Death with Dignity Forum, March 17

I am participating Thursday, March 17 in a public forum discussing pending “Death with Dignity” legislation in the North Carolina General Assembly (Thursday, March 17, 4-7pm, Friday Center in Chapel Hill; free but registration required).

I don’t consider myself an expert on the topic of Assisted Death* (where the patient must administer a lethal dose of prescribed medications; that is the topic of the forum Thursday, and is the basis of the Oregon law) or Euthanasia (where a physician administers a lethal dose of medication; illegal in all U.S. states, but legal in some European countries), but do focus most of my research attention of hospice, palliative care and how we care for persons with disability. I am a member of the “Death with Dignity” panel to discuss how we care for the dying generally in the U.S.

I am ambivalent about Assisted Death legislation–meaning I have conflicted views and can see the issue from both the pro and con positions. I suspect most other panelists have quite strong views, either for or against. This got me to thinking about the most convincing case I have read about the pro and con positions as someone who remains ambivalent.

There is not a singular “pro” piece I can point to, but instead it is the fear of a future unremitting suffering for myself and my family (this worries me most–that I will burden my children) merged with my current position in life that leads me to see the “pro” point of view. By current position in life, I mean that I am a person with prestigious job and career status, power, good economic means and someone who is generally used to things going roughly speaking how I wish them to go. And if they aren’t going as I wish, I have a general sense that I can do something to change the course of events. The “pro” position of maintaining my options is quite intuitive to me.

This from Katherine Sleeman, a Palliative Care physician in England from the Cicely Saunders Institute, University College London is the most convincing, succinct argument against Assisted Dying laws that I have read. I won’t summarize it–it is short, so go and read it. The piece is effective and convincing in arguing against Assisted Dying legislation to me because it doesn’t treat the issue as a simple one, and also because it notes how much work there is to do to improve our systems of caring for sick and infirm citizens regardless of how this issue is decided.

In that sense, the issue of Assisted Dying is far from the most important end-of-life topic of our day, and the noise around this debate crowds out the most important issue as I see it–developing coherent systems of providing the care that most of us will need before we die. The basic policy milieu available to the dying and their families will effect far more persons than any Assisted Dying law ever would. Let’s not forget that.


*A fight of the language of how to even talk about this is possible, but not so useful. I think Assisted Death is the most descriptive term. The law being proposed is called “Death with Dignity” which is a more positive framing, and opponents will sometimes call this anything from killing to murder, which is obviously a less positive framing. My two cents.

More on Duke Sexual Assault Policy

The Tuesday before Thanksgiving class is the least attended session of the year each Fall Semester, and yesterday was no different with about one-third of the 45 students attending my Intro to Health Policy course. So, I covered a few topics that had gotten less attention than they deserved, and then devoted the last 20 minutes of class to talk through Duke’s Sexual Assault policies as laid out in the Duke Community Standard.

Not one of the ~15 undergrads who were there could describe even a brief outline of the policy, or how much it had been changed in the past year. We had a good and interesting discussion about why a University would have a set of policies beyond simply calling the police, talked through the standard of consent outlined, and discussed some of the examples of policy violations listed in the Community Standard.

There is obviously a gap in what the students know and what administrators think (or hope?) they know.

Thoughts on Adjudication of Sexual Assault on Campus

The Rolling Stone article of last week recounting a fulfilled conspiracy to commit rape, apparently as part of a fraternity initiation at UVA, is horrific.The described response by the University and the role that social norms are said to play in preventing victims from coming forward or receiving a just hearing if they do, feels like a tipping point of sorts in addressing rape on college campuses.

It is important for Universities to make policy changes to protect students, as better policy is the most direct and best way to influence campus culture and thus protect members of the community.

I am serving my third semester as a member of the Executive Committee of the Academic Council (Faculty Senate) at Duke University, and here are a few of my emerging thoughts on policy changes at Duke:

  • Generally, I think Duke has improved its policy in this area over the past 18 months, but I am not sure that we have the optimal process.
  • Duke University altered its disciplinary procedures in 2013 to make expulsion “the preferred” (but not mandatory) penalty for an undergraduate found guilty of sexual assault by the University. Prior to this, the “preferred” penalty for a student found guilty of sexual assault was suspension for 3 to 4 semesters, including Summers. In 2012, Duke also eliminated a 1 year statute of limitations for the reporting of sexual assault. These are all good changes in my opinion.
  • Here is the Duke Community Standard for Undergrads for the 2014-15 academic year (note: graduate students are governed by school-specific rules; many refer back to these rules, but there is heterogeneity).
  • A Duke senior was expelled several days prior to graduation in May 2014, and this case is currently being litigated in State court, primarily around process issues related to the policy changes occurring after the sexual assault that the student was found guilty of by the University. The Durham County District Attorney did not bring a criminal prosecution in this case.
  • The Duke Community Standard governs all activities of the University, and sexual assault/consent issues are addressed in detail at pp. 39-45.
  • I think it is good policy to define a strong penalty for sexual assault in the University’s disciplinary procedures, and the clarity of the sexual assault section in the 2014-15 Community Standard puts students on fair warning on this topic. Note, the standard of evidence (preponderance of the evidence, with a student charged with a sexual assault having a presumption of innocence) is different from that in a criminal proceeding, which is legitimate because it is not a criminal proceeding. The Community is filing notice of these expectations and standards of judgement, and students should understand the Community Standard. However, very strong penalties mean that issues of due process and procedure are important, though they are not the same as in a criminal proceeding (being expelled is not the same as being sent to prison for 35 years).
  • I think the impermissible conduct (p. 40) and the importance and definition of consent (p. 41-42) are reasonable. However, I am uncertain that Duke has all of the process issues worked out to best administer this policy. On page 43-44, a series of statements about what “may” happen in terms of investigation should be replaced with more concrete statements of what will happen. Further, I think that the University should consider undertaking more explicit procedures, and perhaps even consider doing something like hiring a retired Superior Court Judge or similar party to run the process of adjudicating sexual assault charges against students.

Duke’s clarification of sexual assault as it relates to its Community Standard has been strengthened in ways that are positive and should serve to change the culture at Duke in a way that better protects students. Better policy is the best way to improve the culture. However, I think the process issues remain a work in progress as University disciplinary procedures move away from traditional issues of academic cheating, to broader issues such as sexual assault.

note: just to be clear, these are my personal thoughts and don’t necessarily represent anyone else’s thoughts.

Courts and Public Policy

ThinkProgress with an interesting post noting that 87% of U.S. counties have no abortion provider; with Mississippi moving toward having no abortion provider.

I wonder if Roe v. Wade had not been decided in the 1970s, and states had continued to muddle through on abortion if we would have a similar epidemiology of abortion provision that we have today, but with less political toxicity around the issue? Getting a “win” for your side via a court ruling can sometimes be the only way (Brown v. Board of Education, Civil Rights cases, for example, in my opinion). In other cases, a court win could actually harm your “sides” ability to make the case politically and culturally.

This is an important consideration generally in public policy.

Duke Statement on Amendment One

Screen shot of email sent to all employees this morning. If you click it the resolution is better. Here is Duke web link on the topic.

I Love North Carolina

I am a proud North Carolinian, who has lived in this state for 40 of my 44 years (I was born on an Air Force Base in Mississippi, and did a post-doc in England). I am not surprised that Amendment 1 has passed tonight, since polls have shown this was going to occur for some time. However, as it has occurred, it makes me feel not angry, but sad, in the “we can do better than this” sense.

It is also the first time I have seen my kids be interested in politics, and my 11th grader especially has been passionately opposed to Amendment 1, and she is disappointed. It is hard to see her first interest in politics end in disappointment, but that is a part of life.

I wrote my reasons for voting against Amendment 1, and some gave me feedback that it was too nuanced. For my daughter it was a simple matter of being opposed to denying a particular groups’ human rights; no nuance whatsoever. That leads me to believe that the Amendment and its result won’t last very long.

As I reflect on recent politics in North Carolina, I realize that by far the more shocking election result was Barack Obama winning this state in 2008 (by ~14,000 votes out of over 4 Million cast). I was a late adopter of President Obama, in part because I viewed Hillary Clinton as inevitable, but mostly because I didn’t think a Black man with a funny name could be elected President, and I wanted my side to win.

Four years ago tonight, the North Carolina primary essentially put the President over the top, but even as I went to a celebration party that night, I was worried that he could not win. Even as I started going door-to-door canvassing in the Summer of 2008 for the Obama campaign, I just didn’t really believe that he could win in North Carolina. Of course he did, and I felt so proud of North Carolina on election night 2008 because I felt like we as a State voted our hopes, and not our fears.

Tonight I think it is just the opposite, and I feel sad, but I still love North Carolina. I know we can do better, and I think we eventually will.



Stephen Carter on SCOTUS role

Stephen Carter’s op-ed on the role of the SCOTUS is the best, most nuanced take I have read.