The Doctor’s Dilemma: Helping Patients to Die…Or Not

“I was leafing through a patient’s chart last year when a colleague tapped me on the shoulder. ‘I have a patient who is asking about the End of Life Option Act,’ he said in a low voice. ‘Can we even do that here?’ I practice both critical and palliative care medicine at a public hospital in Oakland. In June 2016, our state became the fourth in the nation to allow medical aid in dying for patients suffering from terminal illness. Now, five months after the law took effect here in California, I was facing my first request for assistance to shorten the life of a patient. I could see my own discomfort mirrored in his face. ‘Can you help us with it?’ he asked me. ‘Of course,’ I said. Then I felt my stomach lurch.”  J. N. Zitter, The New York Times

ESL Voices Lesson Plan for this post with Answer Key

Excerpt: Should I Help My Patients Die? By Jessica N. Zitter, The New York Times

“California’s law permits physicians to prescribe a lethal cocktail to patients who request it and meet certain criteria: They must be adults expected to die within six months who are able to self-administer the drug and retain the mental capacity to make a decision like this.

But that is where the law leaves off. The details of patient selection and protocol, even the composition of the lethal compound, are left to the individual doctor or hospital policy.

Our hospital, like many others at that time, was still in the early stages of creating a policy and procedure. To me and many of my colleagues in California, it felt as if the law had passed so quickly that we weren’t fully prepared to deal with it.

This first patient of mine was not a simple case. When I walked into his room, he glared at me.  ‘Are you here to help me with this aid-in-dying thing?’ he asked. He was in his early 60s, thin and tired, but in no obvious distress.  From my read of his chart, he met all criteria to qualify. Terminal illness, decision-making capacity, ability to self-administer the medications. And he had made the requisite first request for the drugs two weeks earlier, as procedure dictates.

When I asked why he wanted to end his life early, he shrugged. ‘I’m just sick of living.’ I asked about any symptoms that might lie behind his request: unrelenting pain, nausea, shortness of breath. He denied them all. In palliative care, we are taught that suffering can take many forms besides the physical.

At our second meeting, with more trust established, he issued a sob, almost a keening. He felt terrified and powerless, he said. He didn’t want to live this way anymore. I understood. I could imagine my own distress in his condition — being shuttled like a bag of bones between the nursing home and the hospital. It was his legal right to request this intervention from me. But given how uncomfortable I was feeling, was it my right to say no? …I’ll admit it: I want this option available to me and my family.

I realized it was past time to sort out my thinking and turned to the de facto specialist in our area on this issue for counsel. Dr. Lonny Shavelson, an emergency medicine and primary care physician in Northern California, has been grappling with the subject for many years. Given his interest in the topic, Dr. Shavelson felt a personal obligation to ensure that this new practice would be carried out responsibly after the law was passed. He founded Bay Area End of Life Options, a consulting group that educates physicians, advocates on patients’ behalf and prescribes the lethal concoction for some patients who meet the criteria for participation. Since starting his practice, he has been approached by 398 patients. He has accepted 79 of those into his program and overseen ingestion and death for 48. When I asked Dr. Shavelson how he might have proceeded with my patient, he said he would have tried everything to relieve his distress without using the lethal medication. But if in the end the patient still wanted to proceed, he would have obliged, presuming his depression was not so severe as to impair his judgment.

Photo- The Atlantic

The American Society of Clinical Oncology recommends that patients with advanced cancer receive concurrent palliative care beginning early in the course of disease. In my experience, far too few of these patients actually get it…We must continue to shape our policies and protocols to account for the nuanced social, legal and ethical questions that will continue to arise. We must identify the clinicians who are best qualified and most willing to do this work and then train them appropriately, not ad hoc. And we must remember that this is just one tool in the toolbox of caring for the dying — a tool of last resort.”  


Obama’s tweet after Charlottesville one of most popular tweets ever

former U.S. President Barack Obama

“In subsequent tweets, Obama continued the quote, which read: “People must learn to hate, and if they can learn to hate, they can be taught to love … For love comes more naturally to the human heart than its opposite.”

ESL Voices Lesson Plan for this post

NOTE: Lessons can also be used with native English speakers.

Level: Intermediate – Advanced

Language Skills: Reading, writing, and speaking. Vocabulary and grammar activities are included.

Time: Approximately 2 hours.

Materials: Student handout (from this lesson) and access to news article.

Objective: Students will read and discuss the article
with a focus on improving reading comprehension and learning new vocabulary. At the end of the lesson students will express their personal views on the topic through group work and writing.

I. Pre-Reading Activities

Stimulating background knowledge: Brainstorming

Directions: Place students in groups, ask students to think about what they already know about  the topic.  Next, have students look at the picture(s) in the text and generate ideas or words that may be connected to the article. Debrief as a class and list these ideas on the board. Students can use a brainstorming chart for assistance.

G. Cluster Brainstorming-workshopexercises


II. While Reading Activities

Word Inference

Directions: Students are to infer the meanings of the words in bold taken from the article. They may use a dictionary, thesaurus, and Word Chart for assistance.

  1. Doctors are taught that in palliative care suffering can take many forms.
  2. Oregon was the pioneer 20 years ago.
  3. The law allows physicians  prescribe a lethal cocktail.
  4. The idea of hastening death is uncomfortable.
  5. Many oppose this practice for ethical reasons.
  6. The doctor probed further to find out the truth.
  7. Some terminally ill patients want to die sooner.
  8. Many feel abandoned by their family.
  9. Doctors feel a personal obligation to this new practice.
  10. Dr. Shavelson strives to mitigate all symptoms.

ELLteaching 2.0 vocabualry chart


Reading Comprehension

True /False/NA-Statements

Directions: Review the following statements from the reading.  If  a statement is true they mark it T. If the statement is  not applicable, they mark it NA. If the statement is false they  mark  it F and provide the correct answer. 

  1. In June 2016, California became the  seventh in the nation to allow medical aid in dying.
  2. The details of patient selection and protocol, even the composition of the lethal compound, are left to the patients.
  3. The author felt that  she wasn’t fully prepared to deal with the new law.
  4. The American Medical Association, the nation’s largest association of doctors, has been formally opposed to the practice for 23 years.
  5. The  author’s first patient died in a nursing home, of natural causes, the following year.
  6. Dr. Lonny Shavelson is  an emergency medicine and primary care physician in New York City.
  7. Catholic health systems do not participate in the program.
  8. Dr. Shavelson offers  the medications to most of the patients who request them.
  9. One problem is payment, because many insurers won’t cover it.
  10. Doctors worry that public hospital patients like mine will not be able to afford this degree of care.

 Grammar Focus: Structure and Usage

Directions: The following groups of sentences are from the article. One of the sentences in each group contains a grammatical  error. Students are to identify the sentence (1, 2, or 3 ) from each group that contains the grammatical error.


  1. His patient intake procedures is time-consuming.
  2. Providers can bill for an office visit.
  3. Many insurers won’t cover  treatment.


  1. He counts this cases among his greatest successes.
  2. The patient had carefully thought through the decision.
  3. The vast majority of cases here have gone smoothly.


  1. Most communities won’t have doctors that offer discounts.
  2. These  is inequities we must address.
  3. We must continue to shape our policies.

III. Post Reading Activities

WH-How Questions

Directions: Have students use the  WH-question format to discuss or to write the main points from the article.

Who or What is the article about?

Where does the action/event take place?

When does the action/event take place?

Why did the action/event occur?

How did the action/event occur?

Discussion for Comprehension /Writing

Directions: Place students in groups and have them  discuss the following statements. Afterwards, have the groups share their thoughts as a class. To reinforce the ideas, students can write an essay on one of the topics mentioned.

“But still. I didn’t feel comfortable with the idea of helping to shorten the life of a patient because of depression and resentment. In truth, I’m not sure I am comfortable with helping to intentionally hasten anyone’s death for any reason. Does that make me a hypocrite?”

“There is another question I feel compelled to raise. Is medical aid in dying a reductive response to a highly complex problem? The over-mechanization of dying in America has created a public health crisis. People feel out of control around death. A life-ending concoction at the bedside can lend a sense of autonomy at a tremendously vulnerable time.”

Extra: Web Search

Directions: In groups/partners have students “Google” the topic and see what additional information they can find. Students can either have further discussions or write an essay about the subject.


Directions: Allow students 5 minutes to write down three new ideas they’ve learned about the topic from the reading,  two things they did not understand in the reading, and one thing they would like to know that the article did not mention. Review the responses as a class.


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