Death, Suffering, Spirituality, and Medicine

INSTITUTION: University of California at Berkeley

INSTRUCTOR: Guy Micco, M.D., Director of UCB Center for Medicine, the Humanities, and Law (email:

ENROLLMENT: Students from the Joint Medical Program and graduate students; elective

SEMESTER: Spring 1999. Friday 8-10am.


Does suffering have any meaning? Regardless of your answer, most of us, when faced with a personal crisis, try to find some meaning in it in order to make sense of things, in order to relieve our suffering, in order to be able to “move on.” Meaning is made on the psychological and spiritual planes where Medicine usually does not tread. Rather, biomedicine seeks to alleviate suffering by use of medication for pain, anxiety, and other symptom relief. This addresses the physical, but not the emotional and psycho-spiritual aspects of a person who is suffering. Recently this has been noted to be a problem, thus the hospice and palliative care movements with their “team” approach to care which attempt to address suffering more fully; and, thus this course.

Last year we spoke of the spiritual crisis which often accompanies serious illness. After Paul Tillich, we took the “large view” of spirituality: that which concerns us ultimately and with unconditional seriousness, that which has to do with how we make meaning of the facts of suffering and death. And, as did Arthur Kleinman, we noted that biomedical settings are not places where meanings can easily be found, worked over, resolved, expressed, negotiated with others, and put into the enchanted form of life stories…. In the authorized biomedical version, sickness has no meaning, purpose, or use.

This course will again be a place for us to hear how people have discovered meaning through their own suffering or through the caring for others who have suffered. We start with Job, the archetypical one who suffers, and move on through various notions of how meaning is made through suffering pain, loss, and grief. We also will consider just what a “good death” might be.


January 22: Introduction

January 29:

The Home Hospice: Tony Perrino, Chaplain, Home Hospice (???? Hospice of Northern California)

The Hospital Chaplaincy: Sandee Yarlott, Chaplain, and Chaplaincy residents, Alta Bates Medical Center

February 5: The Book of Job I

Guest: Jeffrey Kuan, Associate Professor of Old Testament, Pacific School of Religion

Reading: The Book of Job, Prologue thru Chapter 21 (from The Bible, New Revised Standard Version)

February 12: The Book of Job II

Guest: Jeffrey Kuan

Reading: The Book of Job, Chapter 22 to end; supplemental texts

February 19: When Bad Things Happen to Good People

Guest: Rabbi Eric Weiss, Ruach Ami: Bay Area Jewish Healing Center

Reading: When Bad Things Happen to Good People, by Harold Kushner; supplemental readings

February 26: Bereavement/grief counseling


J. William Worden, Grief Counseling and Grief TherapyHoward Lunche, LCSW

Reading: Howard Lunche, “Understanding Grief” (Chapters 1 and 2)

March 5: What is a “Good Death”?

Reading: The Death of Ivan Ilych and “Three Deaths” by Leo Tolstoy;

“The Good Death: Is it Compatible with Global Culture & Biomedicine” by Arthur Kleinman

March 12: What is a “Good Death” II — Cancer as a “Gift”

Guest: Rick Fields, poet

Reading: Intoxicated By My Illness by Anatole Broyard

March 19: What is a “Good Death” III: Assisted Suicide and Euthanasia


Joesph Califano, “Physician-Assisted Living”John Lachs, “When Abstract Moralizing Runs Amok”

Daniel Callahan, “Ad Hominem Run Amok: A Response to John Lachs”

Timothy Quill, “Death and Dignity;”

Anonymous, “It’s Over Debbie”

Thomas Gates, “Euthanasia and Assisted Suicide: A Faith Perspective”

March 26: Spring break

April 2: Grief Observed

Reading: A Grief Observed by C.S. Lewis and poems from Without by Donald Hall

April 9: Telling the “Bad News”


Raymond Carver, “What the Doctor Said”John Stone, “Talkng to the Family”

Donald Hall, “Last Days”

Judge Jacob Turkel, “Remarks on Telling the Truth or Lying”

Edmund Pellegrino, “Is Truth Telling to the Patient a Cultural Artifact?” NPR piece

April 16: “Living with Grief at Work, at School, at Worship” — excerpts from and discussion of the 1999 (Wed, 4/14/99; 10 AM-2PM) annual teleconference of the Hospice Foundation of America

Guest: Gail Bigelow, Bereavement Coordinator, VNA and Hospice of Northern California

April 23: Discussion of hospital and home hospice experiences

Guests: Reverends Janet Hanson, Tony Perrino, and Sandee Yarlott

April 23-25: RETREAT at Green Gulch Farm — On Bereavement/Grieving

The retreat begins at dinner-time Friday, April 23 and ends with lunch on Sunday, April 25. Saturday’s agenda: a hospice volunteer (mini-) training with Frank Ostaseski from Zen Hospice

April 30: “Reader’s Theater”

May 6 tba

Three movie night possibilities: Woody Allen’s “Crimes and Misdemeanors” [when good things happen to bad people]; “Shadowland” (CS Lewis story); “Death in Venice;” “Flatliners;” “Red, White, and Blue” (Cole Porter); other


1. Each student will be paired with a hospital chaplaincy resident or seasoned hospice volunteer, and provisions will be made for visiting patients in hospital or home together. The time commitment to, and depth of, this experience is left to each student.

2.Weekly readings and discussions based on these readings. In addition, each student will be expected to write a one-half to one-page *reflection* on each week’s reading prior to that week’s class time. Note that a *reflection*” is not meant to be a polished piece of writing; rather, it may be written within 15 minutes of intense concentration.

3. For a letter grade there will be a 10-15 page paper or a class-related project approved by me due by the last week of April.

The Retreat: On the weekend of April 23-25, a two-day retreat will be held at Green Gulch Zen Center, beginning with dinner Friday evening, ending with lunch on Sunday. The main focus of the retreat will be on loss/bereavement and grief. On Saturday we will have an all-day (mini) hospice training led by Frank Ostaseski, Executive Director, Zen Hospice Project. Like last year, we will also engage in discussions and practices designed to give us a more keen awareness of our sense of life and death and how we deal with our own and others suffering and mortality. The goal is to provide a structured opportunity to explore, integrate, and deepen individual learning from the class.

Required Reading:

Course Reader (available at Copy Central on Shattuck at University)

When Bad Things Happen to Good People by Rabbi Harold Kushner

The Death of Ivan Ilyich by Leo Tolstoy

Intoxicated By My Illness by Anatole Broyard

A Grief Observed by CS Lewis

Highly Recommended:

In the Midst of Winter (Selections from the Literature of Mourning) edited by Mary Jane Moffat

(Books will be available at Living Links Books on Oxford.)

Editor's choice