Notes in the Margin - 3/8/24
I’m bringing back commentaries on things I want to share with you but won’t make into a full essay. I’ll include them in a separate space so they don't make the regular (already long) essays longer. There won’t be any particular schedule. If ever you want to share something with me, just leave it in the comments.
The Strength It Takes to Suffer
Randy Curtis was a leader in palliative care who was afflicted with amyotrophic lateral sclerosis (ALS). Here we have the account from his wife and daughter that he chose to end his life via assisted suicide. Ken Covinsky provides a brief accompanying commentary. These two essays together remind me you cannot, and probably shouldn’t, respond to stories with arguments. Covinsky laments the death of Curtis and expresses his own reluctance to support assisted suicide, but admits Curtis’s story has grown his ambivalence toward the practice. It perhaps has even nudged Covinsky toward support.
Anyone who has worked in hospice and palliative care keeps in their heart dozens, if not hundreds, of stories of courage, resilience, and compassion demonstrated by patients and their families. If we determine that what made these stories true, good, and beautiful is that people did it their way, that these were shrines to individual autonomy, we’ll have desiccated medical practice to the mere satisfaction of preference, rather than the pursuit of health (whatever little bit of it someone may have). On the other hand, if these stories show us something true, good, and beautiful apart from instantiations of autonomy, they provide lights for the path toward a better practice of medicine and a counter-narrative to the one that says a “good death” is one in which we end our own lives (or have them ended).
Law Not Loopholes: Medical Aid in Dying for Those With Dementia
A response from Eric Widera and I to an essay from Thaddeus Pope and Lisa Brodoff on using voluntarily stopping eating and drinking (VSED) as a way to qualify oneself for assisted suicide.
The Reflective Zombie: Problematizing the Conceptual Framework of Reflection in Medical Education
Challenges abound when trying to cultivate any kind of humanities curriculum in medical training. One of them is defining and assessing reflection. As these authors observe, the current technical apparatus of medical training must pick things apart to quantify and analyze them. But that might be the wrong approach, as the reflective zombie reveals. Truly, we have no surefire way to determine whether someone has really reflected on their experience. The authors recommend we shouldn’t stress so much on that point, instead focusing on describing ways reflection can occur, ipsative assessment (use the trainee themselves as their own standard against which progress is measured), and cultivating spaces for reflection.
Writing for Outlets Isn’t Worth It Anymore
This piece is three years old but still reflects my deep ambivalence about publishing. On the one hand, I believe in the importance of institutions. Journals and magazines are institutions and can help form communities. On the other hand, I’m not interested in working as hard as or harder to try to get something published compared to when I write it. I have the luxury of not being dependent on my writing to make a living, and I’m far more interested in cultivating these conversations with as many people as possible.
California Seeks to Expand its End of Life Option Act
Safeguards are seen more and more as barriers to access when it comes to assisted suicide and euthanasia (ASE). The latest bill to come before legislators in California would do away with the six month life expectancy requirement and allow for intravenous administration of the life-ending medication (i.e., euthanasia). If this passes, I anticipate deaths from ASE will rise sharply in California like they have in Canada.
The number of things I want to read is infinite. But I find time to read every one of your posts, Joshua.