Canals, contacts and a tiptoe through the tulips…
Week 2: The Netherlands
From Belgium, to The Netherlands, where I based myself in The Hague. An unusual choice some seemed to think, but this is where the Euthanasia Expertise Centre head office is based…and accommodation was much easier to source (and cheaper) than Amsterdam!
The Hague is a wonderful combination of old and new:
From the 13th century Grote Kerk (translates creatively as ‘Big Church’!), De Ridderzaal (13th century former castle of the Counts of Holland) & Binnenhof (the oldest Parliament buildings in the world still in use).
To the International Court of Justice, a plethora of modern embassy and consulate buildings and the distinctly chic, diplomatic feel to the place. The Hague is also the home to the Dutch King’s ‘working palace’, Noordeinde Palace. As I had planned to be in The Netherlands on the national holiday -Koningsdag (King’s Day), I was somewhat miffed to discover he’d chosen not to stay home for his birthday this year, but rather to celebrate it in Rotterdam, not The Hague. He obviously hadn’t heard I was coming.
But it didn’t stop his subjects literally dancing in the streets in The Hague.
Sunny and clear, but still pretty bloody cold despite being spring, the Dutch were out in force to make the most of the day and the merriment. It was a glorious day to be forced not to ‘work’ and to do what has to be done when in The Netherlands!
Thankfully Amsterdam was only an hour away on the terribly efficient Netherlands rail network, because my best laid plans to meet with people in the Euthanasia Expertise Centre faltered when most of them were unavailable due to school holidays! So a day trip to Amsterdam to meet a wonderful nursing colleague would just have to be bolstered by some sightseeing! I would surely find myself inside the International Court of Justice, if I failed to tiptoe through some tulips, cavort down a canal or two and sample some stroopwafel and proffertjes….so what’s a girl to do? 💁🏼♀️
Fuelled by plenty of Dutch carbs to keep me warm, I headed off to meet Gerard, a wonderful nurse who was one of the founding members of the Expertise Centre team just over a decade ago in 2012. The centre originated from a project initiated by the Dutch equivalent of Dying with Dignity, and was eventually endorsed by government and professional groups alike and now has both sustainable funding and a ‘wait list’ of medical and nursing professionals wanting to work with them!! We can only DREAM of this in Australia….and yet as an optimist, I do exactly that.
Gerard echoed the perspective of his medical colleague Joyce, whom I met in Maastricht, and of the Belgians in having some degree of bemusement about why assisted dying would be separate from either palliative care or other end of life care considerations. It is so embedded in Dutch health culture that it is only the smallest proportion of cases that are considered complex enough to warrant specific services - those requests from people suffering with chronic mental illness and the timing of euthanasia in people with dementia and deteriorating capacity.
I asked Gerard about the recent expansion to include children between 1 and 12 years of age (it is already permissible for young people aged 12 and over in specific circumstances and with parental consent). Notably the proposed expansion has not involved any change in legislation, but rather regulatory change that affords exemptions from prosecution for doctors who provide this care under specific conditions. Again, Gerard was somewhat bemused at my question about how this would be received in amongst health professionals - he was very sure this would amount to so few cases (he postulated less than 10-12 per year at most, from a population of approximately 18 million) that it would not have a significant impact on their euthanasia workforce. I asked who he felt would do this work and whether it would sit with groups such as the Euthanasia Expertise Centre, or the team of SCEN doctors (Support and Consultation on Euthanasia in Netherlands). Both these teams currently undertake most of the work in assessing and supporting for more challenging cases. Gerard, without hesitation, felt sure this work would be handled by the paediatric teams already providing care for these children living with intractable suffering.
Translating some of these perspectives from a culture that has evolved to so expansively accept and assume the right to choose euthanasia, to our own culture where its very availability with much more constrained eligibility is still being debated, has taken some processing for me. Having worked in paediatric oncology, I can definitely recall cases and situations where this might have been relevant and families who might have explored euthanasia. But I take heart that we are likely to be some way off having to fathom how we would manage and staff for this scope of inclusion in Australia…possibly not within my career!
We also spoke a lot about the role of storytelling and public messaging, predominantly from consumers rather than professionals, to improve community discourse and understanding about the relief from suffering that assisted dying offers, as well as family experience of what they perceive as ‘a good death’. The loudest voices are often those who dissent and object to others’ end of life choice.
Much to ponder as I prepare to farewell Europe and head to Canada.
Tip of the day: When seeking good coffee in Amsterdam, be mindful of what you’re asking for in sourcing a ‘specialty coffee shop’! 🌱🪴
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