End-of-Course Reflection

Please comment on at least several if not all of these questions -- use separate posts if you like.   

What have you learned in this course that surprised you?

Would you take another course in philosophy if money/time weren't major barriers?  

Do you have an understanding of the philosophical dimensions of the study and critique of human nature and death & dying?

Have you developed an appreciation for the relevance of metaphysical, epistemological, and ethical questions in our daily lives?

Have you improved in your skills of analysis and critique, as well as in written and oral communication due to this course?

Reflections on Human Nature

Try to address 2 or 3 of the following prompts.  Respond to 1 or 2 of your classmates' postings.

• What is human nature?
• Why is a conception of human nature of important?  What does it do for us?

§  What ought we to do?

§  How ought we live?

§  What kind of society should we have?

§  Who is responsible for what and why?

§  What kind of economic & political system is just?

• What have you learned about death & dying that is important to you?  Is surprising to you?
• Has this helped you reflect on the meaning of life?
• What does life mean?  
• Am I living a good life? 
• What is death? 
• What’s my legacy?

Diving Bell and the Butterfly

More info on the film

• http://www.thedivingbellandthebutterfly-themovie.com/
• http://en.wikipedia.org/wiki/The_Diving_Bell_and_the_Butterfly
• http://www.salon.com/2008/02/23/diving_bell_2/

What questions do you have?  What was your favorite scene?  What "lessons" do you take away from the film? What surprised you? What made you sad?  Make an original post, then come back and comment on 2 of your classmates' posts.

Living Wills & End of Life Conversations

Related to Brittany Maynard and end of life,  PRI report:
http://www.pri.org/stories/2014-11-20/explore-final-moments-dying-man-who-chose-end-his-own-life

Questions to guide end of life conversations:

• http://associationdatabase.com/aws/MCA/asset_manager/get_file/73442/conversations_revision_jan_2014.pdf 
• http://www.dyingwell.org/faq.htm 
• http://theconversationproject.org/ 
• National Hospice & Palliative Care Organization
• http://www.nhpco.org/advance-care-planning
• http://www.nhpco.org/resources/end-life-care--resources

Disclaimer: check with your health care provider or attorney for up-to-date info, this is meant to be illustrative and informative, not legal.

State of Ohio packet of information --and a series of questions -- about end of life
http://associationdatabase.com/aws/MCA/asset_manager/get_file/73442/conversations_revision_jan_2014.pdf

Commonwealth of Kentucky Living Will packet
http://ag.ky.gov/civil/consumerprotection/livingwills/Documents/livingwillpacket.pdf

State of Illinois Living Will template
http://www.idph.state.il.us/public/books/Livin.PDF

Nov current events

*30Nov* OSU Football Student-Athlete, Kosta Karageorge Found Dead
http://espn.go.com/college-football/story/_/id/11960455/kosta-karageorge-ohio-state-buckeyes-found-dead 

Obama Condemns Islamic State’s Killing of Peter Kassig - NYTimes.com
Another beheading by Da'ish a.k.a., ISIS
http://mobile.nytimes.com/2014/11/17/world/middleeast/peter-kassig-isis-video-execution.html?emc=edit_th_20141117&nl=todaysheadlines&nlid=25414714&_r=0&referrer=

Tomas Young Dies at 34; Critic of Iraq War in Film - NYTimes.com
http://mobile.nytimes.com/2014/11/17/us/tomas-young-dies-at-34-critic-of-iraq-war-in-film.html?referrer=

In Death, Girl, 2, Is Caught in Fight Over Organshttp://www.nytimes.com/2014/11/17/nyregion/in-death-girl-2-is-caught-in-fight-over-organs.html?hp&action=click&pgtype=Homepage&module=second-column-region&region=top-news&WT.nav=top-news&_r=0

Military suicides
http://mobile.nytimes.com/2014/11/13/health/new-prediction-model-could-reduce-military-suicides-study-finds.html?emc=edit_th_20141113&nl=todaysheadlines&nlid=25414714&_r=0&referrer=

The concert

What did you think of James Falzone's performance?
Rawness, emotion, meditation, improv, prayer, reflection. What did it mean to you? How does it tie to the course?

Cross-Cultural Implications in Death & Dying

(the area for my senior project, fyi)


(California Healthcare Foundation) – New research highlights the ways in which culture frames end-of-life choices for patients and families. 
http://www.chcf.org/publications/2014/11/gather-round-culture-eol?utm_source=Coalition+for+Compassionate+Care+of+California&utm_campaign=a786db1239-November_newsletter11_7_2014&utm_medium=email&utm_term=0_fe8bdd104b-a786db1239-165205301 

Hospice

• National Hospice and Palliative Care Organization's 2014 Report  http://www.nhpco.org/sites/default/files/public/Statistics_Research/2014_Facts_Figures.pdf

• Many Americans Get Hospice Too Late  http://medicalxpress.com/news/2014-11-americans-hospice-late.html

• One local hospice--Hospice of the Bluegrass--for which I volunteer  http://www.hospicebg.org/ 

The info below came from a weekly news update I receive from Hospice of the Bluegrass 18Nov14

Research

There was an article in the Journal of the American Medical Association last week that examined the effects of enrolling in hospice care on health care utilization for patients with advanced cancer. The cohort of patients who received hospice care had significantly lower rates of hospitalizations, ICU admissions, invasive procedures at the end of life and lower health care costs.

This research contributes to a growing body of evidence that shows hospice services and palliative care services reduce health care utilization (e.g. ED visits, hospital admissions and readmissions, ICU admissions and invasive procedures). While this is important for all of us to know, we need to be careful how we talk about these outcomes. When we describe the benefit and value of hospice and palliative care services, the most important benefits are to the patient and family and any cost-savings are an epiphenomenon or side-effect.

There are scores, if not hundreds of research articles that demonstrate the impact of hospice and palliative care services on clinical outcomes. As you are likely aware it has been well established that hospice and palliative care teams reduce suffering from pain and symptoms, improve patient quality of life, increase caregiver well-being and ensure medical treatments are concordant with a patient’s preferences and values. I think the important take home point from this article is that patients who enrolled in hospice care were less likely to be hospitalized, admitted to the ICU and receive unwanted aggressive care as for many patients, part of their goals of care are to avoid any interaction with the hospital.

The article, a corresponding video and a commentary on quality, transparency and accountability from JAMA are all included below. I have also included comments from NHPCO on the research article and highlighted a quote from Don Schumacher. Finally, there are two research articles from the Journal of American Nursing included below and a blog post describing a new hospice and palliative medicine journal club on Twitter.

·         Association Between the Medicare Hospice Benefit and Health Care Utilization and Costs for Patients With Poor-Prognosis Cancer (Journal of the American Medical Association)

·         Video: Association Between the Medicare Hospice Benefit and Health Care Utilization and Costs for Patients With Poor-Prognosis Cancer (Journal of the American Medical Association)

·         Quality and Costs of End-of-Life Care: The Need for Transparency and Accountability (Journal of the American Medical Association)

·         NHPCO comments on new research (ehospice) - “We know that many people access hospice care too late to fully take advantage of all this team-based, patient and family-focused model of care can offer,” says J. Donald Schumacher, PsyD, President and CEO of NHPCO. “While patients with cancer still make up more than a third of all those cared for by hospice providers, their lengths of stay in hospice are among the shortest.  This points to the desperate need for clinicians treating cancer to have conversations about palliative care and hospice.”

·         Palliative Care Patients Fare Better with Earlier Referrals (American Journal of Nursing)- early referrals for outpatient palliative care reduced ED visits and hospitalizations. Call for increased education in communicating with the seriously ill among nurses.

·         Original Research: Staff Nurses’ Perceptions Regarding Palliative Care for Hospitalized Older Adults (American Journal of Nursing)- nurses play a pirvotal role as informed advocates for palliative care but there is need for more education as palliative care and hospice care were often confused.

·         Hospice and Palliative Medicine Journal Club on Twitter-#hpmJC (PalliMed)- there’s now a hospice and palliative medicine journal club active on Twitter.

 

Brittany Maynard, PAS

Here's the Google search with a bunch of articles:
https://news.google.com/news/story?ncl=http://www.cnn.com/2014/11/02/health/oregon-brittany-maynard/&hl=en&geo=US

Oregon's role in this debate
http://www.htrnews.com/story/opinion/editorials/2014/11/06/editorial-oregon-led-death-dying-debate/18603779/

Vatican Response
http://www.theguardian.com/us-news/2014/nov/03/brittany-maynard-us-right-to-die-laws

Veteran's Day, Armistice Day, poppies, & requiems

Stories and reports from today, Veteran's Day

• http://www.npr.org/blogs/thetwo-way/2014/11/11/363286759/on-armistice-day-in-u-k-a-sea-of-red-poppies-remembers-the-fallen
• http://www.npr.org/2014/11/11/362817642/a-marines-parents-story-their-memories-that-you-should-hear

Past Armistice Day Ceremony in London 

• BBC 2011 Remembrance Sunday Ceremony at the Cenotaph - Part 1 of 3 http://www.youtube.com/watch?v=oe9nE4LhnOo

Memorial Music (classical, but you should listen anyway)

• Barber's AGNUS DEI - Sacred Choral Music - The Choir of New College, Oxford http://www.youtube.com/watch?v=aRwhkBAeheM 
• http://www.youtube.com/watch?v=otcwvO3fXBE&feature=youtu.be  This is set to the very famous poem, In Flander's Field.  This Wikipedia entry explains the poem and the context, including the symbolism of poppies: http://en.wikipedia.org/wiki/In_Flanders_Fields

Atul Gawande's new Being Mortal: Medicine and What Matters in the End

Descriptions:

• http://atulgawande.com/book/being-mortal/ 
• http://www.amazon.com/Being-Mortal-Medicine-What-Matters/dp/0805095152

Reviews:

• http://www.bostonglobe.com/arts/books/2014/10/11/book-review-being-mortal-medicine-and-what-matters-end-atul-gawande/JwyaLEIAGOs5guUGBiG2YN/story.html
• http://www.sfgate.com/news/article/Being-Mortal-by-Atul-Gawande-review-5810483.php
• http://www.theguardian.com/books/2014/oct/22/being-mortal-medicine-what-matters-atul-gawande-review
• http://www.nytimes.com/2014/10/17/arts/being-mortal-by-atul-gawande.html