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Published online by Cambridge University Press: 06 March 2018
The lack of sleep is a significant problem in the modern world. The structure of the economy means that 24 hour working is required from some of us, sometimes because we are expected to be able to respond to share-price fluctuations on the other side of the planet, sometimes because we are expected to serve kebabs to people leaving nightclubs, and sometimes because lives depend on it. The immediate effect is that we feel groggy; but there may be much more sinister long-term effects of persistent sleep deprivation and disruption, the evidence for which is significant, and worth taking seriously. If sleeplessness has a serious impact on health, it represents a notable public health problem. In this article, I sketch that problem, and look at how exploiting the pharmacopoeia (or a possible future pharmacopoeia) might allow us to tackle it. I also suggest that using drugs to mitigate or militate against sleeplessness is potentially morally and politically fraught, with implications for social justice. Hence, whatever reasons we have to use drugs to deal with the problems of sleeplessness, we ought to be careful.
1. I borrow these uses of the terms “utilitarian” and “ideal” from Ronald Dworkin. See Dworkin, R. Positive discrimination. In: Taking Rights Seriously. London: Bloomsbury; 2013, at 279.Google Scholar
2. Royal Society for the Prevention of Accidents. Driver Fatigue and Road Accidents. Birmingham: RoSPA, 2011; available at http://www.rospa.com/rospaweb/docs/advice-services/road-safety/drivers/driver-fatigue-2011.pdf (last accessed 6 Aug 2017).
3. Department for Transport. Reported Road Casualties Great Britain: 2015 Annual Report. London: Department for Transport; 2016, at 303.
4. McCormick F, Kadzielski J, Landrigan C, Evans B, Herndon H, Rubash H. Surgeon fatigue: A prospective analysis of the incidence, risk, and intervals of predicted fatigue-related impairment in residents. Archives of Surgery 2012;147(5):430–35; Garrouste-Orgeas M, Flaaten H, Moreno R. Understanding medical errors and adverse events in ICU patients. Intensive Care Medicine 2016;41(1):107–9; compare West C, Tan A, Habermann T, Sloan J, Shanafelt T. Association of resident fatigue and distress with perceived medical errors. Journal of the American Medical Association 2009;302(12):1294–300.
5. Aran A, Wasserteil N, Gross I, Mendlovic J, Pollak Y. Medical decisions of pediatric residents turn riskier after a 24-hour call with no sleep. Medical Decision Making 2017;37(1):130–1.
6. Landrigan, C, Czeisler, C, Barger, L, Ayas, N, Rothschild, J, Lockley, S. Effective implementation of work-hour limits and systemic improvements. The Joint Commission Journal on Quality and Patient Safety, 2007;33(11):19–29.CrossRefGoogle ScholarPubMed
7. Wolf, L, Perhats, C, Delao, A, Martinovich, Z. The effect of reported sleep, perceived fatigue, and sleepiness on cognitive performance in a sample of emergency nurses. Journal of Nursing Administration 2017;47(1):47.CrossRefGoogle Scholar
8. Ravelingien A, Sandberg A. Sleep better than medicine? Ethical issues related to ‘wake enhancement’. Journal of Medical Ethics 2008;34(9):e9.
9. See note 8, Ravelingien, Sandberg 2008.
10. See note 8, Ravelingien, Sandberg 2008:e9; quote slightly modified.
11. Compare Harris J. Enhancing Evolution, Princeton: Princeton University Press; 2007, at 9.
12. See note 8, Ravelingien, Sandberg 2008.
13. See note 8, Ravelingien, Sandberg 2008.
14. See note 8, Ravelingien, Sandberg 2008.
15. Ashcroft R. Smoking, health, and ethics. In: Dawson A, ed. Public Health Ethics: Key Concepts and Issues in Policy and Practice. Cambridge: Cambridge University Press; 2011, at 94, quote slightly modified.
16. Violanti J, Burchfiel C, Hartley T, Mnatsakanova A, Fekedulegn D, Andrew M, et al. Atypical work hours and metabolic syndrome among police officers. Archives of Environmental & Occupational Health 2009;64(3):194.
17. See note 16, Violanti et al 2009, at 198.
18. Vyas M, Garg A, Iansavichus A, Costella J, Donner A, Laugsand L, et al. Shift work and vascular events: Systematic review and meta-analysis. British Medical Journal 2012;345: e4800, quote slightly altered.
19. World Health Organization International Agency for Research on Cancer. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, vol. 98: Painting, Firefighting, and Shiftwork. Lyon: International Agency for Research on Cancer; 2010, at 764, emphasis in original.
20. See note 19, World Health Organization International Agency for Research on Cancer 2010, at 762.
21. See note 19, World Health Organization International Agency for Research on Cancer 2010, at 762–3.
22. See also Papagiannakopoulos T, Bauer M, Davidson S, Heimann M, Subbaraj L, Bhutkar A, et al. Circadian rhythm disruption promotes lung tumorigenesis. Cell Metabolism 2016;24(2):324; but compare Lucassen E, Coomans C, van Putten M, Kreij S, van Genugten J, Sutorius R, et al. Environmental 24-hr cycles are essential for health. Current Biology 2016;26(14):R669. These authors suggest that the effects of circadian disruption may be reversible.
23. The essence of the example is this: that (Mill claims) if you are about to cross a dangerous bridge knowing that it is dangerous but freely accepting that danger, I do not have the right to intervene to stop you; your own good is not sufficient warrant. See Mill JS. On Liberty. London: Penguin; 1985, at 166.
24. I have argued extensively elsewhere that there is not a duty to support scientific research: see Brassington I. John Harris’ argument for a duty to research. Bioethics 2007;21(3):160; Brassington I. Defending the duty to research? Bioethics 2011;23(1):21. A re-worked version of these articles appears as chapters 8 and 9 of Brassington I. Bioscience and the Good Life. London: Bloomsbury; 2013. Whether my conclusion here forces a modification of my earlier position, or is unexpectedly compatible with it, or is the exception that proves the rule, I am not entirely sure.