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Start the most difficult conversation American isn’t having- the conversation about our end of life preferences

So That We Know How To Live: A Course In Death And Dying

Time of Death. Courtesy Showtime.
Showtime’s ‘Time of Death’ explores end of life-related issues.  Courtesy Showtime.

This spring, I had the honor of creating and teaching a new course at DePaul University: Death & Dying.

When I taught in a medical school, we provided lessons in delivering bad news and hospice care. We briefly discussed the diagnostic tools for death. In one session by the palliative care program, students met with survivors to learn about death from family perspectives and how palliative care informed that experience.

I now teach in an undergraduate program. My students are 18 to 24. Few 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 in which people are trained for specific jobs, but a liberal arts curriculum that teaches students to be independent thinkers and good citizens.

Most undergraduate schools and universities have a course with a similar title. The course is sometimes taught within anthropology or sociology departments, examining worldwide beliefs and rituals around the end of life. Sometimes, it is a psychology course that examines human responses to death, mourning and grief. 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.

DEATH CLASSMy class was taught in the Department of Health Sciences, which offers an interdisciplinary approach to studying human health that incorporates the natural sciences, social sciences and humanities. This class employed all three ways of knowing as a survey of human death and dying. We used public health as a lens to look at the causes of death and briefly studied how people die from certain diseases and conditions. We used clinical medicine to learn about diagnosing death as well as 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 to discuss the funeral industry and how standard American funerals work. We explored how humans died and views of dying throughout history. Psychology offered us perspectives on grief and mourning. Anthropology gave us a look at funeral practices and death beliefs in other cultures. Religion offered views of the afterlife. From the medical humanities, we read novels, poems, plays and short stories. Over the course of ten weeks, we had five guest lecturers who gave of their time, experience and expertise.

Most told me about having “the conversation” with friends or family. What began in the classroom quickly rippled out into a wider world.

Students had profound experiences from the course activities. They conducted a field study in which 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 their own “deathography,” a personal history of experience with death. They also completed their “last hours of life” survey to think about how they want to die.

The assignment that students said significantly transformed them was writing their own obituary. As a former journalist (and one that wrote obituaries for a small newspaper for a summer), I taught them about this writing form. 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 chose to write about dying at 120 years old. Universally, however, they said that this assignment made them really think about what was important and what they wanted to make of life.

DePaul University, Lincoln Park Campus, Chicago
DePaul University, Lincoln Park Campus, Chicago

On the first night of class, I had 18 students- about a third of whom had not experienced the death of a close loved one. By the second meeting, I had 23- plus one student who really wanted to take 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 another studied anthropology. They were open. They allowed themselves to be vulnerable.

We discussed 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 the notion that their own life would 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 of those whom had died by violent means left us in shock.

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

Within a liberal arts setting, the students and I had a chance to explore human death and dying. Maybe such a class should be available in continuing education or as a community service project.

As the ten weeks passed, our interdisciplinary exploration of this basic human experience seemed to focus on a single theme: Life. Most weeks I would ask them, “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 wish to leave as your legacy, you know what kind of person you want to be. 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.