that contribute to a larger, more comprehensive picture of how we die.

That’s the background set-up for the second semester. The question now is what to do about this picture—where is it deficient and what could be done to change this? That is the challenge for the group of participants in the Praxis Lab. Because the summer semester intervenes between its first semester in Spring 2016 and its second semester in Fall 2016, participants may have wanted to do such things as review national and international policies affecting how we die—for instance, about pain management strategies or investigational drugs; or volunteer with a Hospice program; or shadow a physician who works with terminally ill patients; or make use of international travel to explore how dying goes in other quite different nations, and so on. Depending on what the group elects to do or not do over the intervening summer semester, schedule adjustments may be made in the fall semester to recognize these efforts and maximize their contribution to the Praxis Lab project.

Days, time – Tuesdays 3:40-6:40pm MHC 1206A

Applications are being accepted through October 30th

Faculty

Margaret P. Battin, PhD – Distinguished Professor, Philosophy and Adjunct Professor, Internal Medicine and Division of Medical Ethics and Humanities

If you want to address me formally, it’s Margaret Pabst Battin, M.F.A., PhD., Distinguished Professor of Philosophy and Adjunct Professor of Internal Medicine, Division of Medical Ethics and Humanities, at the University of Utah, or, for short, Peggy.  You could make it more ostentatious by pointing out that I’ve authored, co-authored, edited, or co-edited at least twenty books (I think I’ve lost count), including works on philosophical issues in suicide, case-puzzles in aesthetics, ethical issues in organized religion, and various topics in bioethics.  You could embellish it by observing that I’ve published two collections of essays on end-of-life issues, The Least Worst Death and Ending Life, and have been the lead for two multi-authored projects, Drugs and Justice and The Patient as Victim and Vector: Ethics and Infectious Disease.  In 1997, I won the University of Utah’s Distinguished Research award, and in 2000, received the Rosenblatt Prize, the University’s most prestigious award. You can find a TEDMED talk I did in 2014 by googling the web. This is all very flattering, but what’s important to me is not just what I’ve done in the past, but what I’m working on now: a comprehensive historical sourcebook on ethical issues in suicide, being published by Oxford, a multi-co-authored volume of case-puzzles about issues in disability (also Oxford), and a book on large-scale reproductive problems of the globe, including population growth and decline, teen pregnancy, abortion, and male roles in contraception, along with new ideas like urban design or thought-experiments or even how to redesign the ICU. Of course, there’s hardly ever enough time, but big new make-the-world-a better-place ideas, the very kind of thing a Praxis Lab is intended to generate, seem to me what it’s all about.
Jennifer H. Edwards, MD

I am a practicing intensivist, which means I work in the intensive care unit. I completed a residency in Emergency Medicine, and a fellowship in Critical Care Medicine. For 3+ years I was on faculty as an assistant professor in the Department of Critical Care Medicine at the University of Pittsburgh, where I taught medical students, residents and fellows, and created and ran their Morbidity and Mortality conference. My undergraduate degree is in Philosophy, and I am currently taking Philosophy courses at the University of Utah. I have found that philosophy, ethics and difficult ‘life decisions’ play a prominent role in the ICU, and to some extent in many areas of medicine. “How we die” is a particular interest of mine.

Roger A. Freedman, M.D. – Professor (Clinical), Department of Medicine

I am a practicing cardiologist at University Hospital, a position I have held for over 20 years. My practice is about 50% outpatient care and about 50% procedures, such as pacemaker implants. For years I have been teaching medical students, residents and fellows, and I currently have a leadership role in cardiology fellowship training at U. I have also held leadership roles in Contracting for University physicians and the University Hospital, which involves negotiating payments from the various insurance payers in the state. This Praxis Lab will be my first experience teaching undergraduates (since I was a TA in college…).