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08/11/2015

…So That We Know How to Live

by Craig Klugman, Ph.D.

This Spring Quarter I had the honor of creating and teaching a new course at my university: HLTH 341 Death & Dying. Most readers of this blog in bioethics probably work in the medical school environment. When I taught in a medical school we provided lessons and experiences in giving bad news and hospice. We may have even taught briefly on the diagnostic tools to diagnose death. In one session put on by the Palliative Care program (thanks Sandra), students met with survivors and learned about death from the family perspective and how palliative care informed that experience.

I now teach in an undergraduate (baccalaureate) program. My students are 18 to 24 years of age. Few of them have worked with patients. Few have experienced the death of a loved one. Most are searching for a personal and professional identity—figuring out who they want to be in the world. This is not a professional program where people are trained for specific jobs, but a liberal arts curriculum where we teach people to be independent thinkers and good citizens of the world.

Most undergraduate schools and universities have a course with a similar title. Sometimes the course is taught through Anthropology & Sociology and examines how people around the world hold beliefs and rituals around the end of life. Sometimes it is a Psychology course that examines human responses to death, mourning, and grief. And other times it may be a course in Philosophy or Religious Studies that looks at various belief systems, historic practices, and sacred texts that discuss the good death and what comes next.

My class was taught in Health Sciences, an interdisciplinary approach to studying human health where we use the natural sciences, social sciences, and humanities. This class employed all three of those ways of knowing as a survey of human death & dying. We used public health to look at the causes of death and briefly looked at how people die from those diseases/conditions. We used clinical medicine and to learn about diagnosing death and the hospice/palliative care experiences. A medical examiner showed us how corpses tell stories. The natural sciences taught us how cells explode and how insects and bacteria consume the corpse.

Through Bioethics, local experts in “the conversation” talked to students about advance care planning as well as looking at advance directives, euthanasia, and assisted suicide. Sociological perspectives brought us a funeral director talked to us about the funeral industry and how standard American funerals work. We explored how humans died and views of dying throughout history. Psychology offered us perspective on grief and mourning. Anthropology gave us a look at funeral practices and death beliefs in other cultures. And Religion offered views of the afterlife. From the Medical Humanities, we read novels, poems, plays, and short stories. Over 10 weeks, we had 5 guest lecturers who gave of their time, experience, and expertise.

Students had the most profound experiences from the course activities. They conducted a field study where they spent several hours in a place associated with death. Many went to cemeteries. One went to a funeral parlor. Another went to the medical examiner’s office. They created a wiki on death and dying from different cultures and historical times. Students wrote a “deathography,” their personal history of experience with death and completed their “last hours of life” survey to think about how they want to die.

The assignment that students said significantly changed them was writing their own obituary. As a former journalist (and one that for a summer wrote obits for a small newspaper), I taught them about this writing form and each student wrote his or her own. They could choose whatever age and reason for their death. They could decide who their family might be, what profession they might have, and for what they would be known. Some chose to write from the perspective of dying now and others from dying at 120 years of age. Universally, however, they said that this assignment made them really think about what was important and what they wanted to make of life.

On the first night of class, I had 18 students, about a third of whom had not experience the death of a close loved one. By the second meeting I had 23 and one student who really wanted the course but had no room in her schedule. Could she audit? I said yes and she was a great contributor. Most students were in the Health Sciences program but one was an English major, one was a Psychology major, and one was in Anthropology. They were open. They allowed themselves to be vulnerable.

We talked about how to talk to someone who was dying and what to say to someone in mourning. We discussed funeral etiquette and other life skills.

The class was challenging academically and personally. The students had to think not only about death in society and of others but also the notion that their own life would some day end. The day we went to the university museum to look at photographs of a body farm was viscerally difficult—staring at images of decaying bodies. The day on grief and mourning was emotionally challenging. The slideshow on corpses that died by violent means presented by the medical examiner’s office left us in shock.

After the course, they thanked me for the experience. Several of them said the course changed what they wanted to do with their lives both professionally and personally. Several of them had friends or relatives die during the course—the practical application of their learning created a special meaning for this learning experience for them. Most of them told me about having “the conversation” with friends or family and sharing course concepts with others. What began in the classroom quickly rippled out into a wider world.

The students and I had a chance in a liberal arts setting to explore human death and dying. But most people do not. Maybe such a class should be available in continuing education or as a community service project.

As the 10 weeks passed, our interdisciplinary exploration of this basic human experience seemed to focus on a single theme: Life. Most weeks I would ask them question, “Why are we studying death and dying? What attracted you to study this topic that most people try to avoid?” By knowing the finality of life, thinking about its meaning and what you want to leave as your legacy, you know what kind of person you want to be and how you want to live. By the end, our unofficial class motto was “We study death and dying so we know how to live.” And after class, I sent them out to live the lives for which they wanted to be remembered.

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