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“Now I Lay Me Down to Sleep”

by on November 6, 2014

                                                “Now I Lay Me Down to Sleep…”

                                                       by Marco M. Pardi

Note: All comments are appreciated, read, and responded to accordingly.  The COMMENTS sections for all previous articles have been opened for use.  I will certainly look forward to your comments.  Comments that do not specifically address content will be trashed as SPAM.

“For those who took the initiative of killing themselves, the SS issued (Dachau 1933) a special order: prisoners who attempted suicide but did not succeed were to receive twenty-five lashes and prolonged solitary confinement. Supposedly this was to punish them for their failure to do away with themselves; but I am convinced it was much more to punish them for the act of self-determination.” Bruno Bettelheim (1903-1990). In W. H. Auden, “Camps, Concentration,” A Certain World: A Commonplace Book. 1971

(Suicide) is a privilege of man, which the deity does not possess.”

Pliny the Elder (CE 23 – 79) In R. Whitwell, Analecta Psychiatrica, D.30, 1976. 

Some say those who advocate for the Right to Die should understand what it is to terminate life. I well understand.  Some say these advocates should have experience in speaking with people who have declared intent to end their lives.  I have that experience.  And, some say advocates should be experienced in dealing with the aftermath of self termination, expected and welcomed and/or unexpected and shocking.  I have that experience.

The recent case of Brittany Maynard, a vibrant 29 year old woman, has burst onto the media stage in ways which are both encouraging and disturbing.  It is encouraging in that, perhaps partly due to our media filled age there can be few still unaware of her circumstances and decision.  This may very well lead to a groundswell of support for legislation that provides the public and social framework for an act which is inherently a personal decision.  Disturbing because the media seem to concentrate on her youth, her recent marriage,  and largely on her physical attractiveness.  She was not a middle aged or older person emaciated from years of living immobilized in “locked in” syndrome, often but not always the end stage of Amyotrophic lateral sclerosis (ALS),.  She was not an elderly, chronically ill person who simply felt the time had come.  And, she was not a person who had little or no access to media, struggling to die quietly in some nursing home, visited by almost no one.

In the years during which I was a licensed counselor to dying individuals and their families I interacted with a very attractive young woman confined to her wheelchair with Multiple Sclerosis, a progressive demyelinating disease of the central nervous system.  A young man I attended had advanced Muscular Dystrophy, a progressively wasting disease.  Of course, unlike Brittany, one could not look at them and say “They look fine”.   

Brittany’s case is disturbing for those of us who have spent decades in the academic and the applied field of thanatology – death & dying, not just on its own merits, but on its contrasts to the crowds of ghosts from our pasts.

As I have said elsewhere in this blog,  my initiation into the formal study of death & dying came at the hands of a 22 year old student who, coming to me after one of our night classes, informed me she had inoperable brain cancer and no one to talk with.  That was the early 1970’s.  I had noticed in her a behavioral syndrome throughout the course but could not ascertain a source.  My first question to her asked why she had no one to talk with.  Did she not have a family?  Indeed, she did.  A “country girl” from rural Central Florida she had a family of people who, when she opened her mouth about her situation ran to the family bible and began quoting chapter and verse.  They did not want to talk with her; they wanted to talk to her.  She, on the other hand, had no interest in rehashing the scriptures, seeing them as a garbled “telephone game” passed down through the centuries by tired old men.       

I did talk with her; I talked with her until she was no longer able to communicate and was relegated into the hands of the medical caregivers to allow the cancer to eat and storm its way through her cranium, cannibalizing the brain as it went.

Resistance to the right to self termination is often based in agenda driven myth and misunderstanding.  Even the word suicide, self killing, has lost its original neutrality.  That’s right, it is a neutral word.  It does not imply right or wrong; it does not imply purpose.  It speaks only of an act.  Yet, for centuries it has been vilified in some societies as de facto proof of mental illness.  It has been castigated as against the will of some god figure, a sin.  It has actually been criminalized by statute in some American States and still carries the onus of criminality through the ubiquitous linguistic coupling with the word “commit”, as in commit suicide, instead of the word “perform”.  And, by extension, people who have been helped in the performance of this act must surely have been unduly influenced to do so, probably for personal gain.  Hence, the assistants are themselves criminalized.  Let’s look at these ideas.

A central focus of my teaching has been culturally induced cognitive dissonance.  Examples abound, but interesting cases include the soldier who volunteers for a “suicide mission” and the soldier who dives onto a grenade to shield others from its blast.  In either case, when death occurs we scrape together the pieces and pin a medal on them, saying he died for the greater good.  We do not say the soldier was a suicide; we say he was a hero.  Except in extreme and rare cases we do not charge the commanding officer with influencing his men to give up their lives.  Why no War Crimes prosecutions for the simpering neo-cons who, with the exception of Colin Powell and his Deputy, evaded military service (or got a posting in the National Guard) and then lied, influenced, and coerced American youth into the invasion of Iraq and the subsequent deaths, by most international analyses, of over one million people while their company connections brought in billions of dollars? Why are they not serving life sentences in SuperMax prisons?  Interestingly, this same political party is consistently shrill about personal freedom, yet it uses every tool possible to impose Draconian legislation on personal medical choices from conception to end of life choices.  In direct contradiction of their mantra of personal freedom and self determination this group cites an invisible, unknowable, non-human entity as having dominion over mankind and as having communicated its behavioral preferences to a select few who then, by legislation, force people to continue living in horrendous circumstances which, if applied to prisoners, would swiftly bring charges of “Cruel and unusual punishment.” To ensure the success of their pogrom, they extend the reach of that legislation to those who would help to relieve and end  suffering by threatening them with imprisonment and destruction of their professional careers.  In what alternate universe does that make sense?

In fighting the Affordable Care Act this party raised the specter of “Death Panels” to frighten Americans into thinking some government panel would decide Granny had to go.  The response was predictable, given the median American I.Q.  But no one thought to look at the existing death panels: the insurance company panels that decide which conditions they will cover and for how long and which medical procedures they will deem acceptable;  the FDA/Pharmaceutical Cartel panels that determine drug approval on scales including an acceptable number of adverse outcomes, including death; and,  military field commanders who devise tactical objectives partly based on “acceptable losses”.  No, it was simpler to listen to a self styled “Mama Grizzly” wiggling herself from stage to stage.

This same group has tried to claim that patients in the Netherlands who chose end of life assistance were depressed, and therefore not competent to make such a choice. Aside from avoiding full disclosure of the depressing conditions which had brought them to this medical decision in the first place, the underlying presumption here seems to be that pumping these people full of psycho-active drugs (anti-depressants) somehow renders them competent to make decisions.  Benny’s really pumped.  You can trust him now.  Dr.  Margaret Pabst Battin, Professor of Bioethics and Philosophy at University of Utah has published extensive rebuttals on this subject, including her research findings in Oregon and the Netherlands.  But, those writings don’t make the daily news; no media cachet.  I was impressed by Brittany’s rebuttal of the assertion that she was suicidal.  To paraphrase her, “I did not choose to kill myself.  Cancer chose to kill me. I am simply determining the time and the circumstances.”

Judie Brown, president of the American Life League, a Catholic group, opined on Brittany’s choice that “Suicide is never a good solution, regardless of the circumstances that one is confronting.” Elaine Harvey, a Republican State Representative in Wyoming, said, “The big guy upstairs chooses when we go and when we stay.”

Startled by the breadth and depth of alcohol related problems with dying patients and/or their families I sought and received permission to sit in on closed A.A. meetings.  Despite their disclaimer on religion, a common mantra was, “God doesn’t want you to die drunk.”  I barely contained myself when one old regular said, “God does want me to die drunk, as an example to my kids of what not to do.”

Is there anywhere a match for the hubris encapsulated in the assertion that one knows God, and knows what this God wants?  No doubt the last speaker was addressing this issue in his way.  It came as no surprise that he was dismissed as “just kidding around.”

Through the media exposure Brittany Maynard has emerged as a thoughtful, rational and deeply caring person.  Yet there are hundreds, if not thousands of Brittanys among us, perhaps not all as eloquent or as photogenic.  They, along with their loved ones are sentenced by society to weeks, months, and even years in silent agony.  I remember those with whom I interacted.  Though dead now, they are still with me.

In contrast to the frequently botched lethal injections administered to kill prisoners,  the medically supervised preparation commonly used in Oregon and other civilized places is mixed into a glass of orange juice.   The individual soon goes to sleep and the passing is marked only by cessation of vital signs.  So it should be.  

 

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21 Comments
  1. This is one of your best posts. And nothing I can see to argue with. You can see this picture so clearly it must make you crazy how inane our laws are and approach to death. Please keep up the good fight.

  2. Imagine my surprise this morning when your blog post matched my own in subject matter. I quickly scanned your to ascertain whether we had taken a similar tact in presentation (we had not), but it still took me hours to convince myself to add my own thoughts to the mixture. Yours are, of course, well thought out and immensely interesting. I cannot begin to match your skill in writing, and it goes without statement that you have few peers in your chosen field.

    • Thank you, Rose. I had a feeling we would converge on this, though I have not yet seen your post. My “word magic”, as grad school professors called it, is simply my own way of communicating. I stand in awe of your literary talents and, more importantly your mind as it unfolds for us. Marco

  3. Thank you, Mary. Very sincerely, I am humbled by your comments. Indeed, today I was contacted by a radio station requesting my appearance for discussions. I will take your advice with me, and continue to do all I can. Thank you. Marco

  4. Rebecca Work permalink

    Marco, I do not know where to begin. Your post, as usual, carries far more than I can address. And is incredibly informative.

    For me, Brittany Maynard’s death was not assisted suicide. Rather, it was ‘Death With Dignity”.

    Having been down similar roads with loved ones begging for assistance to die is excruciatingly painful. My hospitalized father-in-law implored my physician husband to put an end to his suffering. Had he done so, he would have charged with murder. In a short time, my father-in-law went from being independent to a double above knee amputee with diabetes. It was heartbreaking to listen to his pleas prior to dying. My mother had an aggressive lymphoma and lived with us to receive treatment . This after seeking ineffective holistic treatments. She founded Hospice of South Carolina. Her only wish was to die in our home, not in the hospital. Because of medications keeping her alive for loved ones to say goodbye, she died in the hospital. I ran interference with any medical interventions to spare her. Still, I know she wished to die in familiar territory, and in tears, I told her that could not be.

    Lastly, my father had metastatic bone cancer and had in home Hospice. (Ten plus years had passed since my mother and father-in-law’s demise.) He implored that I help him die when things got too difficult to bear. I promised I would recognizing the legal implications. Months before his death, he withdrew his request sharing he could not bear the legalities that would engulf me. He was dying and I still had a life to live. Fortunately, his was not a protracted death.

    So, Marco, the 22 year old who sought you out, was so fortunate to have you. Am delighted you will be a guest speaker again soon, and are to be on radio. I am humbled by all I continue to learn from you in ever so many ways. Thank you.

    • Thank you so much, Becky. Your experiences, and your courage in bringing them to light show the way for those who would look. And, the fact that you continue to offer so much to us despite what would drive others to silent despair gives us a remarkable guide to follow. Marco

  5. Marco, thank you for this. I am also for dying with dignity. cannot find any other words in myself .

  6. Let me remake one of your most salient points here: Brittany Maynard caught our hearts and minds because she was young, beautiful, and had so much more life she should have been allowed to live. Here’s the thing: there are many thousands of people out there who are not young and beautiful, but are also suffering as she did, in great pain and with horrible illnesses. Can we take just one moment to feel for them, too. If Death With Dignity laws were passed in every state, many of these people could end the horror that is now there life. Done preaching now! Rose

  7. Thank you, Rose. By the way, this article has been read over 80 times in 8 different countries across the world. While I wonder what the readers think, I also wonder that the response comments come from a certain core of people.

  8. Ray Rivers permalink

    No matter how many times we hear this kind of message, it can never be enough so long as people refuse individual freedom for all to be they are and want to be. It should never be that hard. Well said Marco.

    • Thank you, Ray. Your assessment means much to me. I suspect our current turn of political events will make this hoped for development that much harder to achieve. But, we remain vocal. Marco

  9. Mark Dohle permalink

    It is easy to for anyone to say ‘what’ they would do, nor never do in any situation. Of course no one knows In the world today, as long as doctors don’t decide when someone dies, or if it does not become an expectation for someone to opt for suicide, then yes, a person in good mental health has the right.

    Years ago, a man was trapped in a truck near here on 1-20. The back end of the truck was burning, he could not get out, so as the fire came forward he was begging someone to please help him, he did not want to burn to death. If I was a doctor, I would have done something, If I was there and had a gun, I am not sure, but I think I would have used it. Then be willing to go to jail.

    Would that me the right moral decision….not sure….in the midst of suffering, I doubt anyone knows what they would do. Many people are affected by a suicide, the fabric of a family can be destroyed by it. So I don’t have any easy answer.

    I do think the death process is like any others process we go through, we get through it. Most don’t ope for suicide, again, I just hope it does become an expectation when it becomes legal in all the states…..of that I have no doubt.

    Thank you Marco for a thoughtful presentation, one I don’t agree with totally, but understand.
    your thoughtful considerations.

    Peace
    Mark

    • Thank you, Mark, for the context you bring to this divisive issue. Your recounting of the trucker experience reminded me of my inclination to “shoot the wounded.” I think that as long as all are agreed and the outcome is inevitable, there is just cause for termination of suffering, a point you make well. I admit that, for me, a very stimulating aspect of this issue is the insistence on the part of some that they have the authority to determine the acts of all others. The recent election cycle seems to ensure that this authority will remain in place despite the desires and the needs of real people. Marco

  10. Mark Dohle permalink

    Sorry for the typos. I meant “would that be the right moral decision”……then further down, “I just hope it does not become an expectation”.

    I really have to stop typing in a hurry ;-).

    peace
    mark

  11. Mark. A further note to add clarity is that, due to how the Oregon law is written Brittany had to act while she could. A doctor presribed the drugs which she took, but had she waited longer to take them she may have been too disabled to do so on her own. At that point, anyone helping her out by mixing and administering the drugs for her would be open to criminal prosecution.

  12. Petr K permalink

    According to the Mental Health Aide certification that I received a few months ago, the new PC term for an act of suicide is “completing suicide.” however, regardless of how we preface the word suicide, it will still have a negative connotation in society. in the more medicalized version of this, as it was for Britney, death with dignity is a rather favorable choice of words.

    • Thanks, Petr. I’m glad to see the usage changing. Yes, death with dignity was always the backdrop on which this played out.

  13. Dana permalink

    Marco, as always, I would like to see your analyses, along with your decades of shared experience, published widely where others could read it.

    I am fortunate to know and work with others who support death with dignity. This is what I would want for my own life, as impossible as it is to imagine the circumstances.

    • Thank you, Dana. Your thoughts, and your feelings are ever important to me. I, too – if I may say it, would like to see a broader venue and more participation. But, I can only hope that people who feel these analyses are worth sharing do so wherever and whenever possible. Thank you, Dana

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