Explainer

Care

Creed

30 June 2023

6 min read

Bed rotting and an old art of rest

In a culture where “exhaustion is seen as a status symbol,” bed-rotting is an emerging trend. Lianne Howard-Dace reflects on self-care and how to rest and refresh.

Lianne Howard-Dace

Lianne Howard-Dace is a writer and trainer, with a background in church and community fundraising.

a sleeper pulls a blanket up over their head.

There’s a trend doing the rounds on TikTok which is attracting a fair amount of comment; the practice of taking (at least) a day in bed to recuperate when you’re running low on energy. Gen Z are - with characteristic directness - calling it ‘bed rotting’.

At first, this sounds like nothing new. People have been taking to their bed for centuries. Gen X might’ve called it vegging out, millennials would call it a duvet day.

From the discourse that’s sprung up about bed rotting though, it seems like some bigger questions are being explored around this trend. Firstly, Gen Z are reclaiming the need to stay in bed by branding it as a form of self-care. This picks up on some broader wellbeing trends online, where people are trying to decouple their sense of worth from their productivity. This train of thought picked up steam during the Covid-19 pandemic, and seems to continue to be something people are wrestling with.

As others are pointing out... is getting to the point of needing a day to rot in bed is really a good approach to self-care?

I rather like the visceral nature of the phrase ‘bed rotting’ and I’m sure that, whichever generational cohort we fall into, we can all relate to the occasional need to totally switch off to refresh and recalibrate. However, as others are pointing out, a second consideration is whether getting to the point of needing a day, to rot in bed, is really a good approach to self-care. Or would more preventative measures be the better way to care for yourself? Some commentators on TikTok have suggested that a combination of other gentle activities would actually be better at delivering the desired results than lounging in bed alone.

Dr Saundra Dalton Smith suggests in her book Sacred Rest that there are seven types of rest: physical, mental, spiritual, emotional, sensory, social and creative. Whilst bed rotting provides perhaps three or four of these types of rest, it may not provide the long-term refreshment sought if it doesn’t nurture the other parts of us as well.

Should we all just be expected to mindfulness our way out of a mental health crisis or yoga our way out of chronic pain?

While framing this extreme need for rest as self-care may give people permission to stop and reduce the stigma of doing nothing, it also puts the onus on the individual. I think the risk of self-care narratives in general is precisely in the focus they put on the self. While it can be healthy and empowering to take action to improve your wellbeing, it also draws attention away from the societal systems and structures that are contributing to everyone feeling so exhausted all the time. Should we all just be expected to mindfulness our way out of a mental health crisis or yoga our way out of chronic pain? Or should we be looking more widely at what is going on in the world?

This tension between taking responsibility for my own wellbeing but also reflecting on how I relate to the wider concepts of work, productivity and success is a very live, everyday issue for me. I have fibromyalgia, a chronic health condition characterised by fatigue and widespread muscular pain. Whilst conventional medicine gives some relief, I have to manage my energy levels very closely and intentionally pace myself to avoid my symptoms flaring up, though sometimes it is out of my control.

Unfortunately, if I were to let myself get to the point of desperately needing to bed rot it might take me a week or two to fully recover. I have to resist the urge to say yes to every invite and make sure I have a balance of work, rest and play in each week. This is helped by the privilege of being able to schedule my work around my own needs, it would certainly be much harder if I was tied to a very strict working pattern. In a way, it's like I have an early warning system for burnout, and I’ve become very attuned to fluctuations in my mood, energy or pain levels that might indicate the equilibrium is off.

As part of my energy management strategies, I have also found that the ancient practice of sabbath from the Judeo-Christian tradition has helped me to both take regular time to rest and to remind myself that I am a human being, not a human doing.

In Genesis, the opening poem of the Hebrew scriptures, we hear that after six days of hard work creating the universe, God rested on the seventh day. For thousands of years, Jews and Christians have attempted to learn from this and incorporate a day of rest into each week. The practice also exists in Islam.

Each Sunday I try to do as little as possible and particularly to disconnect from digital channels, because I know they often take more energy than they give me.

The way that this plays out in people’s lives ranges from very strict observance to more loosely held rules and rituals. However, you approach it, there is much to be learned from this ageless wisdom. I initially began practicing sabbath myself when I went freelance and realised how easily I could end up working seven days a week if I didn’t pay attention. This was six months or so before the first Covid-19 lockdown in the UK and I was extremely grateful to have established this habit in my life when that occurred.

For me, sabbath isn’t just ensuring I’m squeezing rest into each week but also creating rhythm. It punctuates my week and gives everything else breathing space. Each Sunday I try to do as little as possible and particularly to disconnect from digital channels, because I know they often take more energy than they give me.

In The Ruthless Elimination of Hurry, John Mark Comer helpfully suggests two simple criteria to decide whether something is permissible on the sabbath. Is it rest or worship? If it’s not one of those two things then it can wait. For me, worship usually means going to church, but for you that could be something else that helps you connect to something bigger than yourself and experience a sense of wonder. Perhaps immersing yourself in nature, or engaging with an awe-inspiring work of art.

Another helpful piece of advice about sabbath I heard from Annie F. Downs on Instagram:

“If you work with your hands, sabbath with your mind. If you work with your mind, sabbath with your hands.”

As someone who spends most of my working week creating content on a computer, this is a useful reminder not just to read and journal on my sabbath but to swim, crochet or cook as well.

Lastly, Jesus said “The sabbath was made for man, and not man for the sabbath”. This reminds me to do sabbath in a way that is life-giving for me, even if that looks different to what works for others. These guidelines have helped me establish a practice of sabbath which provides clarity and routine, whilst being expansive enough to allow me to give myself whichever type of rest I need at a given time. Occasionally I do just bed rot, but usually I do things that restore me and bring me joy, whether that’s taking a walk or cycle if I have the energy or simply taking my lunch to the beach.

Of course, I’m not always perfect in the way I sabbath. That’s why it’s called a practice. But I do notice I flag later in the week if I’ve skip it. So, even if I occasionally switch the day or bend one of my rules for a practical reason, I keep coming back to it.

If you don’t already, I really encourage you to try the routine of sabbath for yourself. Pick a day of the week that works for you, put some boundaries in place, try it for a few weeks and adjust accordingly. Treat it as an experiment, a gift to yourself and perhaps as a little way to opt out of the madness of modern life for a beat. And by all means, bed rot if you need to. As Brené Brown says:

“It takes courage to say yes to rest and play in a culture where exhaustion is seen as a status symbol.”

Article

Assisted dying

Care

Culture

Death & life

13 November 2024

8 min read

The deceptive appeal of assisted dying changes medical practice

In Canada the moral ethos of medicine has shifted dramatically.

Ewan Goligher

Ewan is a physician practising in Toronto, Canada.

A tired-looking doctor sits at a desk dealing with paperwork.

Francisco Venâncio on Unsplash.

Once again, the UK parliament is set to debate the question of legalizing euthanasia (a traditional term for physician-assisted death). Political conditions appear to be conducive to the legalization of this technological approach to managing death. The case for assisted death appears deceptively simple—it’s about compassion, respect, empowerment, freedom from suffering. Who can oppose such positive goals? Yet, writing from Canada, I can only warn of the ways in which the embrace of physician-assisted death will fundamentally change the practice of medicine. Reflecting on the last 10 years of our experience, two themes stick out to me—pressure, and self-deception.

I still remember quite distinctly the day that it dawned on me that the moral ethos of medicine in Canada was shifting dramatically. Traditionally, respect for the sacredness of the patient’s life and a corresponding absolute prohibition on deliberately causing the death of a patient were widely seen as essential hallmarks of a virtuous physician. Suddenly, in a 180 degree ethical turn, a willingness to intentionally cause the death of a patient was now seen as the hallmark of patient-centered doctor. A willingness to cause the patient’s death was a sign of compassion and even purported self-sacrifice in that one would put the patient’s desires and values ahead of their own. Those of us who continued to insist on the wrongness of deliberately causing death would now be seen as moral outliers, barriers to the well-being and dignity of our patients. We were tolerated to some extent, and mainly out of a sense of collegiality. But we were also a source of slight embarrassment. Nobody really wanted to debate the question with us; the question was settled without debate.

Yet there was no denying the way that pressure was brought to bear, in ways subtle and overt, to participate in the new assisted death regime. We humans are unavoidably moral creatures, and when we come to believe that something is good, we see ourselves and others as having an obligation to support it. We have a hard time accepting those who refuse to join us. Such was the case with assisted death. With the loudest and most strident voices in the Canadian medical profession embracing assisted death as a high and unquestioned moral good, refusal to participate in assisted death could not be fully tolerated.

We deceive ourselves if we think that doctors have fully accepted that euthanasia is ethical when only very few are actually willing to administer it.

Regulators in Ontario and Nova Scotia (two Canadian provinces) stipulated that physicians who were unwilling to perform the death procedure must make an effective referral to a willing “provider”. Although the Supreme Court decision made it clear in their decision to strike down the criminal prohibition against physician-assisted death that no particular physician was under any obligation to provide the procedure, the regulators chose to enforce participation by way of this effective referral requirement. After all, this was the only way to normalize this new practice. Doctors don't ordinarily refuse to refer their patients for medically necessary procedures; if assisted death was understood to be a medically necessary good, then an unwillingness to make such referral could not be tolerated.

And this form of pressure brings us to the pattern of deception. First, it is deceptive to suggest that an effective referral to a willing provider confers no moral culpability on the referring physician for the death of the patient. Those of us who objected to referring the patient were told that like Pilate, we could wash our hands of the patient’s death by passing them along to someone else who had the courage to do the deed. Yet the same regulators clearly prohibited referral for female genital mutilation. They therefore seemed to understand the moral responsibility attached to an effective referral. Such glaring inconsistencies about the moral significance of a referral suggests that when they claimed that a referral avoided culpability for death by euthanasia, they were deceiving themselves and us.

The very need for a referral system signifies another self-deception. Doctors normally make referrals only when an assessment or procedure lies outside their technical expertise. In the case of assisted death, every physician has the requisite technical expertise to cause death. There is nothing at all complicated or difficult or specialized about assessing euthanasia eligibility criteria or the sequential administration of toxic doses of midazolam, propofol, rocuronium, and lidocaine. The fact that the vast majority of physicians are unwilling to perform this procedure entails that moral objection to participation in assisted death remains widespread in the medical profession. The referral mechanism is for physicians who are “uncomfortable” in performing the procedure; they can send the patient to someone else more comfortable. But to be comfortable in this case is to be “morally comfortable”, not “technically comfortable”. We deceive ourselves if we think that doctors have fully accepted that euthanasia is ethical when only very few are actually willing to administer it.

We deceived ourselves into thinking that assisted death is a medical therapy for a medical problem, when in fact it is an existential therapy for a spiritual problem.

There is also self-deception with respect to the cause of death. In Canada, when a patient dies by doctor-assisted death, the person completing the death certificate is required to record the cause of death as the reason that the patient requested euthanasia, not the act of euthanasia per se. This must lead to all sorts of moments of absurdity for physicians completing death certificates—do patients really die from advanced osteoarthritis? (one of the many reasons patients have sought and obtained euthanasia). I suspect that this practice is intended to shield those who perform euthanasia from any long-term legal liability should the law be reversed. But if medicine, medical progress, and medical safety are predicated on an honest acknowledgment about causes of death, then this form of self-deception should not be countenanced. We need to be honest with ourselves about why our patients die.

There has also been self-deception about whether physician-assisted death is a form of suicide. Some proponents of assisted death contend that assisted death is not an act of deliberate self-killing, but rather merely a choice over the manner and timing of one's death. It's not clear why one would try to distort language this way and deny that “physician-assisted suicide” is suicide, except perhaps to assuage conscience and minimize stigma. Perhaps we all know that suicide is never really a form of self-respect. To sustain our moral and social affirmation of physician-assisted death, we have to deny what this practice actually represents.

There has been self-deception about the possibility of putting limits around the practice of assisted death. Early on, advocates insisted that euthanasia would be available only to those for whom death was reasonably foreseeable (to use the Canadian legal parlance). But once death comes to be viewed as a therapeutic option, the therapeutic possibilities become nearly limitless. Death was soon viewed as a therapy for severe disability or for health-related consequences of poverty and loneliness (though often poverty and loneliness are the consequence of the health issues). Soon we were talking about death as a therapy for mental illness. If beauty is in the eye of the beholder, then so is grievous and irremediable suffering. Death inevitably becomes therapeutic option for any form of suffering. Efforts to limit the practice to certain populations (e.g. those with disabilities) are inevitably seen as paternalistic and discriminatory.

There has been self-deception about the reasons justifying legalization of assisted death. Before legalization, advocates decry the uncontrolled physical suffering associated with the dying process and claim that prohibiting assisted death dehumanizes patients and leaves them in agony. Once legalized, it rapidly becomes clear that this therapy is not for physical suffering but rather for existential suffering: the loss of autonomy, the sense of being a burden, the despair of seeing any point in going on with life. The desire for death reflects a crisis of meaning. We deceived ourselves into thinking that assisted death is a medical therapy for a medical problem, when in fact it is an existential therapy for a spiritual problem.

We have also deceived ourselves by claiming to know whether some patients are better off dead, when in fact we have no idea what it's like to be dead. The utilitarian calculus underpinning the logic of assisted death relies on the presumption that we know what it is like before we die in comparison to what it is like after we die. In general, the unstated assumption is that there is nothing after death. This is perhaps why the practice is generally promoted by atheists and opposed by theists. But in my experience, it is very rare for people to address this question explicitly. They prefer to let the question of existence beyond death lie dormant, untouched. To think that physicians qua physicians have any expertise on or authority on the question of what it’s like to be dead, or that such medicine can at all comport with a scientific evidence-based approach to medical decision-making, is a profound self-deception.

Finally, we deceive ourselves when we pretend that ending people’s lives at their voluntary request is all about respecting personal autonomy. People seek death when they can see no other way forward with life—they are subject to the constraints of their circumstances, finances, support networks, and even internal spiritual resources. We are not nearly so autonomous as we wish to think. And in the end, the patient does not choose whether to die; the doctor chooses whether the patient should die. The patient requests, the doctor decides. Recent new stories have made clear the challenges for practitioners of euthanasia to pick and choose who should die among their patients. In Canada, you can have death, but only if your doctor agrees that your life is not worth living. However much these doctors might purport to act from compassion, one cannot help see a connection to Nazi physicians labelling the unwanted as “Lebensunwortes leben”—life unworthy of life. In adopting assisted death, we cannot avoid dehumanizing ourselves. Death with dignity is a deception.

These many acts of self-deception in relation to physician-assisted death should not surprise us, for the practice is intrinsically self-deceptive. It claims to be motivated by the value of the patient; it claims to promote the dignity of the patient; it claims to respect the autonomy of the patient. In fact, it directly contravenes all three of those goods.

It degrades the value of the patient by accepting that it doesn't matter whether or not the patient exists.

It denies the dignity of the patient by treating the patient as a mere means to an end—the sufferer is ended in order to end the suffering.

It destroys the autonomy of the patient because it takes away autonomy. The patient might autonomously express a desire for death, but the act of rendering someone dead does not enhance their autonomy; it obliterates it.

Yet the need for self-deception represents the fatal weakness of this practice. In time, truth will win over falsehood, light over darkness, wisdom over folly. So let us ever cling to the truth, and faithfully continue to speak the truth in love to the dying and the living. Truth overcomes pressure. The truth will set us free.