January 4, 2012

Sleep No More


Okay I get it now. It took a few days, but I get it. And now that I have, I get that it wasn’t about figuring it out. “It” is a show in Manhattan “Sleep No More.” For three hours I moved with the audience through a dark labyrinth of rooms, masked à la Stanley Kubrik’s Eyes Wide Shut, following ghost-like characters as they dance and pantomime their way through a hazy, broken Shakespearean plot line. The audience is transformed into a dream state where meaning and logic are illusive.

The title is from Macbeth who likens sleep to “the death of each day’s life.” And the experience is like a sleepless night, one where you are coming in and out of dreams. So, I get it, death is likened to a mysterious sleep state.

There is no proof of this, but the idea has been around for a long time. Shakespeare used the line “sleep no more” earlier in Hamlet. Remember?

To die: to sleep;
No more; and by a sleep to say we end
The heart-ache and the thousand natural shocks
That flesh is heir to, ’tis a consummation
Devoutly to be wish’d. To die, to sleep;
To sleep: perchance to dream: ay, there’s the rub;

So let’s skip a few steps and take the Bard’s word for it. Sleep is like death. And sleep has become more and more illusive. Recently, the New York Times reported that 84% of all women suffer from insomnia and that “mother’s little helper of the new millennium may in fact be the sleeping pill.” Arianna Huffington’s campaign to “Sleep Your Way to the Top” warns women that sleep deprivation “is, literally, killing us.” We put ourselves to sleep with Ambien, Lunesta, Melatonin and wine. Michael Jackson’s use of Propofol landed him in “the sleep of death.” We put our pets “to sleep,” and conclude our yoga practice with Savasana, the corpse pose. As the social commentator, Fran Liebowitz, concludes:

Life is something that happens when you can’t get to sleep.

Clearly, the relationship between sleep and death persists today. So why, if we medicate ourselves to sleep, do we all not have the right to medicate ourselves to die? The right to die at our own hand is now legal only in Oregon, Washington and Montana. Legislation is pending in nine more states. Do we think “‘tis nobler” to die suffering? Doesn’t look like it. Hospice and palliative care put us out of our pain at the end of life through opiates, like morphine, to bring us to our final sleep. In the three states where it is now legal to put ourselves to sleep, it is done with a prescription for a high dose of a sleeping sedative. “Palliate” means to reduce the suffering at the time of death. It is done by medicating us to an unconscious state, a sleep state called TS (Terminal Sedation.) Even Catholic hospitals maintain the practice. The Catholic writer Mary DeTurris Poust summarizes that “a patient can receive pain treatment even if that treatment could hasten death.” Over a half century ago Pope Pius XII condoned the use of narcotics for End-of-Life care.

Is the suppression of pain and consciousness by means of narcotics (when it is demanded by a medical indication) permitted, by religion and morality, to the patient and the doctor (even at the approach of death and when one foresees that the administration of narcotics will shorten life)?’ One must reply, ‘If there exist no other means and if, in the given circumstances, it does not prevent the fulfillment of other religious and moral duties’ — Yes.

The salient difference between palliative care practices, even those authorized by the Vatican, and the Right-to-Die legislation is the administrator. Palliative care is prescribed and administered by a physician. In states where the Right-to-Die is legal, large doses of sedatives are prescribed by a physician but self-administered by the dying. If there is an important distinction here, I just don’t get it.

It is easy to see a not so distant future when it will not exist at all. This is an “eyes wide shut” moment. We are aware but not fully aware. Our desire to die without the nightmare of pain, by our own hand, in our own home is slowly being unmasked. It is a big responsibility, but one we can figure out. In the past we may have been content to place this responsibility in the hands of physicians and medical institutions. Death itself remains as mysterious as our dreams. But, how we die need not be so. We are not a generation used to giving our power over to authority. We are a DIY population, waking up to how we die. On this issue, we can “sleep no more.”

Comments (2)

  1. January 11, 2012
    John McIlwain said...

    When S decided to end her suffering she looked at all alternatives. She had tried and failed once before so the normal cocktail of drugs obtainable w/o a doctor were ruled out. There is a drug obtainable in Mexico w/o a prescription but only if the animal pharmacy is willing to blink. A guy on a website who said he could get it proved very sketchy. Friends were not willing to risk flying to Mexico to obtain the drug and risk the Mexican police and jails. S could not go herself. Nor could she fly to Switzerland to die legally there. What to do to make sure of her death this time? It came down to a gun, which she bought legally. She trained at a firing range. Then, having put her affairs in order, she went to a motel alone and successfully took her life. Friends who wanted to be there stayed away lest they be thought by the police to have aided her and be arrested for murder.

    It took all of S’s strength and determination. She did succeed, but she died alone in a quick but violent way when a humane society would have supported her in a peaceful death surrounded by loved ones.

    • January 11, 2012
      aftert11 said...

      Dear John,

      Truly a horror story. Do you feel that the prescriptive drugs legal in Oregon would have been effective?

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