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Furthermore, providers should educate patients that VSED is an available treatment alternative. Informed consent requires more than just acceding to a decision to refuse treatment. It also requires making patients aware of their end-of-life options. But in many jurisdictions such a decision has the same status as a contemporaneous decision made by a patient with capacity. Consequently, legislators and regulators should clarify the safe harbor protections afforded to health care providers.

There are many circumstances under which a longer life is not a better life. When quality of life diminishes, some individuals would prefer to hasten death or at least not prolong dying rather than endure the perils of what, at least to them, is an exceedingly poor quality of life. See, e. In these jurisdictions, there may be some limitations to a surrogate making a decision to VSED. See Charles P. See Sandra H. See Janet L. McCarthy et al. For some, loss of independence might diminish quality of life to the point where they would request a hastened death. For others, it may be extreme physical suffering.

For these and other reasons, requests to hasten death are common throughout the United States and the world. First, we discuss end-of-life suffering and the predicaments associated with common diseases and medical conditions that cause the most deaths in this country. Third, we demonstrate that there are some people who, for clinical, practical, or legal reasons, are ineligible for any of these five options. It is primarily for these people that we explore VSED as a sixth exit option. Suffering at the End of Life Many people do not fear death, but rather dying. Perhaps the worst problem and greatest fear when a person considers the end of life is the fear that suffering will be uncontrollable and independence will be lost. Meier et al. See supra note Cruzan v.

Dep't of Health, U. The individuals who seek to hasten death are often dependent upon healthcare providers in a long-term care facility or are afflicted with a condition under medical management. Moreover, many people want the assistance or supervision of healthcare providers to assure that any death hastening is appropriate, effective, and pain-free. Timothy E. See Georges et al. Any of these situations may cause additional pain, suffering, and loss of dignity at the end of life. Hastening Death to Avoid Physical Pain Many illnesses and injuries are marked by excruciating physical pain.

Those several cases that we have the space to describe here. Terman ed. It was all those peripheral issues: the crippling osteoporosis, the nearblindness, the heart failure that had left her almost immobilized, the constant pain, and the frustration that no symptom ever got better. Linda Ganzini et al. Physical symptoms include pain, nausea, diarrhea, dyspnea, paralysis, pressure ulcers, and edema. Psychological symptoms include depression, anxiety, and delirium. Existential symptoms include meaningless of life, loss of control over self-care, loss of social role, becoming a burden or nuisance to others, and hopelessness.

See Mohamed Y. See Timothy E. Quill et al. Cantor , supra note 25, at See also Timothy E. In , Dax was twenty-five years old when he became victim to a devastating gas line explosion that caused severe burns to over sixty-five percent of his body. That man declined. Timothy Quill famously described Diane, a patient of his who refused treatment for leukemia because she wished to live the remainder of her life at home with friends and family rather than undergoing painful treatments that only had a twenty-five percent chance of success. Quill noted that the patient was an independent person who liked to be in control of her own life. Kliever ed. See id.

Unfortunately, Dax's requests to stop treatment to hasten his death were continually denied, and he was forced, against his will, to endure the pain. See Burton, supra note 43, at ; Robert B. Hastening Death Due to Loss of Function Often, in addition to or instead of pain, patients are motivated to hasten death because of a loss of bodily functions, resulting in a loss of independence and control. Then, in , he was struck by an automobile while cycling. Before the accidents, Rossiter was an active sportsman who enjoyed keen bushwalking, rock climbing and cycling. See Bouvia v. McAfee, S. Bergstedt, P. Andrew Kirkpatrick, Rodas v. Interestingly, many quadriplegic individuals who seek and even secure the right to die do not actually proceed to hasten their death.

See Satz v. Perlmutter, So. Akron Gen. This sort of situation has been popularly depicted in widely released films. Metro-Goldwyn-Mayer Brightwater Care Group, Inc. COM Aug. I am a prisoner in my own body. I can't move. Bouvia was a twenty-eight-year-old quadriplegic with severe cerebral palsy. Hastening Death to Avoid Severe Dementia While some illnesses and injuries affect the body, others affect the mind.

UK Aug. This was Rossiter's own assessment of his own life. As with all the cases in this section, the authors do not assert or defend any position regarding the appropriate treatment choices for any individual. The point is that some individuals, based on their own values and preferences, make an informed and deliberate decision to hasten death.

Others make different choices. Quadriplegic Steven Fletcher, for example, has served in the Canadian Parliament since Bouvia v. We acknowledge that Bouvia is a troubling case from a disability perspective. Bouvia, Cal. In , upon reaching the mandatory retirement age of seventy, Judge Hammerman left the Baltimore, Maryland bench on which he had served for over forty years. For one who all of his life has enjoyed an exceptional memory, it has seen degeneration at a quicker and quicker pace for two or three years or so.

This has been embarrassing and difficult to deal with in all aspects of my life. The most common thingsevery dayI find great difficulty with. What particularly grieves me is the loss of memory. The simplest tasks are now becoming more and more difficult to do. Confusion is my daily companion. The thought of Alzheimer's is dreadful to me. I'd need institutionalization. The awareness that I could become disabled that would require me to be shipped out to assisted living or worse.

I could not accept. Judge Hammerman carefully deliberated for sixteen months before finally committing suicide in November Dementia indicates problems with at least two brain functions, such as memory, speech, coordination, or sense of time. POST, Nov. Many seriously ill patients find their lives marked with extreme suffering and both physical and mental deterioration. Unfortunately, many do not have or perceive that they do not have access to a medically-supervised, peaceful death like Diane or Christian Rossiter.

Too many patients commit suicide through violent means such as shooting, hanging, or various other forms of self-deliverance. VSED provides an alternative: the assurance that they can die when they want based on their own criteria and can enjoy life for a longer period of time. But death is unavoidable. People suffering from the diseases that cause the majority of deaths in this country will often experience significant suffering and loss of independence. Five Options for Hastening Death in Order to Avoid Suffering Fortunately, for those who can no longer bear living with their physical or mental impairments, there are five options by which they can hasten death to avoid suffering.

First, if dependent upon life-sustaining medical treatment such as a ventilator or artificial hydration, patients can simply refuse that treatment either before or during its administration. Second, for those with intense physical pain, high dose opioids to treat the pain can hasten death. This makes the patient dependent upon artificial nutrition and hydration which can be refused per option 1. Fourth, for terminally ill patients in some states, where assisted suicide is legal, they can get a lethal dose of barbiturates. Fifth, there is voluntary active euthanasia, in which the physician instead of the patient takes the final overt step causing death. Refusing Life-Sustaining Medical Treatment Modern advances in science and medicine have made possible the prolongation of the lives of many seriously ill individuals, without always.

Matthew Miller et al. Judith K. It stems from the common-law principle that any unwanted touching is a. See Thomas Wm. See Arthur E. Doka et al. Rubenfeld eds. Prendergast et al. See Quill, supra note 25, at High Dose Opioids Another option for terminally ill patients94 who are in intense physical pain is the liberal administration by medical providers of opioids, a class of medication that is widely accepted in the medical community for pain relief. See Cruzan v. This right.

The right to refuse is a corollary of the patient's right to bodily integrity and informed consent. See Canterbury v. Spence, F. Since the birth of bioethics in the early s, the right of the patient to be the primary decision maker in decisions regarding her own health care has been valued and protected. Cruzan, U. Glucksberg, U. Quill, U. But see Glucksberg, U. To have capacity, a patient would need to substantially understand and appreciate his or her medical condition. This includes an appreciation for available treatments versus nontreatment, the risks and benefits of each, and the treating physician's professional opinion about how to proceed. Beers et al. See 42 U.

See Quill, supra note 25, at ; Schwarz, supra note 81, at Nevertheless, administering high doses of opioids is legal because the primary intent is to relieve pain, not specifically to cause death. First, the drugs may cause side effects, such as nausea and muscle twitching, that are intense and distressing. Palliative Sedation to Unconsciousness If a person is terminally ill, suffering, and at the very end stages of life, palliative sedation to unconsciousness PSU may be a treatment option to hasten death. See Vacco v. Glucksberg U. See Schwarz, supra note 81, at 56; Quill , supra note 97, at See Schwarz, supra note 81, at Unfortunately, because of aggressive enforcement, providers may be chilled from prescribing adequate pain care.

See generally Diane E. Hoffmann, Treating Pain v. See Jeffrey T. See Schwarz, supra note 81, at 57; Quill , supra note 97, at Timothy W. See Quill et al. With PSU, on the other hand, the medical provider administers medication where the intended goal is unconsciousness not death. The underlying illness or some complication of it could cause death since PSU is only used when the patient is in the very end stages of illness. PSU patients, who are unconscious, cannot eat or drink and are dependent upon artificial nutrition and hydration. However, these patients almost always refuse such measures. Each of these two methods is universally accepted as being a legal treatment choice. Furthermore, PSU may be limited to those whose suffering is physical in etiology.

See Quill, supra note 25, at 19; Schwarz, supra note 81, at Boudewijn E. Death is not caused by the PSU itself. See generally M. Maltoni et al. See also Molly L. Olsen et al. The patient then obtains the drugs and ingests them or at least has them available to ingest when and where he or she chooses. Thus, PAS is an option for those who cannot exercise the right to refuse and who are ineligible for high-dose opioids or PSU.

For example, a cancer patient may fall into this category. Many times, people with terminal cancer do not wish to endure the final stages of it. Patients in the end stages are unable to care for their own hygiene or go to the bathroom independently; they may have nausea and vomiting, weakness, fatigue, loss of appetite, and loss of taste. Knowing that these end stages and symptoms are inevitable or at least forecast , the person may want to die before entering them. At the earlier point, when this person may choose physician-assisted suicide, there may be few other options because he or she is not dependent on any lifesustaining medical treatment and is ineligible for terminal sedation or high dose opioids. But while PAS may be an attractive option, it is a very limited one.

Specifically, it is limited in two ways. First, it is legal in only three states: Montana, Oregon, and Washington. See Kathy L. See Cristina Monforte-Royo et al. Wilson et al. Baxter v. State, P. The Montana Legislature reconvenes in January , when bills, both to implement and to override this decision, will be introduced. Charles S. Moreover, even if all these conditions are satisfied, many patients have difficulty finding a physician willing to write the prescription.

Voluntary Active Euthanasia In contrast to physician-assisted suicide, voluntary active euthanasia VAE involves a physician who both prescribes and administers the lethal medication. VAE is legal in the Netherlands. See Anthony L. Back et al. Patients in the United States also have the option of traveling to a country that permits PAS or euthanasia. Medical tourism is experiencing tremendous growth. See I. There has been a growth in suicide tourism in particular. Rather, it is a survey of what is now available in this country. People who wish to hasten death can often choose one of these options depending upon their particular predicament. Those dependent on technology will likely refuse that technology.

Terminally ill patients with intractable suffering may choose PSU. People in excruciating pain may opt for high doses of opioids. Terminally ill residents of Montana, Oregon, and Washington may ask a physician to prescribe a lethal amount of barbiturates. Absent is an option for people with severe forms of dementia, cancer that is not in the end stages, AIDS, quadriplegia, Huntington's disease, ALS, and other chronic illnesses. Some individuals with these conditions wish to hasten death before reaching end stages that they find heinous. This group of people would prefer to preserve dignity and independence, and to avoid altogether the pain and suffering associated with the end of life in these circumstances.

VSED is appropriate for those who are unable to use any of the other exit options because they lack dependence on machines, because the end stages of illness have not yet come, or because of legality. In Oregon, for example, physician-assisted suicide is a legitimate option. First, it might depend on the importance placed on control. While PAS entails a single instantaneous and irrevocable. There are other nonmedical options for hastening death. For example, various books and organizations advise individuals about how to use a helium hood and how to obtain and take Nembutal.

See supra notes 1 to 22 and accompanying text. See supra notes 61 to 69 and accompanying text. See Ganzini et al. VSED has more support amongst healthcare providers. Harvath et al. Second, the slower process permits relationship reconciliation and a healing goodbye. Third, a preference for VSED over PAS might also depend on access to a physician who will prescribe lethal medication, other beliefs, and family views.

Currently, VSED is an option available to many terminally ill patients. However, it was, until recently, rarely discussed as a viable alternative to the other means of hastening death. Its advocates profess its legality and practicality. Ganzini et al. See infra notes In this over-stuffed world, it is hard to imagine why a person would opt to refuse the food and drink that we hold so dearly, especially as a way to die. Persons suffering at the end-of-life, however, have many good reasons to cease eating and drinking.

For example, Margaret Page suffered a brain hemorrhage in See Melissa A. Schwarz , supra note 40, at See infra note See also Bernat et al. This is important because many people wish to maintain independence and control at the end of life. VSED allows this because ultimately the patient is able to make a purposeful, independent decision to stop eating and drinking. Chug, supra note Since the individual is. Second, we will quickly trace its history, from ancient Greece to the contemporary United States. Third, we methodically explain, both biologically and medically, how VSED enables a good quality death. Parameters of VSED VSED entails deliberately ceasing the self or assisted oral intake of all food and fluids, except for those small amounts of fluids necessary for mouth comfort or for the administration of pain medication.

Alan D. Elliot M. It is important to minimize liquids because even a moderate amount will prolong the dying process. See infra Part III. This causes a peaceful death by dehydration. VSED does not apply to persons dependent upon a feeding tube or upon any other form of artificial nutrition and hydration. It does not apply to patients who. First, individuals seeking to hasten their deaths are often dependent upon healthcare providers for treatment of their underlying illnesses. Second, medical supervision is recommended.

For example, the recently popular case of Christian Rossiter, while characterized as an individual's right to starve to death, was not about VSED. Rossiter was physically unable to eat or drink; nutrition was provided to him through a tube inserted directly into his stomach. Since depression, paranoia, and dementia may result in food refusal, patients refusing food should be screened for these diagnoses. Cohen et al. Some have proposed limiting VSED to those patients with an irreversible lethal illness not responsive to standard palliative care.

Otherwise, they argue, VSED looks too much like suicide. Lynn A. While we do not, in this paper, defend specific clinical indications, we do not think that VSED should be so limited. Furthermore, VSED does not include those patients who lack capacity, whether due to anorexia nervosa or dementia, as many of those suffering from dementia do not recognize their food as food. Ninety-two-year-old Mary Hier, for example, suffered from a cervical diverticulum in her esophagus, which greatly impeded her ability to ingest food orally. In re Hier, N. Patients refusing food and fluid should be screened for these conditions. Areas of concern are: swallowing disorders, poor oral health, inadequate staffing, improper bed position, and food choices.

The individual with dementia may have issues with self-feeding, recognizing food, maintaining attention, persistence of action, or apraxia. Emley et al. History of VSED Ongoing debates surrounding when to use or to stop use of many types of end-of-life treatment, such as CPR and ventilators, date only to the s. In contrast, VSED is a method of hastening death that dates back thousands of years. In one of its rituals, Santhara or Sallekhana , a Jain stops eating with the intention of preparing for death. VSED should be distinguished from stopping eating for political reasons, from spontaneous diminishment of eating and drinking, and from incapacitated decisions to stop eating and drinking. ETHICS , discussing political reasons for which prisoners go on hunger strikes ; Jansen, supra note , at See John M.

Centuries ago, elderly members of Native American tribes wandered into the woods to die without food or drink. Eskimo families sent the elderly off on ice floes to meet their maker. Braun, supra note , at Sixty-one-year-old Vimli Devi Bansali, a resident of the Indian state of Rajasthan, was suffering from incurable brain cancer. Hinduism includes a similar practice called Prayopavesa. While it also entails fasting to death, Prayopavesa is limited to those: a who are unable to perform normal bodily purification; b whose death appears imminent or whose condition is so bad that life's pleasures are nil; and c who engage in the ritual under community regulation. VSED itself causes no pain. Next, we review the clinical experience, which demonstrates that deaths hastened by VSED were comfortable and without pain.

We explain the physiological effects of VSED. In short, we demonstrate not only that VSED poses little risk of pain, but also that it can provide significant benefit by helping patients avoid suffering. In addition, studies not specific to VSED have found that dying patients who are dehydrated and malnourished do not feel hunger or thirst. See Mary J. His goal was to line it up so that the wires would send maximum current directly through the two cells, pushing them toward each other and confusing their membranes enough to make them fuse. The fusion fails. Thus, she was able to tell the heartbreaking tale of Lia Lee, a young Hmong girl with severe epilepsy. Fadiman showed how the wildly divergent views of health and illness, body and spirit held by her devoted parents and her conscientious doctors doomed Lia to a living death.

As I reported my story on population genetics, I discovered that not only were researchers running their own DNA to check their haplotypes, just for fun, but a few also were running DNA tests for individuals curious about their own heritage. Amidst all that, I saw an amazing tale emerging on Taking Your Story to the Next Level 37 the swift democratization of new technology. So I haunted genealogy Internet chat rooms, pestered population geneticists to spread the word, talked to lots of anthropologists, even asked workers in genetics labs if they had run their own DNA and if they would talk about it.

New research tracing male Y chromosomes had tracked genes shared by cohanim back 3, years, to the time of Aaron, the Biblical progenitor of the caste. Through genetic testing, Carvin found out not only that his Y chromosome had the cohanim markers, but that his markers matched those of another man in the database, making it likely that they shared a forefather within the past years. So in November , Carvin took the train to Philadelphia and met year-old Bill Skwersky, his genetic cousin. And Doug Mumma, who searched the Internet for people with similar surnames, paid for Y-chromosome testing of strangers in Germany, and found relatives there.

I searched long and hard until I found an Alaskan Aleut elder who not only had had her DNA tested, but who was willing to talk about it. In fact, she was amused by her Siberian roots. My search took way too much time, and many days along the way I doubted if the people I was looking for even existed. But those few paragraphs may be the most important ones. The world makes more sense, if only for a bit. When a good story idea, meticulous reporting, great characters, and the right perspective combine in a single article, the results can be riveting. We have since become more cautious, Gawande explains. Now a single death can halt all human gene-therapy experiments. In more than two decades as a newsman for the Detroit Free Press and Knight-Ridder newspapers,he has reported from 23 states and 11 foreign nations.

He has written about the environment, energy, politics, economics, government, and labor, and he has been a copy editor, city editor,Washington correspondent, investigative reporter and editor, and a contributing author of three books. His journalism,essays,humor,and fiction continue to appear in newspapers,magazines,and literary journals and online. David began teaching journalism and writing in , while still a practicing journalist. He lives in the Washington,D. A few minutes into her answer, I sensed confusion in the classroom.

Many science writers also must contend with journalistic precepts that subjugate or even eliminate individual style. In this chapter I review the complications and examine the tools of voice and style, concluding with exercises that should help writers identify and hone their own. When writers for the New York Times or the Modern Language Association or the New England Journal of Medicine talk of style, they often mean the strict rules of spelling, punctuation, abbreviation, and other usage as set forth in hallowed style manuals.

For academics, style has classical roots in Aristotle, Cicero, and that granddaddy of Rhetoric, Hermogenes, who rated style as grand, middle, or plain. Voice is an individual writing personality, whether distinctively our own, one we recount or create, or, sometimes inescapably, both. The tune and words are the same, but what a difference style makes. With voice, what we do not write is as important as what we do. With style, we make readers feel a certain way without mentioning that feeling. Some examples: Finding a Voice and a Style 41 Paleontologist Stephen Jay Gould employed an almost Victorian formalism in his writing, to underscore his wondrous view of the smallness of humanity confronted by the might of anthropological time.

Nature essayist David Quammen combines numbers, theories, and chemical names with blunt memoir and adventurous word choice to probe his life, past and present, amid the inherently metaphorical outdoors. Many writers mistakenly believe that voice and style arise only from beautiful writing. But a trait as simple as clarity, especially when clear thought matches lucid expression, can create its own voice. In neon yellow, I highlighted the obviously lyrical passages or phrases in each book. Does this mean Dillard is a better stylist than McPhee?

Only if you focus on prose poetry. His explanatory and structural mastery assumes, as he once said, that his readers are smarter than he is, and his voice is as solidly subtle as his viewpoint. In contrast, we have the famous opening scene in Pilgrim, in which a home-coming cat tracks its bloody paws on a sleeping Dillard. As beautifully 42 Learning the Craft written and assertively expressed as the scene is, readers have since learned that it fails the accuracy test of a middle school journalism class. For many science journalists, the quest for objectivity stymies two of the most valuable tools of style and voice—opinion and emotion. Emotion sets our voices free.

Remember, too, that the style of some writing is determined as much by the publication as by its writers. Compare that style with that of another weekly, The New Yorker, which most often presents pyramidal narrative, assertive intellectualism, and a density of sophisticated language. A good writer can adopt a house style and still strive to be uncommon. You should use different styles for a news report on the discovery of life evidence on Mars, an investigation of cost overruns on the latest Mars mission, and a philosophical contemplation of a possible human expedition to the Red Planet. Study strong voices. Read the text and make lists; underline words or phrases. It gets easier the more you do it. I once spent an hour underlining examples of this courageous technique in her book.

Other strong voices in science writing include Ackerman, Gould, and Ian Frazier. You also might record and study a speaking voice. Van Gogh learned to paint by copying Rembrandt and Delacroix; you should try copying too. Exchange and discuss imitations with writing compatriots. Notice how a small change in word choice can alter a voice; notice, too, how style and voice cannot be divorced from content. One verb will sound more like Gould than like Ackerman. That comfort level is an important clue for the next set of exercises, when you begin to sharpen your own style and voice. Freewriting and journaling. Another option is a journal, in which you write about one moment from every day of your life for a month and describe, as deeply as you can, how you felt during that moment, without worrying about how you express yourself or whether anyone will read it.

The goal for both exercises is to let your instincts emerge and then study the results as closely as you did in exercise 1 above. Underline your own writing; list your own techniques. Tape yourself. Have someone record you without your knowing it, in a meeting or during dinner-table conversation. Analyze how you speak; consider whether that is the way you think. If so, it likely will touch on the way you do or should write, without the professional restrictions of style manuals or editorial dictate. Revise for style. Which was easier? What techniques did you use? Which did you avoid? I once had a student whose job was to write about AIDS for a government agency. Later, if you decide to follow the classic advice and write what you know, you might try doing it from a wildly different perspective to help detect your own style.

Freed from the conventions of your profession or workplace, you should begin to use techniques that reveal genuine voice. Notice how passion and opinion can be essential tools for style. What do you detect in these exercises that is different from your everyday writing? Examine your personal letters or e-mails. This writing often is designed to express feelings rather than ideas, to speak casually rather than publicly. You may therefore display hints of your voice more easily than in the serious writing for which you strive professionally. Amid all the exercises, text analysis, and rhetorical debate, you will feel more attuned to that personality the more you use it.

Regardless of which you are, I predict that life will improve. It certainly did for me, after I made the jump from Boston bureau chief of the New York Times to science and health reporter for the Boston Globe. You can do it. Not only can you do it, you should. Presidential campaigns, Mideast wars—so much of general news moves in cycles. Enough pep talk. Now shop talk.

But these disparate descriptions also carry an overarching message, one perhaps best summed up by what a Hollywood friend of mine once told an eggheady screenwriter of dull movies: Dare to be sexy. A favorite editor adds: Dare to be simple, too. So call it seduction, or call it salesmanship—all stories need it, but various media require various kinds. As do various audiences—whether scientists or lay folk, Web clickers or traditional breakfast newspaper readers. My personal favorite is: You, the reader, will gain new insights into your own nature that will change your self-concept forever after. Ron talks about making something called proteomics readable for an audience with a minute and a half to devote to it.

But it is an endeavor both noble and necessary. The second is what you might call juiciness. I like the juice image because it combines two elements: What you write must be appetizing in a human way—the characters must be somehow colorful, the action compelling—and it must be well squeezed, with loads of pulp thrown away. Yes, it hurts to discard work that it took many megahertz of brainpower for you to absorb and understand. But such ruthlessness is well rewarded. When Mariette DiChristina writes in chapter 16 about what an editor looks for, she mentions nothing about giving a reporter credit for mastering complex science.

Of course, science journalists in all markets must also practice a kind of anti-salesmanship, what Lee Hotz calls the gatekeeper function. That gatekeeper function adds some cool water of conscience to all the salesmanship. One other aspect of story-sales that several writers here mention: the package. Not all of us go as far as Alan must at MSNBC, thinking of quizzes, blogs, and photo galleries to go with our stories. But images are so important in science and science reporting that MIT held a special conference on the topic a couple of years ago. To end on a technical note, these pages are full of technical hints, and though they are not exactly trade secrets, they strike me as truly gracious.

Lee Hotz has just saved me hours of testing digital recorders, for one thing, and Carl Zimmer may save you days of struggling with footnotes with the software he recommends. But most gracious of all, these distinguished journalists write with thoughtful candor about what it is like to be them. So it seems not only possible to aspire to emulate an admired byline, but eminently worthwhile—fun, even. He covers breaking science news from the University of Wisconsin and travels the state and the upper Midwest writing about current environmental issues. After all, I made a terrible mess of the frog I was supposed to dissect in high school all those years ago.

Between assignments, I had time to give a talk about science writing to a local high school biology class and to win one of the ongoing games of Scrabble in the cubicle at the newspaper where I make my workday home. The State Journal is the second-largest daily newspaper in Wisconsin, with a daily circulation of 95, and a Sunday circulation of , Yet there are few other reporters who do nothing but write about science for their publications. All you have to do to understand this trend is think about the writers you ran into at the last meeting of the National Association of Science Writers. How many science writers, however, did you meet from daily newspapers in places such as Nashville or Peoria or Fort Wayne or Aberdeen? Chances are, not many. Which is a shame.

At a time when science in one form or another permeates every corner of our lives, one of the most important sources for science news—the daily newspaper—seems to be devoting fewer resources than ever to covering the subject. So here are a few recommendations for the feeding and nurturing of science reporters at small and mid-sized daily newspapers. They are meant to be followed by reporters and editors alike. About 10 or so years ago, when our science reporter left for a job at Science News, in Washington, D. I quickly suggested that the new science reporter also be given the job of cover- Small Newspapers 51 ing environmental issues, which are generally mostly science anyway.

I then lobbied for the job and managed to get it. As I had hoped when I proposed combining two beats that might not stand alone at a medium-sized paper, together they provide enough breaking news to justify keeping them. Other papers match science and medical or technology beats, which also makes sense and seems a good way to keep science in the mix. There are plenty of arguments to be mustered for keeping the science beat on papers such as the State Journal. At a time when medium-sized papers are scrapping for readers and competing with television and the Internet, science, presented clearly and succinctly, offers the kind of interesting and useful material that keeps newspaper readers reading.

Few beats offer more such stories than the science beat. This was no small thing, considering the almost iconic role that deer hunting plays in Wisconsin. More than , hunters, from all over the country, come to Wisconsin to try and get their deer; over the course of a week, they kill about , Generations share the tradition of deer camp. Radio stations play deer hunting songs. Blaze orange becomes a fashion statement—just check out the stands in Lambeau Field during a November Packers game.

Still, at its heart, chronic wasting disease in Wisconsin is a science story. I became the CWD expert. I developed sources at the University of Wisconsin, including wildlife ecologists and the scientists studying prions, the little-known malformed proteins that cause the disease. Most uncertainty centered on whether there was a risk that the disease could spread to humans. Unlike with mad cow disease, scientists have so far found no evidence that CWD has resulted in any cases of variant Creutzfeld Jakob disease, the human version caused by eating tainted meat.

And our regular and accurate coverage of the issue earned the paper the respect of scientist and hunter alike. The work on chronic wasting disease later paid off in another way. When mad cow disease was discovered in Washington State, I was well prepared to report the story and its impact on Wisconsin. I wrote once again about the science behind prion diseases and about the differences between mad cow and chronic wasting disease in deer. I worked hard to accurately assess and convey risk—another important job of a science reporter, and information that is meaningful to the general readership of a daily newspaper.

Especially today, so many stories that end up on the front pages of newspapers have to do in one way or another with science. I try hard to keep our editors aware of this and rarely pass up a chance to point out the science angle in the stories we cover. Sometimes I become the lead reporter on the story. Other times I simply contribute a sidebar report about the science. A good portion of my work involves keeping track of the research that comes out of laboratories at the University of Wisconsin in Madison. The university provides not only valuable sources but also remarkable stories about Small Newspapers 53 everything from human embryonic stem cells the University of Wisconsin is a world leader in such research to brain imaging and the science of emotion.

Having a full-time science reporter allows the State Journal to pick up more of these fascinating stories, not only the major research projects that are published in the well-known journals but also the less noticed work that might not get covered were the paper relying on general assignment reporters for science coverage. Most of the time, there is simply too much to write about. And I like to think that many of the stories I cover would not have been given the attention were I not around to prod the editors. Wilson, even though the story turned out to be a timely and interesting discussion of biodiversity in our own backyards.

I know that readers appreciate these efforts. They read and nod and frown and laugh and, sometimes, share a bit of news with the person next to them. People care about the news in their local papers. For a couple of years, I was the farm reporter for an even smaller daily in the middle of Illinois corn country. I became accustomed to farmers in their muddy coveralls tromping into the newsroom to share news about everything from the weather to the vegetable in their garden that resembled Richard Nixon. This closeness to the people who read your work makes the job both more demanding and more fun.

Of course, working on a smaller newspaper has its drawbacks, especially at a time when daily circulation is dropping and most papers are struggling to make money. But there are a number of training programs and fellowships out there that will cover part or all of your 54 Choosing Your Market expenses. The website Journalismjobs. The science reporter gets no exemption at the State Journal, for example, from having to pitch in and help compile the annual business tab or cover a local county board race or work the Saturday general assignment beat once a month.

He has twice received national reporting awards from the Society of Professional Journalists and three times won the science writing award given by the American Association for the Advancement of Science. He was a Pulitzer Prize finalist in for his coverage of genetic engineering issues and again in for his stories about the space shuttle Columbia accident. And he shared in a staff Pulitzer in for the L. Lee is an honorary life member of Sigma Xi, the scientific research society, and vice president and president-elect of the National Association of Science Writers. The rock was a ,year-old hand ax. The Spanish archaeologists who discovered it called it Excalibur. And they claimed it was the earliest known evidence of the dawn of the modern human mind.

If so, it was , years older than any other evidence that such early human species honored their dead. As a reporter, I was in a bind. Discovery of the rock offered an opportunity—the potential news hook— for a fascinating story. They center on the validity of the work, its importance to the general public, and whether independent scientists can vouch for it. There also are practical considerations. How quickly can the story be turned around? Is there enough material for a graphic? Can we get a photograph? How much space does it deserve? Does it have a chance of getting on page one?

The claim being made by the Spanish archaeologists was certainly provocative and, no doubt, sincere. But how reliable was it? In this instance, I had to ask myself whether there was anything besides the speculative enthusiasm of the archaeologists who made the discovery to support such an extraordinary claim. To pursue the story, I interviewed the archaeologists themselves, going back twice with follow-up questions. They were articulate, charming, dedicated, authoritative, and infused with the romance of possibilities. I also interviewed them at length. As part of the exhibition, the museum curators had convened a two-day conference about the state of research into European prehistory.

Journalists Large Newspapers 57 were not allowed to listen in on the actual scholarly debates. Instead, a special session was convened for reporters. Several scientists summed up the proceedings. They also distributed a carefully worded consensus statement about the importance of the specimens on exhibit. Such reticence began to trigger mental alarm bells. But the work would be detailed at a later date in a more minor but respectable academic journal in Europe that specialized in human anthropology, I was told.

In effect, the museum exhibit itself was the public announcement of the claim. The ax, however, took up just two pages of the tome, most of which were devoted to a large color photograph. There was a single terse paragraph of supporting text. Clearly, there was no suggestion of fraud or conscious deception. I did wonder, however, whether the Spanish archaeologists had in good faith simply overreached. Other researchers, too polite perhaps to naysay their claim in public, were damning it with faint praise.

By this point, I had invested two days in researching the story, and under other circumstances, I might have given up on it entirely as being too speculative or offered a brief about the exhibit to our travel section. One advantage of working at a very large newspaper like the L. Times, however, is that a reporter often has more freedom to scratch his curiosity itch and pursue a tantalizing lead with the implicit understanding that breaking news may at any moment interrupt his work and plunge him into deadline coverage of unfolding news events.

At the L. Times, a reporter sometimes can spend weeks or even months on a single story, able to pursue it with a tenacity and depth beyond what a smaller paper can usually afford. In particular, the science writers at the L. Times have considerable latitude in choosing their assignments. The Times employs about a thousand reporters and editors, more than two dozen of whom specialize in coverage of science, technology, medicine, or the environment. The science editor reports directly to the managing editor and attends the daily meetings where story play and space allocation decisions are made.

Competition for a place on the front page is especially intense. Normally only seven or eight stories can be displayed on the front page of the L. I was reluctant to let go of this story just yet. Talking it over with L. Times science editor Ashley Dunn, I began to realize that the uncertainty itself might be the core of the story. It was a curiously ambiguous claim.

The researchers had taken the prehistory of the mind right to the edge of what could be deduced from an inanimate object. Now I had reached a point in my reporting when I had to draw more directly on my own resources. Any reporter has to be a packrat when it comes to collecting information. Some of us raise the practice to the level of a personality disorder. In that regard, the advent of the electronic newsroom has been a blessing. As a journalist, I am a card-carrying member of the digerati. Every aspect of my work is informed and organized by computer tools.

Work habits should be just that—habits—a collection of ingrained techniques that come as easily and automatically as touch typing. I keep track of hundreds of sources in a contact management computer program, not too different from the computer programs that salespeople use to keep track of customers. Many people use Microsoft Outlook for this purpose, mostly because so many computers come with it already installed, but for the past 15 years I have relied on an information management program called Commence produced by the Commence Corporation.

It allows me to crossreference people by story or expertise and to link them to ongoing projects, todo lists, or calendar appointments. For interviews, I use an Olympus digital voice recorder. The audio quality is better than conventional tape. There are no moving spools to jam, no tapes Large Newspapers 59 to lose or mistakenly erase. The removable memory card can hold up to 22 hours of interviews. To improve the quality of those recordings, I also use an external stereo microphone about the size of a bottle cap.

A digital recording is also faster to work with than a conventional tape that must be mechanically wound and rewound, during the effort to cull accurate quotes. The sound quality is usually superior, too, because there is no tape hiss or machine noise during playback. I have noticed that my radio colleagues favor Sony minidisc recorders, which record on tiny CD platters, or digital audio tape DAT machines, both of which combine broadcast quality audio with the ease of electronic editing.

So far, however, these programs can be trained to master only the speech patterns of one voice. I still have hopes, though. To round out my digital toolkit, I recently started carrying a digital Canon camera in my briefcase. I take pictures during lab visits or interviews as a form of note-taking, to capture details of places and people that I might not be observant enough to jot down.

To collate news clippings, research papers, Web pages, and anything else that might one day become indispensable on deadline, I use a free-form database called askSam, produced by askSam Systems. The program is designed to automatically turn information into a database that can be easily searched in more ways than any other database program I have tested. I use it to build electronic archives on topics of general interest to me, such as neuroscience or the U. I also use it to collate source material for major stories. Soon I was conducting follow-up interviews with independent experts in Spain, at the Smithsonian Institution in Washington, D.

Playing telephone tag across so many time zones can be expensive and exasperating. I often use email as a way of introducing myself and arranging interviews. Over the course of a week and a half, a story about the archaeology of the mind started to take shape. The rock neatly illustrated the problem of documenting mental evolution. At the same time, I began working with our art department. For a science news story, informational graphics are an essential element.

The L. To help put the ax in context, we created a timeline that noted milestones in the history of the evolving mind. We also prepared a map showing the site of the excavations. From the museum staff, I obtained color slides of the ax and of researchers working in the eerie cavern in which it was discovered. In this form, the story joins the jostle for space and display. The quality of the writing can help lift a news feature from the interior of the paper and into the spotlight of the front page.

Next I started drafting. Large Newspapers 61 The article began this way: NEW YORK—To the primitive hands that deftly shaped it from rose-colored quartz , years ago, a glittering stone ax may have been as dazzling as any ceremonial saber. It was found in the depths of a Spanish cavern among the skeletal remains of 27 primitive men, women and children—pristine, solitary and placed like a lasting tribute to the deceased whose bones embraced it.

The Sunday front page had been wiped clean by events. We all were mobilized to cover that breaking news story. It was weeks before we thought again about anything as esoteric as a prehistoric ax. The museum exhibit that had prompted the press conference now merited just a passing mention. On Saturday, February 22, the story of the quartz ax was published on the front of the L. Times World section, giving more than three-quarters of the page to the ancient mysteries of the evolving mind. She is co-author,with Dr. Janice has won 11 awards for her medical stories. I like to know how things work—why plaque piles up in arteries, how microbiologists identify different strains of bacteria, how surgeons separate conjoined twins, why some medical centers are better than others.

I want to give people information that will help them make better medical decisions. Most magazine articles begin with a proposal, also called a query letter. Eva Marie would spend three days in the pediatric intensive care unit and at least seven days in the hospital. How can you explain to a 4-year-old what major heart surgery means? They were fortunate. With a circulation of nearly 36 million and a readership of 80 million— nearly one-third of the nation—the granddaddy of general interest magazines is Parade. It is the Sunday magazine of newspapers. Parade has a commitment to health coverage; it runs one major health story a month, plus a health column. The information we give our readers has to be useful. Health has some popular-psychology stories. Fitness and Shape lean toward exercise stories.

There are also health newsletters published by medical schools and major medical centers; many of them use freelance writers. Among the science magazines, the most famous is Scientific American, whose readers are mostly men in their 40s with high incomes. News editor Philip Yam says the magazine is serious, but lighter and livelier than it used to be. It covers all areas of science, not just medicine. Most of my queries open with a sentence that becomes the lead of my story. Editors love a query that shows you have found people and experts to interview. Address the proposal to the right editor. Only a few years ago, writers put a neatly typed query letter and some of their best clips into an envelope and mailed it. These days many editors prefer e-mail.

But it varies. Some editors like snail mail better because they think a proposal and clips on paper are easier to review and pass around. Find out what editors prefer by calling the magazine and asking. After you send it, your query will probably fall into a black hole. Most editors do not respond unless they are interested. Some queries get lost. Remind her politely about your query and paste a copy of the query into the e-mail. That seldom happens. If it does, you can take the best offer or do different stories on the same subject. A colleague started work on a timely story before he got the contract and then—whoops!

But nobody had told him he was required to tape interviews, and by then he had already conducted several. Travel writers often resold articles to newspaper travel sections across the nation. Things changed with electronic databases and the Internet. Publishers wanted all rights to stories—not so much because they could resell stories to the same markets that writers used to sell to, but because they gained handsome fees from selling the entire contents of their publications to databases. Could you send me the other one?

Sometimes all you can do with an especially dreadful contract, if the publisher is unwilling to negotiate, is to turn down the assignment and refuse to write for that magazine. I have, and so have many of my colleagues. Writing and Submitting the Story Writing an article is a process of gathering too much information and then winnowing it down. I try whenever possible to do my interviews in person, to watch the surgery, to go to the lab. I tape when I can, but I usually listen only to crucial quotes. I take careful notes as well. I learned to outline the story in my head before I sat down to write.

Then I try writing the individual parts of the story with the aim of linking them together. Often a structure appears as I do this. One way of organizing is starting in media res in the middle of things, as the Romans said. You begin at the crisis point and then you go on to explain to the reader just what led up to the crisis, what happened next, and how it was resolved. Another popular method is to begin with a touching story to engage the reader. A variant of this opening is to mention a current news event or a historical discovery, then explain why it happened and what it led to. Your editor may want revisions or additional information. At other magazines your story will be circulated to all editors and their comments and requests for revisions will be consolidated before they get to you.

Popular Magazines 67 You should be paid upon acceptance, not upon publication. Kill fees range from 10 percent to percent; most are 25 to 30 percent. When your article has been accepted and edited, it will probably be factchecked by a bright young person who may save you from errors. Give this person copies of your published sources, marked to show what supports what you wrote, and a list of the people you interviewed, with their phone numbers. Some magazines ask for your notes and also for tapes of your interviews and for transcriptions. You need to know this up front. The Best Part The best reward for all this hard work—besides just seeing your name in print and your article beautifully displayed—is getting a handwritten note from someone whose life you have saved.

The most touching was from a California woman who was successfully treated for a dangerous brain tumor thanks to my article in Parade, and then went on to have two wonderful children. Stories like this make it all worthwhile. He has a degree in Liberal Studies in Science from Manchester University in the United Kingdom, but no formal training in science journalism. He learned on the job—and continues to do so—first at Nature as a staff writer in London and Washington, D. After temporarily curing himself of the urge to write books with The God That Limps , about the social impact of new technology, he returned to weekly journalism, joining Science in as a writer and editor in the news department.

A fraction of your readers will know a good deal more about the topic than you do, and a larger fraction will be quick to jump on any mistakes. So what makes a good story for a professional magazine? Only scientists can write accurately and with authority about science, the argument went. We still hear that refrain occasionally. At a young age, there is the fine line between becoming an introvert or an extrovert- living our lives in extravagance or happily alone. For Esther Greenwood, her pivotal moment led her to the act of conforming for society, hiding behind the title of magazine editor while contemplating suicide within.

In her novel The Bell Jar, Sylvia Plath explores the ideas of conformity and insanity all within two hundred forty four pages through her main characters, Esther Greenwood and Buddy Willard. Before seeing a psychiatrist, she had already attempted suicide. Visits with her psychiatrist reduced her drinking, but did not stop her abusing Veronal tablets since she was addicted. Big Blonde is written as a background to show how she struggled and to tell readers the mistakes she has made in life. Life can be tough sometimes and that is what Dorothy is trying to demonstrate. Girl, Interrupted is a movie about a young lady named Susanna who is institutionalized after having taken aspirin with a bottle of vodka.

In this reflection, I shall highlight notable scenes in the movie, which illustrate important sociological concepts and themes. The first scene that caught my attention was when Susanna was admitted. The case of Anna O, is about a young woman who dealt with hysteria. Her case has acted as the base of psychoanalytic theories and practices. Anna O was described as a twenty-one year old girl, with high intelligence, who started to develop signs of illness while she was nursing her father who died of tubercular abscess, which lasted over two years. First she started by having a cough, then developed physical and psychological disruptions. She also suggests Hazel attends a local support group of other young people who are living with or surviving cancer.

I have chosen the movie precious and have viewed this movie two times with the goal that I can compose a make the great notes for composing the reflection about this movie. The movie Precious in light of the novel Push by Sapphire around is about a girl Claireece Precious Jones who was brought up in an oppressive family unit with her mother and her mother 's sweetheart, where she manages verbal, physical and sexual abuse from both her mother, and father who lives in an alternate home. Precious has one kid with Down 's Syndrome, however her mother doesn 't let the infant stay in the house with them so she lives with her grandmother and the main time Precious gets the chance to see the infant is the point at which the social worker visits to assess the tyke care. This movie was extremely reasonable.

It demonstrated what a few individuals really need to manage in ordinary life. While Arehart-Treichel expresses statistics regarding how women are portrayed in three different psychiatric journals, she points out a commonality. Women are portrayed in psychotropic drug ads as fulfilling a family role, leisure role, or asleep and rarely portrayed in a professional role. Men on the other hand were shown in more independent and productive roles.

Like many before her, she carried her poverty into adulthood, doing odd jobs with periods of homelessness and hunger.

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