A Dutch day trip
Day 5: Maastricht, The Netherlands
Hanging at the bottom of Holland, sandwiched between Belgium and Germany, is the Dutch province of Limburg with its stunning fortress capital Maastricht. It was easier to make a day trip from Belgium to meet a wonderful euthanasia practitioner who works in this part of The Netherlands, as part of a group called the Euthanasia Expertise Centre.
The group functions largely to support health professionals across The Netherlands and provides mentoring, direct patient assessments and education to health professionals. They do work directly with patients, but mostly alongside existing health care professionals and teams who are caring for people who wish to explore euthanasia.
I left Ghent’s inclement weather and watched the skies lift during the 2.5 hour train journey, arriving to glorious sunshine washing over Maastricht.
There is a widely held perception that Dutch euthanasia law is both liberal and accessible, in part due to media reports but also reflected in data that show The Netherlands having the highest rate of assisted deaths in the world at 4% of all deaths; a rate that has risen over the two decades since euthanasia was legalised. I was eager to hear the reflections of the Dutch from within.
It stands to reason when stepping back to consider that more inclusive criteria will, ipso facto, result in more people being able to access this end of life choice, and rates will be higher. So should it actually raise the eyebrows and consternation of people who claim this to be evidence of the ‘slippery slope’? It’s fairly simple maths, really, and reflects demand for choice, rather than some downhill slide to a tsunami of assisted deaths.
While the Dutch certainly have considerably more inclusive eligibility that Australia, the practitioners with whom I met, nonetheless hold the responsibility of assessment and determination of access with the gravity it deserves. What struck me is how embedded this option is in ‘normal’ end of life care, such that most euthanasia and assisted dying assessment, care and administration is conducted by existing clinicians, including GPs, treating specialists and health care teams already known to the person seeking it. Everyone I spoke with in Europe asserted that this is as it should be - the health professionals who have existing and often longstanding therapeutic relationships with these patients, are without doubt, best placed to understand their background and values in terms of health care decision-making and what has led them to explore euthanasia. Who better to gauge and assess someone’s eligibility against criteria such as voluntariness and the presence or absence of any underlying mental health drivers of such an exploration, than someone who knows their health and treatment history.
Specific services such as those offered by the Euthanasia Expertise Centre are predominantly used in complex cases including psychiatric illness and dementia. Joyce is a physician, with a background in emergency medicine and more recently aged care, who has worked part-time for the Expertise Centre in her region for the past 7 years. She talked about being drawn into euthanasia work both for professional reasons - searching for something meaningful at a career juncture - and having been personally moved by a high profile documentary that aired in The Netherlands. She described the program as having had a significant impact on health professionals’ perceptions of euthanasia, as well as raising awareness amongst the broader population.
It seems that it is the open discourse and hearing people’s stories about their choices that many describe as having contributed to euthanasia being such an accepted part of end of life health care in The Netherlands. Whilst it is of course a private and intimate process, the subject is not maintained in secrecy. Joyce spends a reasonable proportion of her time providing education to groups of medical colleagues both within and beyond her country. She talked of a recent presentation to a group of Finnish respiratory physicians (Finland does not yet have euthanasia laws) and noticing some significant shifts in the audience questions and discussions after hearing her case-based presentation.
Joyce also spoke of the importance of a local network of physician and nurse colleagues employed by the Expertise Centre, with whom she works closely and participates in quarterly facilitated ‘intervision’. She explained that she would always attend a euthanasia procedure with a colleague - either a health professional from within the person’s usual care team, or one of her Expertise Centre nursing buddies. The Expertise Centre works with this buddy model, recognising the value of peer support, education, mentoring and the combined skill sets that the patient and family benefits from.
Joyce’s calm, gentle explanations of her work left me much to reflect upon, warranting a beverage amongst the beautiful historic surroundings and listening to the tolling of nearby church bells, before making my way back to the train station to return to Belgium.
Tip of the day: commencing travels in a country that drives on the ‘other’ side of the road is no less risky where cycling is the preferred means of transport for the local populace - get good travel insurance!
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