“Now I Lay Me Down to Sleep”

                                                “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.