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Teaching Sicko Elizabeth Weeks Associate Dean for Faculty Development & J Digital Commons @ Georgia Law Scholarly Works Faculty Scholarship 1-1-2009 Teaching Sicko Elizabeth Weeks Associate Dean for Faculty Development & J. Alton Hosch Professor of Law University of Georgia Main Campus, [email protected] Repository Citation Elizabeth Weeks, Teaching Sicko , 37 J.L. Med. & Ethics 139 (2009), Available at: https://digitalcommons.law.uga.edu/fac_artchop/1257 This Article is brought to you for free and open access by the Faculty Scholarship at Digital Commons @ Georgia Law. It has been accepted for inclusion in Scholarly Works by an authorized administrator of Digital Commons @ Georgia Law. Please share how you have benefited from this access For more information, please contact [email protected]. iesahing Heahh Law Teaching Sicko Necessity Is the Mother of my upper-level courses. I do not use Invention Power Point in class. I am not entirely In long Midwestern winters, two sure how to turn on the "smart class- Elizabeth Weeks Leonard things are certain: snow and basket- room" "sympodia" that clutter the ball. But two things that you cannot fronts of our classrooms and require count on are snow day school closures me to stash several remote control and a home-team collegiate basket- devices before placing my casebook ball championship. In Kansas last and printed out, manila-filed notes winter, we had both. Winter pre- on the dais. For better or worse, I cipitation was much above average, understand my mission primarily to resulting in a rare invocation of the teach students to "think like lawyers,"' University's inclement weather policy not to entertain them. to cancel classes in early February. Accordingly, the idea of using a And the Kansas Jayhawks basketball feature-length, major Hollywood team brought home the National Col- studio release in class seemed scan- legiate Athletic Association champi- dalous. I recognize that our students onship trophy for the first time in two are products of the media generation, decades. The Chancellor commemo- suffer from hyper-stimulated, short rated the achievement with a campus- attention spans, and are immersed in wide celebration, including all-day visual and electronic stimuli. But I class cancellation. This is all well and resist playing into their "weaknesses.' good. I am all for respecting Mother Rather, I believe in teaching them Nature's forces and celebrating re- patience and the slow, deliberate, markable athletic accomplishments. and sometimes dry process of legal But the combination of events does reasoning.2 Accordingly, I felt guilty, leave law professors nearing the end like a busy parent buying the kids of the semester in a bit of a quandary. McDonald's for dinner and sticking How to make up the cancelled classes them in front of the television when to ensure compliance with Ameri- what they really need and deserve is a can Bar Association accreditation good helping of vegetables and some instructional hours requirements? fresh outdoor air. But I rationalized How to cover the missed course con- that if I added a sufficiently meaty tent? How to find mutually agreeable assignment along with the movie- make-up class times and locations viewing, maybe they would get some with a group of busy, upper-level law sustenance out of it. And after all, my students? Faced with the prospect of students had worked hard all semes- having to make up two hours each of ter; maybe they deserved a break that my Health Care Financing and Regu- day.3 lation course and my Public Health I required students in both classes, Law seminar, I turned to the teacher's either during an in-class make-up little helper: the DVD player. session on a Friday afternoon or on By way of full disclosure, I must their own, to watch and comment on admit that I am doggedly old-school Michael Moore's 2007 documentary AboutThis Column in many of my teaching philoso- expos6 of the U.S. health care sys- phies and methods. I mostly stick tem, Sicko.4 I required the seminar Charity Scott, J.D., is a Professor of to some "soft" version of the tradi- students to write short, two-to-three- Law and Director of the Center for tional Socratic, case-method even in page "reaction papers" to satisfy Law, Health & Society at the Georgia State University College of Law. Elizabeth Weeks Leonard, J.D., is an Associate Professor at the University of ([email protected]) Kansas School of Law. VULNERABILITY IN BIOMEDICAL RESEARCH * SPRING 2009 JLME COLUMN their attendance and class partici- blockbuster or a bust. I wondered if instead to view the film with critical pation requirements for the missed a film could provide a fair and fertile and analytical eyes, applying their class. With the survey course, I took analytical subject from which I could legal knowledge. They rose to the the exercise even further: I used derive one-third of the survey course occasion. Moreover, they taught me the film as ready-made fact-pattern students' final grades. to question my own preconceptions for students to issue-spot and ana- The specific assignment for the about nontraditional approaches to lyze as a one-hour, eight-page-limit, take-home exam 7 was as follows: teaching and the power of the mov- take-home exam question. The idea ing image. of watching a Hollywood movie in Write a critical response and school alone would make me wince, analysis of the issues raised, What They Learned but now I, who almost without excep- problems presented, and argu- The students' essays gravitated to- tion give in-class, closed-book exams, ments made by the film, draw- ward many of the same, highly salient had allowed an open-book, take-home ing on your understanding of examples in the film. Their reactions, exam, based on a "question" that I did the U.S. health care system, insights, and abilities to identify the not write. Professor Kingsfield would based on regulations, financ- relevant laws and policies, while cit- be rolling over in his grave.5 ing, laws, and policies that we ing specific cases and readings in the covered in class. course materials8 and classroom dis- Warning: Don't Try This at Home cussions, were surprisingly good. A Contrary to good judgment and By"critical" I do not mean that few examples follow. teaching wisdom, I had not actually you have to disagree with the watched Sicko when I assigned it to film's premise or conclusions. Duty to Treat and EMTALA my students. For over a year since Rather, I want you to be in- Students were particularly drawn to the film was released, I had been un- sightful - more insightful, I two stories in the film involving pa- able to bring myself to watch Moore's hope, than someone who has tients who were denied emergency latest diatribe, addressing a topic a not taken the class would be care because they lacked health in- surance or their health insurer re- fused to cover the cost of care at a particular hospital. The first story in- I required students in both classes, either during volved a mother who took her infant, an in-class make-up session on a Friday afternoon Mychelle, to the emergency room with a high fever. The mom's health or on their own, to watch and comment on Michael insurer, Kaiser Permanente, we are Moore's 2007 documentary expose of the U.S. told, refused to cover the ER visit at a health care system, Sicko. non-Kaiser hospital. By the time that the mom managed to transport My- chelle to a Kaiser hospital, the baby had died from a high fever and sei- zure. little too near and dear to my heart. in reacting to the film. Your The second scenario involved indigent, uninsured patients being Moore, of course, has famously taken opinions, as informed by the on other industries and scandals, in- class, are welcome. The closer dropped off by ambulances at home- less shelters or community health cluding U.S. auto makers, the gun you can tie your analysis to the lobby, the Bush administration, and assigned readings and class clinics on Los Angeles's skid row. One patient seemed disoriented. Another the 9/11 terrorist attacks. Assuming discussion, the better. I will was still wearing a hospital gown and that Moore followed the same hack- be grading based on what we appeared to be suffering acute, un- neyed "docu-tainment" formula to the studied and learned, not sim- health care industry, I expected Sicko ply your personal opinions treated injuries. Moore offers these examples to be a frustratingly over-simplified, about health care system, of or "patient-dumping" to highlight the tug-at-the-heartstrings portrayal of your arm-chair critic's view of single-minded, money-grubbing all that is wrong with the U.S. health the film or the filmmaker. care system, urging the no-brainer motives of U.S. health care providers. The solution of single-payor, universal The seminar assignment was less health care industry is so cold 6 and calculating that even patients health care. Watching the film for specific and invited general reactions - even the first time during the in-class view- based on our much briefer discussion babies - with emergency and life-threatening conditions are ing session, I realized that my assess- of the U.S. health care system and denied care if they cannot pay. ment was not too far off of the mark. broader discussion of public health While recognizing the tragedy of the sto- But more to the point, I watched and population-based perspectives. ries, the students quickly pointed anxiously to see whether my ad hoc, I challenged students to avoid being out that there is a federal experimental assignment would be a sucked in by Moore's rhetoric and statute, JOURNAL OF LAW, MEDICINE & ETHICS Elizabeth Weeks Leonard the Emergency Medical Treatment patients who had already been preexisting conditions, scrolled omi- and Labor Act (EMTALA), 9 that screened and stabilized in the emer- nously across an endless black screen expressly prohibits such conduct.
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