SYP6745 (SYA7933): Aging and End-of-Life Issues
Fall
2009
Class: Thursdays 6:15 to 9:10 p.m. in 2303 Turlington
Instructor: Monika
Ardelt, Ph.D.
Office: 3350
Turlington
Phone: 392-0265
ext. 247
E-mail: Ardelt@ufl.edu
Office Hours: Wednesday
s and Thursdays 1:45-2:45 p.m. and by appointment
WWW: http://web.clas.ufl.edu/users/ardelt/
Course Content
What constitutes dying well for older
persons, and how can families and institutions make the dying experience less
painful and more emotionally rewarding for the dying and those close to them? I
define dying well as the maintenance of psychological well-being, even under
adverse circumstances. Based on a theoretical orientation that assumes
life-long psychosocial development and potential for psychological growth, the
dying experience can be considered the last developmental milestone of a
person’s life course. However, dying well in old age is still a relatively
neglected topic. Unfortunately, dying well also appears to be the exception
rather than the norm. Too many older people spend their last days or hours of
their lives in places, such as hospitals or nursing homes, that may not spare
any expenses to keep them alive but lack the human contact and compassion to
facilitate a “good” death.
In this course, we will explore the issues
surrounding dying well from multiple perspectives, including sociology,
psychology, biology, medical sciences, ethics, history, spirituality/religion,
and economics. In particular, we will start by studying dying well from a
developmental or life course perspective. Then we will discuss the medical,
psychological, social, spiritual/religious, economic, ethical, and legal
aspects of death and dying. We will end the course by considering cultural
variations in end-of-life issues, examining the grieving process for survivors,
and discussing the question of life after death.
Required
Gaughen, Shasta.
2003. Coping with Death. Contemporary Issues Companion.
Nakaya, Andrea C. 2005. Terminal Illness. Opposing Viewpoints.
Tolstoy, Leo. 2003. The Death of Ivan Ilych and Other Stories. New York: New American Library. (Available for purchase at Goerings Textbooks, 1717 NW 1st Avenue, Gainesville, FL 32603, Tel. 352-377-3703, goerings@bellsouth.net)
Additional reading will be made available to students through the instructor’s “library”.
Recommended
Maimon, Elaine P., Janice H. Peritz, and
Kathleen Blake Yancey. 2007. A Writer’s Resource. A
Handbook for Writing and Research. 2nd
Edition.
Requirements
To prevent the instructor from doing all of
the talking during class, each student will serve as the discussion leader for
two class sessions, which will be rewarded with 10% of the final grade (5% for
each class session). There might be more than one discussion leader for a given
topic. As discussion leaders, students will have the privilege to ask their
most “burning” questions about the class topic first and add information from 1
or 2 recent article(s) or book chapter(s) that are not listed in the class
schedule outline to the discussion. To receive full credit, students need to
give the instructor the complete reference(s) and an electronic or hard copy of
the additional article(s) or book chapter(s).
Attendance: Attendance of class is
required because non-attendance by several students at a time will destroy the
dynamic of the class. Students who have to miss all or part of a class session
must inform the instructor in advance about their absence.
Service Learning Project: To facilitate learning and to understand the material
from an experiential perspective, students are asked to volunteer for 2-4 hours
each week (after receiving the appropriate training) either at Haven Hospice of
North Central Florida http://www.havenhospice.org/volunteer_opportunities.html
or at one of the nursing homes in Gainesville (see http://web.clas.ufl.edu/users/ardelt/List_of_Nursing_Homes_in_Gainesville.htm).
As their volunteering experience, students should assist and/or be a companion
to older residents who are near the end of their lives.
Reflection
Journal:
For each class, you will write at least three pages (i.e., a minimum of 72 lines) for a reflection “journal”.
Reflections should be typed and
double-spaced and should contain a heading that identifies the
student and the class topic. To receive credit for the reflection journal
entries, you should submit them during
the class for which the entries were written. Each set of reflection
journal entries is worth 3 points for a total of 33% of your final grade.
Before you
start volunteering, the reflection journal entries will consist of one or more questions
based on the assigned readings and possible answers to those questions or
issues that should be considered when attempting to answer those questions.
Reflect on how the readings might be relevant for your personal or professional
life.
After you started volunteering, the reflection journal entries will begin with a
detailed description of the service learning experience during the past week.
This will be followed by an analysis of the experience, particularly with
regard to the current class topic and the assigned readings. End by reflecting
on the relevance of the service learning experience and/or the course content
for your personal or professional life. For each set of reflection journal
entry, use the following subheadings: (a) service learning experience from
<date(s)>, (b) analysis of the service learning experience, (c)
application to personal or professional life.
The following are guidelines for writing the
description of your service learning experience:
1. Write down the date, time, and location of the service learning experience.
2. Describe the environment (does not need to be repeated if the environment does not change in subsequent visits).
3. Describe all persons in detail, i.e., age, gender, race, physical appearance, etc. (does not need to be repeated if the same persons are encountered in subsequent visits).
4. Make sure that all persons remain anonymous, i.e., use only pseudonyms as names.
5. Describe what people are doing when you arrive. Give a physical description of the people – clothes etc.
6. Give your impression of the resident(s) – (mental alertness, physical demeanor, etc.)
7. Describe your service learning experience in chronological order and in as much detail as possible.
8. Include any information that you think would be noteworthy.
Term Paper: There will be one term
paper that is due on December 3 during regular class time. The term paper
should be based on your service learning project and your reflection journal.
It should be between 15 and 25 pages long. You will present a summary of your
term paper during the class meeting on December 3. Detailed instructions for
the term paper will be distributed in class.
Cheating: I define copying parts or
all of an author’s or another student’s work, allowing another student to copy
parts or all of your work, or simply duplicating parts or all of your
reflection journal entries as cheating.
WARNING:
Students who are caught cheating in this way will fail the class immediately!
Exams: There are no exams in this
course!
Accommodations for Students with Disabilities: Students requesting classroom accommodation must first register with the Dean of Students Office. The Dean of Students Office will provide documentation to the student who must then provide this documentation to the Instructor when requesting accommodation.
Grading
|
Requirement Discussion leader Reflection journal Term paper Presentation of paper |
% of Final Grade
10%
33%
47%
10% |
I will not grade on a curve, i.e. your grade
will depend on your absolute performance, not your performance compared to
other students.
The points that you will earn can be
translated into letter-grades as follows:
|
92.5 - 100.0 = A 90.0 - <92.5 = A- 87.5 - <90.0 = B+ 82.5 - <87.5 = B 80.0 - <82.5 = B- 77.5 - <80.0 = C+ |
72.5
- <77.5 = C 70.0
- <72.5 = C- 67.5
- <70.0 = D+ 62.5
- <67.5 = D 60.0
- <62.5 = D- <60.0 = E |
For information on current UF grading
policies for assigning grade points, see http://www.registrar.ufl.edu/catalog/policies/regulationgrades.html
Tentative Class Schedule
08/27 - Introduction: Preparing to Become a Compassionate Companion
09/03 - Living
with Death and Dying
Coping with death: pp. 15-20.
Tolstoy, Leo. The Death of Ivan Ilych.
Rolheiser, Ron. 2005. “Life’s Key Question.” Good News 12, Oct. 15-16.
Chinen, Allen B.
1995. “The Mortal King.” Pp. 335-36 in The Path Ahead. Readings in Death and Dying,
edited by L. A. DeSpelder and A. L. Strickland.
Attig, Thomas. 1995.
“Coping With Mortality: An Essay on Self-Mourning.” Pp. 337-41 in The Path Ahead. Readings in Death and Dying,
edited by L. A. DeSpelder and A. L. Strickland.
Killilea, Alfred G.
1995. “The Politics of Being Mortal.” Pp. 342-47 in The Path Ahead. Readings in Death and Dying,
edited by L. A. DeSpelder and A. L. Strickland.
Bertman, Sandra L.
1995. “Bearing the Unbearable: From Loss, the Gain.”
Pp. 348-54 in The Path Ahead. Readings in Death and Dying,
edited by L. A. DeSpelder and A. L. Strickland.
Enck, Graves. 2003. “The Dying Process.” Pp. 457-67 in Handbook of Death and Dying. Vol. I: The presence of death, edited by C. D. Bryant et al. Thousand Oaks, CA: Sage.
09/10 - No class
No
regular class: Meet at the
Reitz Union in classroom 355 from 6 to 9 p.m. for Hospice
volunteer training. Additional required
Hospice volunteer training is on September 15, 21, and 24 at the Reitz
Union in classroom 355 from 6 to 9 p.m.
09/17- Biological, Psychosocial, and Spiritual
Perspectives of the Dying Process
Biological Perspective
Coping with death: pp. 11-14.
Nuland, Sherwin B. 1994. How We Die. Reflections on Life’s Final Chapter. New York: Knopf, Chapters 3-5.
Psychosocial Perspective
Kübler-Ross,
Elisabeth. 1969. On Death and Dying.
Edgley, Charles. 2003. “Dying as Deviance. An Update on the Relationship between Terminal Patients and Medical Settings.” Pp. 448-56 in Handbook of Death and Dying. Vol. I: The presence of death, edited by C. D. Bryant et al. Thousand Oaks, CA: Sage.
Spiritual Perspective
Kübler-Ross,
Elisabeth. 1999. “The Cocoon and the Butterfly.” Pp. 41-76 in The Tunnel and the Light. Essential Insights on
Living and Dying, edited by G. Grip.
Dass, Ram. 2001. Still Here: Embracing Aging, Changing, and
Dying.
Singh, Kathleen Dowling. 2000. The Grace in Dying: How We Are Transformed
Spiritually as We Die.
No
regular class: Meet at the
Reitz Union in classroom 355 from 6 to 9 p.m. for Hospice
volunteer training.
10/01 - Hospice and Palliative
Care
Terminal illness: pp. 19-35, 49-57, 78-90, 102-112
Coping with death: pp. 51-54, 114-125
Byock, Ira R.
1996. “The Nature of Suffering and the Nature of
Leming, Michael R. 2003. “The History of the Hospice Approach.” Pp. 485-94 in Handbook of Death and Dying. Vol. I: The presence of death, edited by C. D. Bryant et al. Thousand Oaks, CA: Sage.
Connor, Stephen R.
2000. “Hospice Care and the Older Person.” Pp. 227-38 in Death Attitudes
and the Older Adult. Theories,
Concepts, and Applications, edited by A. Tomer.
Brabant, Sarah. 2003. “Death in Two Settings. The Acute Care Facility and Hospice.” Pp. 475-84 in Handbook of Death and Dying. Vol. I: The presence of death, edited by C. D. Bryant et al. Thousand Oaks, CA: Sage.
Zerzan, Judy, Sally Stearns, and Laura Hanson. 2000. “Access to Palliative Care and Hospice in Nursing Homes.” Journal of the American Medical Association 284:2489-94.
10/08 - Being with Dying
Terminal illness: pp.115-127, 134-141
Wray, Elizabeth. 2003. “Learning to Let Go.” Alternative Medicine 57, May 2003: 88-126.
Steinhauser, Karen E, Elizabeth C Clipp, Maya McNeilly, Nicholas A
Christakis, Lauren M McIntyre, and James A Tulsky. 2000. “In Search of a Good Death:
Observations of Patients, Families, and Providers.” Annals of Internal
Medicine 132 (10):825-32.
Kovacs, Pamela J. and David P. Fauri. 2003. “Formal and Informal Caregiving at the End of Life.” Pp. 502-10 in Handbook of Death and Dying. Vol. I: The presence of death, edited by C. D. Bryant et al. Thousand Oaks, CA: Sage.
Gross, Jane.
2009. “Sisters Face Death with Dignity and Reverence.” The New York Times,
July 9, 2009.
Fahnestock, Deborah T. 1999. “A Piece of My Mind: Partnership for Good Dying.” Journal of the American Medical Association 282:615-16.
Orr, Robert D. 2001. “A Piece of My Mind: You Have the Power.” Journal of the American Medical Association 286:2067-68.
Sachs, Greg A. 2000. “A Piece of My Mind: Sometimes Dying Still Stings.” Journal of the American Medical Association 284:2423.
10/15 - The Role of Religion and Spirituality at the End of
Life
Terminal illness: pp. 128-133
Coping with death: pp. 38-43, 108-113
Daaleman, Timothy P. and Larry VandeCreek. 2000. “Placing Religion and Spirituality in End-of-Life Care.” Journal of the American Medical Association 284:2514-17.
Thibault, Jane. 2003. “How Can Health Care Professionals Meet the Spiritual Needs of Dying Older Patients.” Geriatric Times I:6pp.
Doka, Kenneth
J. 1993. “The Spiritual Need of the Dying.” Pp. 143-50 in Death and
Spirituality, edited by K. J. Doka and J. D. Morgan.
Morgan, John D. 2003. “Spirituality.” Pp. 110-16 in Handbook of Death and Dying. Vol. I: The presence of death, edited by C. D. Bryant et al. Thousand Oaks, CA: Sage.
Leming, Michael R. 2003. “Religion and the Mediation of Death Fear.” Pp. 117-25 in Handbook of Death and Dying. Vol. I: The presence of death, edited by C. D. Bryant et al. Thousand Oaks, CA: Sage.
Siegel, Karolynn and Eric W. Schrimshaw. 2002. “The Perceived Benefits of Religious and Spiritual Coping Among Older Adults Living With HIV/AIDS.” Journal for the Scientific Study of Religion 41:91-102.
Horrigan, Bonnie. 2001. “Therese Schroeder-Sheker: Music Thanatology and Spiritual Care for the Dying.” Alternative Therapies 7: 69-77.
10/22 - The Cost of Health Care
and End-of-Life Care for Older Adults
Coping with death: pp. 55-60
Brogden, Mike.
2001. Geronticide. Killing the Elderly.
Callahan, Daniel. 1990. “Why We Must Set
Limits.” Pp. 23-36 in A Good Old Age? The Paradox of Setting Limits,
edited by P. Homer and M. Holstein.
Holstein, Martha. 1990. “Voices of the
Old.” Pp. 37-43 in A Good Old Age? The Paradox of Setting Limits,
edited by P. Homer and M. Holstein.
Wetle, Terrie and Richard W. Besdine.
1990. “Letting Individuals Decide.” Pp. 53-57 in A Good Old Age? The Paradox of Setting Limits, edited by P. Homer
and M. Holstein.
Perry, Daniel and
Robert N. Butler. 1990. “Aim Not Just for Longer Life, but Expanded
‘Health Span’.” Pp. 91-94 in A Good Old Age? The
Paradox of Setting Limits, edited by P. Homer and M. Holstein.
Somers, Anne R. 1990. “Setting
Limits or Promoting Health?” Pp. 101-5 in A Good Old Age? The Paradox of Setting Limits, edited by P. Homer
and M. Holstein.
Reagan, Michael D. 1993. “Is Global
Budgeting the Way to Set Limits on Health Care for the Elderly?” Pp. 125-35 in Facing Limits. Ethics and Health Care for the Elderly, edited
by G. R. Winslow and J. W. Walters.
Menzel, Paul T.
1993. “Counting the Costs of Lifesaving Interventions for the
Elderly.” Pp. 137-49 in Facing Limits. Ethics
and Health Care for the Elderly,
edited by G. R. Winslow and J. W. Walters.
Begley, Charles E. 1993. “Cost
Containment and Conflicts of Interest in the Care of the Elderly.” Pp. 151-60 in Facing Limits. Ethics and Health Care for the Elderly, edited
by G. R. Winslow and J. W. Walters.
Schneider, Edward L. 1993. “Changing the Debate about Health Care for the Elderly.” Pp. 161-74 in Facing Limits. Ethics and Health Care for the Elderly, edited
by G. R. Winslow and J. W. Walters.
Spielman,
Bethany. 1993. “Achieving Equity and Setting Limits: The Importance of Gender.”
Pp. 177-89 in Facing
Limits. Ethics and Health Care
for the Elderly,
edited by G. R. Winslow and J. W. Walters.
Culpepper, Emily Erwin. 1993. “Ageism,
Sexism, and Health Care: Why We Need Old Women in Power.” Pp.
191-209 in Facing Limits. Ethics and Health Care for the Elderly, edited
by G. R. Winslow and J. W. Walters.
Winslow, Gerald R. 1993. “Exceptions and the Elderly.” Pp. 231-43
in Facing Limits. Ethics and Health Care for the Elderly, edited
by G. R. Winslow and J. W. Walters.
Holmes, Holly M., Déon Cox Hayley, G. Caleb
Alexander, and Greg A. Sachs. 2006. “Reconsidering Medication Appropriateness for Patients Late in
Life. Archives of Internal Medicine 166 (6):605-609.
10/29 - Euthanasia and
Physician-Assisted Suicide
Terminal illness: pp. 91-101, 144-188
Coping with death: pp. 126-136
Quill, Timothy E. 1993. “Doctor, I Want to Die. Will You Help Me?” Journal of the American Medical Association 270:870-73.
Angell, Marcia. 1997. “The Supreme Court
and Physician-Assisted Suicide - The Ultimate Right.” The
Foley, Kathleen M. 1997. “Competent Care for the Dying Instead of Physician-Assisted
Suicide.” The
Eddy, David M. 1994. “A Piece of My Mind: A Conversation with My Mother.” Journal of the American Medical Association 272:179-81.
Muskin, Philip R. 1998. “The Request to Die: Role for a Psychodynamic Perspective on Physician-Assisted Suicide.” Journal of the American Medical Association 279:323-28.
Hardwig, John.
1997. “Is There a Duty to Die?”
Osgood, Nancy J. 2000. “Ageism and
Elderly Suicide: The Intimate Connection.” Pp. 157-73 in Death Attitudes and the Older Adult. Theories, Concepts, and Applications,
edited by A. Tomer.
Moody, Janis. 2003. “Euthanasia: A Need for Reform.” Nursing Standard 17:40-44.
Ganzini, Linda, Elizabeth R. Goy, and Dobscha, S. K. (2008). Prevalence of Depression and Anxiety in Patients
Requesting Physicians’ Aid in Dying: Cross Sectional Survey [Electronic
Version]. BMJ 337:
a1682. Retrieved January 14, 2009.
Meier, Diane E. 1998. “A Change of Heart on Assisted Suicide.” The New York Times, April 24, 1998.
McNeil, Donald G. Jr. 2003. “First Study on Patients Who Fast to End Lives.” The New York Times, July 31, 2003.
11/05 - Legal Preparations for
the End-of-Life
Terminal illness: pp. 36-48
Coping with death: pp. 44-50
Five Wishes at http://web.clas.ufl.edu/users/ardelt/Five_Wishes.pdf
Pevey, Carolyn. 2003. “Living Wills and Durable Power of Attorney for Health Care.” Pp. 891-98 in Handbook of Death and Dying. Vol. II: The response to death, edited by C. D. Bryant et al. Thousand Oaks, CA: Sage.
Glass, Anne P. and Lusine Nahapetyan. 2008. “Discussions by Elders and Adult Children about End-of-Life Preparation and Preferences [Electronic Version]. Preventing Chronic Disease. Public Health Research, Practice, and Policy 5:8 pp. Retrieved August 18, 2009.
Fagerlin,
Angela and Carl E. Schneider. 2004. “Enough. The
Failure of the Living Will.”
Miller, Robert K. Jr, Jeffrey Rosenfeld, and Stephen J. McNamee. 2003. “The Disposition of Property. Transfers between the Dead and the Living.” Pp. 917-25 in Handbook of Death and Dying, edited by C. D. Bryant et al. Thousand Oaks, CA: Sage.
11/12 - Cultural Variations in End-of-Life Issues
Meagher, David K. and
Craig P. Bell. 1993. “Perspectives on Death in the Africa-American
Community.” Pp. 113-30 in Death
and Spirituality, edited by K. J. Doka and J. D.
Morgan.
Mouton, Charles P. 2000. “Cultural and Religious Issues for African Americans.” Pp.
71-82 in Cultural Issues in End-of-Life
Decision Making, edited by K. L. Braun, J. H. Pietsch,
and P. L. Blanchette.
Talamantes, Melissa A., Celina Gomez, and Kathryn L. Braun. 2000.
“Advance Directives and End-of-Life Care: The Hispanic Perspective.” Pp. 83-100
in Cultural Issues in End-of-Life Decision
Making, edited by K. L. Braun, J. H. Pietsch, and
P. L. Blanchette.
Yeo, Gwen and Nancy Hikoyeda. 2000.
“Cultural Issues in End-of-Life Decision Making Among Asians and Pacific
Islanders in the
Long, Susan Orpett. 2004. “Cultural Scripts for a Good Death in
Japan and the United States: Similarities and Differences.” Social Science
& Medicine 58 (5):913-928.
Krakauer, Eric L., Christopher Crenner, and Ken Fox. 2002. “Barriers to Optimum End-of-Life Care for Minority Patients.” Journal of the American Geriatrics Society 50:182-90.
Coping with death: pp. 61-65, 67-72, 80-83, 97-100, 141-147
Doka, Kenneth
J. 1993. “The Spiritual Crisis of Bereavement.” Pp. 185-93 in Death and
Spirituality, edited by K. J. Doka and J. D.
Morgan.
Neimeyer, Robert A. and Louis A. Gamino. 2003. “The Experience of Grief and Bereavement.” Pp. 847-54 in Handbook of Death and Dying. Vol. II: The response to death, edited by C. D. Bryant et al. Thousand Oaks, CA: Sage.
Rosenblatt, Paul C. 2003. “Bereavement in Cross-Cultural Perspective.” Pp. 855-61 in Handbook of Death and Dying. Vol. II: The response to death, edited by C. D. Bryant et al. Thousand Oaks, CA: Sage.
12/03 - Is There Life after
Death? and Class Presentations of Papers
Coping with death: pp. 21-36
Dillon, Jane. 2003. “Reincarnation. The Technology of Death.” Pp. 65-76 in Handbook of Death and Dying. Vol. I: The presence of death, edited by C. D. Bryant et al. Thousand Oaks, CA: Sage.
Gowan, Donald E. 2003. “Christian Beliefs Concerning Death and Life after Death.” Pp. 126-36 in Handbook of Death and Dying. Vol. I: The presence of death, edited by C. D. Bryant et al. Thousand Oaks, CA: Sage.
Rodabough, Tillman and Kyle Cole. 2003. “Near-Death Experiences as Secular Eschatology.” Pp. 137-47 in Handbook of Death and Dying. Vol. I: The presence of death, edited by C. D. Bryant et al. Thousand Oaks, CA: Sage.
Betty, L.
Stafford. 2006. “Are They Hallucinations or Are They Real? The
Spirituality of Deathbed and Near-Death Visions.” Omega: Journal of
Death & Dying 53 (1/2):37-49.
Kübler-Ross,
Elisabeth. 1999. “Life, Death and Life after Death.” Pp. 79-106 in The Tunnel and the Light. Essential Insights on
Living and Dying, edited by G. Grip.
Rolheiser, Ron. 2004. “The Law of Karma.” February 8, 2004, http://www.ronrolheiser.com/