Anker Susan. Real Essays with Readings with 2009 MLA Update

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READINGS

Chapter 51 • Argument Casebook 847

he explains the facts behind widely held but mistaken beliefs about

medicine. His essays have appeared in the Washington Post, USA Today,

and Slate, and he is a frequent guest on television news programs and

National Public Radio. His books include False Alarm: The Truth about

the Epidemic of Fear (2005), named one of the top twenty books of the

year by Discover magazine, and Bird Flu: Everything You Need to Know

about the Next Pandemic (2006).

“Treating the Pain by Ending a Life” ﬁ rst appeared in the Boston

Globe in January 2006 shortly after the U.S. Supreme Court ruled in favor

of the state of Oregon in a suit that the Bush administration brought

over an Oregon state law permitting physician-assisted suicide.

GUIDING QUESTION

What does Siegel say are the two primary roles for a physician, and

how do these two roles shape his argument?

1 The U.S. Supreme Court ruled this week that doctors in Oregon

should not be charged with a crime for overdosing patients in the name

of treating pain and hastening death. This decision should be applauded

and must not be circumvented

by new laws.

2 Ten years ago, I assumed the care of a woman with advanced pan-

creatic cancer that had spread to her spine. She was a well-known writer,

and we quickly became friends. I would travel to her apartment and visit

her for hours there, something I’d rarely done before and haven’t done

since. She had a close group of friends who visited her constantly, and an

Irish nursing agency that cared for her impeccably around the clock. At

ﬁ rst, her cancer wasn’t causing her pain, though it paralyzed her below

the waist and bound her to her bed and wheelchair. Still, she enjoyed

the visits, mine and everyone else’s, until the fateful day when the cancer

spread to her bones and began what was clearly an escalating pain. I

dialed up the morphine

to compensate, until the day came when the

amount of morphine necessary clearly hastened her death. I was able to

predict roughly the time she would die, and her friends said their good-

byes. I used morphine in the name of relieving suffering, not as a murder

weapon. No one who knew her seemed upset by the trade-off, a tortured

life for a peaceful death, and all thanked me for my care at the end.

3 Morphine and other narcotics suppress breathing and lower blood

pressure. It is not unusual for physicians to use these drugs to relieve suf-

fering and thereby accelerate death in terminal cases. What is unusual is

PAUSE: How do

you respond to the

“trade-off” of “a

tortured life for a

peaceful death”?

circumvented: bypassed; gotten around

morphine: a powerful pain-relieving medication

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848 Part Eight • Readings for Writers

for doctors to be prosecuted for overdosing their patients deliberately in

the name of this cause. Oregon has been the focus of the Bush adminis-

tration’s attempts to criminalize the activity, but this use of medications

to knowingly end a tortured life is not conﬁ ned to Oregon. It has been

part of a physician’s end-of-life role for many years, whether it is formal-

ized in the law or not.

4 Any effective physician has two fundamental roles. The ﬁ rst is to

prolong life. The second is to ease suffering. In most situations, easing

suffering is part of prolonging life, as when we guide a patient through

an accident or a surgery and treat pain as part of ensuring survival.

Sometimes, though, our two roles collide, and a decision must be made

as to which to prioritize.

This decision is made, in part, by considering

long-term outcome as well as the wishes of the patient. It is never a per-

fect situation, but we physicians have been making this determination

for eons, and we cannot be penalized or prosecuted and still be expected

to function.

5 In the Netherlands, active euthanasia

is legal, which means that

a cancer patient who is still ambulatory and thinking clearly can ask a

doctor for a lethal injection. I am not in favor of this policy, not because

I believe that a person doesn’t have a right to end his or her life when

given a terminal diagnosis, but because I question the role of a physi-

cian in facilitating

this outcome. Such a role should not be assumed,

because it is not strictly a part of relieving suffering.

6 But this is not the same thing as the Oregon law, which allows

a physician to participate when pain predominates, when the patient

is in agony, when reducing morphine cannot bring back quality of

life. When the only choice is pain or death, doctors routinely — with

their patients’ advance approval — help them choose death. The U.S.

Supreme Court is wise to acknowledge one of our fundamental roles.

We are not “Kevorkian-izing”

our doomed patients when we help ease

their path from this world.

PAUSE: Summarize

the central point of

this paragraph.

PAUSE: Under

what conditions,

according to Siegel,

should doctors be

allowed to pre-

scribe potentially

lethal doses of nar-

cotics to patients?

prioritize: give greater importance to

active euthanasia: the assistance in or hastening of death by using drugs or other

means. In passive euthanasia, death is a side-effect of the treatment of pain or the

withholding of other forms of treatment.

facilitating: making easier

“Kevorkian-izing”: actively helping people commit suicide. Dr. Jack Kevorkian,

a controversial ﬁ gure in the debate over physician-assisted suicide, created several

devices that allowed individuals to self-administer lethal dosages of drugs. Kevorkian,

a trained physician whose medical license was revoked in 1991, claimed to have

participated in the suicide of some 130 people and was convicted of second-degree

murder in 1999.

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Chapter 51 • Argument Casebook 849

SUMMARIZE AND RESPOND

In your reading journal or elsewhere, summarize the main point of “Treat-

ing the Pain by Ending a Life.” Then, go back and check off support for this

main idea. Next, write a brief summary (three to ﬁ ve sentences) of the essay.

Finally, jot down your initial response to the reading. How sympathetic are

you toward Siegel’s beliefs about doctors’ “end-of-life role”?

CHECK YOUR COMPREHENSION

1. Which of the following would be the best alternative title for this essay?

a. “A Doctor’s Competing Roles: The Need to Prioritize”

b. “The Right to Relieve a Patient’s Suffering”

c. “The Use of Morphine to Treat Pain”

d. “Active Euthanasia”

2. The main idea of this essay is that

a. doctors should not be barred from using narcotics to relieve the suf-

fering of patients who are in incurable, unbearable pain — even if the

narcotics prove to be lethal.

b. a doctor’s primary roles are to prolong life and to ease suffering.

c. doctors should do everything in their power to save a patient’s life.

d. the patient’s wishes are irrelevant when a doctor decides to adminis-

ter a potentially lethal dosage of pain medication.

3. Siegel makes the point in the essay that he is opposed to

a. the use of morphine and other narcotics.

b. Oregon’s law permitting doctors to administer narcotics to hasten a

patient’s death.

c. active euthanasia.

d. predicting when a patient will die.

4. If you are unfamiliar with the following words, use a dictionary to check their

meanings: impeccably, compensate (para. 2); collide (4); predominates (6).

READ CRITICALLY

1. What is the point of the example that Siegel writes about in paragraph 2?

Why do you suppose that he decided to develop it in detail and include it

early in the essay?

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850 Part Eight • Readings for Writers

2. What is the purpose of paragraph 3? Does the information that Siegel

offers here surprise you in any way?

3. What distinction does Siegel make between using drugs in potentially

lethal doses to relieve pain and practicing active euthanasia, which is legal

in the Netherlands? Why do you think that he feels the need to make this

distinction?

4. Evaluate Siegel’s ﬁ nal paragraph. How effectively do you think he makes

his case here?

5. How would you deﬁ ne Siegel’s intended audience? How does his perspec-

tive as a physician shape his argument?

WRITE AN ESSAY

Write an essay in which you argue your views regarding another controversy

in the practice of medicine — for example, the medical use of marijuana, ani-

mal testing and experimentation, condom distribution in schools to stem the

spread of disease, human cloning, the publication of the names of people who

are infected with HIV, the effectiveness of alternative medical practices, or the

mandatory treatment of the dying children of parents whose religion forbids

it. You may wish to do some research so that you have a good grasp of differ-

ing opinions on the issue.

Jerry Fensterman

I See Why Others Choose to Die

Jerry Fensterman was a devoted father, husband, and golfer, among

other things. He graduated from University of California, Santa Cruz,

and received a graduate degree from University of California at Berke-

ley. His last and perhaps most satisfying job was as director of devel-

opment at the Fenway Institute. After he was diagnosed with cancer,

Fensterman found solace in writing. During his illness, his writing ener-

gized him, and he said that if his health improved, he would write seri-

ously about topics that he thought were important. After Fensterman’s

death in 2007, his wife, Lisa Bevilaqua, sorted through his belongings

and discovered journals that began in his years in college and continued

Jerry Fensterman with

his son

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Chapter 51 • Argument Casebook 851

beyond graduation. In these journals, Fensterman confronted a range

of life issues and worked through problems of all sorts. He also left

many letters for family and friends to read after his death. Fensterman

discovered himself in the act of writing, and his writings during his ter-

minal illness inspired others.

In the essay that follows, Fensterman offers a unique position on

the issue of physician-assisted suicide, showing that complex questions

rarely have simple black-and-white, one-size-ﬁ ts-all answers.

GUIDING QUESTION

What kinds of changes, both physical and psychological, does

Fensterman describe undergoing in the years following April 2004?

1 The U.S. Supreme Court’s decision to let stand Oregon’s law per-

mitting physician-assisted suicide

is sure to fuel an ongoing national

debate. Issues of life and death are deeply felt and inspire great passions.

It would be wonderful, and unusual, if all those joining the fray would

do so with the humility and gravity

the matter deserves.

2 I am approaching ﬁ fty, recently remarried, and the father of a ter-

riﬁ c thirteen-year-old young man. By every measure, I enjoy a wonder-

ful life. Or at least I did until April 2004, when I was diagnosed with

kidney cancer. Surgery was my only hope to prevent its spread and save

my life. The discovery of a new lump in December 2004 after two sur-

geries signaled that metastasis

was under way. My death sentence had

been pronounced.

3 Life may be the most intense addiction on earth. From the moment

I ﬁ rst heard the words “you have cancer,” and again when I was told

that it was spreading out of control, I recognized my addiction to life

almost at the cellular level. I have tried since then, as I did before, to live

life to the fullest. I also committed myself to doing everything within my

power to extend my life.

4 Toward that end, I am participating in my third clinical trial in a

year. I have gained some small beneﬁ t from it. I am, however, one of the

PAUSE: What

do you predict

will be Fenster-

man’s position on

physician-assisted

suicide?

Oregon’s law permitting physician-assisted suicide: the Death with

Dignity Act, the 1997 law that Oregon enacted to allow terminally ill Oregonians

to end their lives through the voluntary self-administration of lethal medications

that are expressly prescribed by a physician for that purpose. The U.S. Supreme

Court struck down the Bush administration’s legal challenge to the law in

January 2006.

gravity: seriousness

metastasis: the process by which cancer spreads throughout the body

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852 Part Eight • Readings for Writers

ﬁ rst people with my cancer to try this drug. Its median beneﬁ t seems to

be only on the order of three months. So my expectations are modest.

The side effects of these drugs are signiﬁ cant, as are the symptoms of

the cancer’s gallop through my body. All things considered, I believe I

have earned my merit badge for “doing all one can in the face of death

to stay alive.”

5 That the experience has changed me is obvious. I have a few scars,

have lost 50 pounds, and my hair is thinner. I rely on oxygen nearly

all the time, can no longer perform the job I loved, and have difﬁ culty

eating. More profoundly, my universe has contracted. Simply leaving

home has become an enormous task, and travel is essentially out of the

question. I can no longer run, swim, golf, ski, and play with my son.

I haven’t yet learned how to set goals or make plans for a future that

probably consists of weeks or months, not years. I am also nearing a

point where I will not be able to take care of my most basic needs.

6 Mine has been a long, difﬁ cult, and certain march to death. Thus,

I have had ample time to reﬂ ect on my life, get my affairs in order, say

everything I want to the people I love, and seek rapprochement with

friends I have hurt or lost touch with. The bad news is that my pain

and suffering have been drawn out, the rewarding aspects of life have

inexorably shrunk, and I have watched my condition place an increas-

ingly great physical and emotional burden on the people closest to me.

While they have cared for me with great love and selﬂ essness, I cannot

abide how my illness has caused them hardship, in some cases dominat-

ing their lives and delaying their healing.

7 Perhaps the biggest and most profound change I have undergone is

that my addiction to life has been “cured.” I’ve kicked the habit! I now

know how a feeling, loving, rational person could choose death over life,

could choose to relieve his suffering as well as that of his loved ones a

few months earlier than would happen naturally. I am not a religious

person, but I consider myself and believe I have proved throughout my

life to be a deeply moral person. Personally, I would not now choose

physician-assisted suicide if it were available. I do not know if I ever

would. Yet now, I understand in a manner that I never could have

before why an enlightened society should, with thoughtful safeguards,

allow the incurably ill to choose a merciful death.

8 The Supreme Court’s ruling will inﬂ ame the debate over physician-

assisted suicide. Besides adding my voice to this debate, I ask you to

carefully search your soul before locking into any position. If you op-

pose physician-assisted suicide, ﬁ rst try to walk a mile in the shoes of

those to whom you would deny this choice. For as surely as I’m now

wearing them, they could one day just as easily be on your feet or those

of someone you care deeply about.

PAUSE: Underline

some of the

changes that

Fensterman

describes he has

gone through.

PAUSE: Summarize

Fensterman’s

main point in this

paragraph.

PAUSE: Underline

Fensterman’s thesis

statement.

PAUSE: How do

you respond to

Fensterman’s

argument?

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Chapter 51 • Argument Casebook 853

SUMMARIZE AND RESPOND

In your reading journal or elsewhere, summarize the main point of “I See Why

Others Choose to Die.” Then, go back and check off support for this main

idea. Next, write a brief summary (three to ﬁ ve sentences) of the essay. Finally,

jot down your initial response to the essay. What impression of Fensterman

does the essay create for you? How do you react to his basic argument?

CHECK YOUR COMPREHENSION

1. Which of the following would be the best alternative title for this essay?

a. “Physician-Assisted Suicide: The Perspective of an Incurably Ill Pa-

tient”

b. “Physician-Assisted Suicide: An Issue That Inspires Great Passions”

c. “Life: The Most Intense Addiction on Earth”

d. “How Illness Changed My Life”

2. The main idea of this essay is that

a. the debate over physician-assisted suicide should be approached with

great seriousness.

b. people with incurable illnesses suffer physically, psychologically, and

emotionally, but they are also able to escape their addiction to life.

c. physician-assisted suicide should be legal, and people opposed to

the practice should consider the wishes of those suffering incurable

illnesses.

d. the U.S. Supreme Court’s ruling in favor of Oregon’s law permitting

physician-assisted suicide has fueled the debate over the practice.

3. Fensterman implies that some people who oppose physician-assisted

suicide are

a. humble.

b. acting reasonably.

c. overly passionate.

d. no longer addicted to life.

4. If you are unfamiliar with the following words, use a dictionary to

check their meanings: median (para. 4); rapprochement, inexorably (6);

enlightened (7).

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854 Part Eight • Readings for Writers

READ CRITICALLY

1. What do you think of Fensterman’s suggestion in paragraph 3 that “[l]ife

may be the most intense addiction on earth”? How do you react to the

idea that he has “kicked the habit” (para. 7)? How well do you think this

language serves his argument?

2. Fensterman waits until late in the essay to state his thesis. Why do you

think that he might have chosen to position the thesis as he does? Do you

ﬁ nd his choice appropriate given his purpose and audience?

3. In paragraphs 5 and 6, Fensterman describes the changes that suffering

from an incurable illness have brought about in his life. What effect do

these details have on his overall argument?

4. In paragraph 7, Fensterman writes that he is “not a religious person” but

considers himself to be “a deeply moral person.” Why do you think he

reveals this about himself? How does this information affect your reading

of his argument?

5. Evaluate Fensterman’s concluding paragraph. Do you think that it will

have its intended effect on those who oppose physician-assisted suicide?

Why or why not?

WRITE AN ESSAY

Write an essay arguing for or against a controversial legal decision that you

feel strongly about or that affects your life directly. Alternatively, you may

choose to write about a particular law that you agree or disagree with and

about which opinions differ. The issue can be one on the local, state, or fed-

eral level, but be sure to deﬁ ne it clearly for your readers. Feel free, as Fen-

sterman does, to base your argument in part on personal experience. Keep

in mind that, like Fensterman, you are writing to an audience that doesn’t

necessarily share your views.

Write an Essay in Favor of Legalized

Physician-Assisted Suicide

Read the three essays that support physician-assisted suicide. Each of the

authors has a different perspective on the subject. Drawing from at least two

of the three essays, write your own argument supporting physician-assisted

suicide. You may use your own experiences in your argument as well

as outside sources. When you use material from the essays here or from

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Chapter 51 • Argument Casebook 855

another source, be sure to cite the source. (For information on citing

sources, see Chapter 21.)

Your introduction should include a statement of your position on the

issue. In the body of your essay, develop reasons for your opinion, using

the essays and other sources. In your conclusion, summarize your reasons,

and restate your opinion based on the evidence you have presented.

Legalized Assisted Suicide: Opposed

Marilyn Golden

Why Progressives Should

Oppose the Legalization

of Assisted Suicide

Marilyn Golden has been an advocate for the rights of the disabled since

shortly after her graduation from Brandeis University, when she herself

acquired a disability. She was closely involved with development of the

Americans with Disabilities Act, which Congress passed in 1990. She also

served for nine years as director of Access California, a clearinghouse for

information on architectural accessibility for people with disabilities, and

in 1996 was appointed by President Bill Clinton to the U.S. Architectural

and Transportation Barriers and Compliance Board, a position she still

holds. On the international front, she has served as codirector of the

Disabled International Support Effort. The author of numerous articles

and policy papers, Golden is currently a policy analyst with the Disability

Rights Education and Defense Fund, the country’s foremost advocacy

group for disability civil rights, based in Berkeley, California.

The following essay originally appeared in BeyondChron, San Fran-

cisco’s alternative online daily newspaper. In it, Golden takes a stand

against the legalization of assisted suicide in California.

GUIDING QUESTION

What kinds of evidence and outside authorities does Golden cite to

support her argument?

1 There is a widespread public perception that those opposed to

legalization of assisted suicide in California are religious conservatives,

and that the logical position for a liberal is in support.

PAUSE: Do you

think that legaliz-

ing assisted suicide

is supported mostly

by liberals?

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856 Part Eight • Readings for Writers

2 But Californians Against Assisted Suicide shows a diversity of polit-

ical opinion that may be surprising to those who have not looked closely

at the issue. In opposition are numerous disability rights organizations

generally seen as liberal-leaning: the Southern California Cancer Pain

Initiative, a group associated with the American Cancer Society; the

American Medical Association and the California Medical Association;

and the Coalition of Concerned Medical Professionals,

which does

anti-poverty work in poor communities. Catholic organizations are in

the mix, but no one could consider this a coalition of religious conserva-

tives. They represent many groups coming together across the political

spectrum. Why?

Managed Care and Assisted Suicide: A Deadly Mix

3 Perhaps the most signiﬁ cant reason is the deadly mix between assisted

suicide and proﬁ t-driven managed health care. Again and again, health

maintenance organizations (HMOs) and managed care bureaucracies

have overruled physicians’ treatment decisions, sometimes hastening

patients’ deaths. The cost of the lethal medication generally used for as-

sisted suicide is about $35 to $50, far cheaper than the cost of treatment

for most long-term medical conditions. The incentive to save money

by denying treatment already poses a signiﬁ cant danger. This danger

would be far greater if assisted suicide were legal.

4 Though the bill would prohibit insurance companies from coerc-

ing

patients, direct coercion is not necessary. If patients with limited

ﬁ nances are denied other treatment options, they are, in effect, being

steered toward assisted death. It is no coincidence that the author of

Oregon’s assisted suicide law, Barbara Coombs Lee, was an HMO

executive when she drafted it.

5 A 1998 study from Georgetown University’s Center for Clinical

Bioethics underscores the link between proﬁ t-driven managed health

care and assisted suicide. The research found a strong link between

cost-cutting pressure on physicians and their willingness to prescribe

lethal drugs to patients, were it legal to do so. The study warns that there

must be a “sobering degree of caution in legalizing [assisted suicide] in

PAUSE: Underline

the two sentences

that best express

Golden’s argument

in paragraph 3.

PAUSE: How might

Lee’s position have

inﬂ uenced her

action?

Coalition of Concerned Medical Professionals: a group that was formed

in opposition to AB 654, a state bill that would have legalized assisted suicide in

California. As of this writing, no such legislation has passed the California Assembly.

health maintenance organizations (HMOs) and managed care bureau-

cracies: group health insurance plans that entitle members to the services of partici-

pating physicians, hospitals, and clinics for a ﬂ at fee, usually paid monthly. HMOs

often are criticized for making treatment decisions based on considerations of proﬁ t.

coercing: forcing

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