Taming the mind…
Updated: May 2, 2023
Day 3: Ghent, Belgium.
Who would have thought that getting back to running (or shuffling, as is the case for me) would be what was required to tame the frisson in my head that has been hard to rein in through this first 3 days of exploration and investigation on my Churchill Fellowship. Between marvelling at the wonderful surroundings and concentrating on navigating cobblestones, a morning run has been the time my mind has been able to take some rest from all the reflection and processing of what I’m hearing and experiencing. Before getting back onto planning what else I need to be asking people in future meetings.
My first meeting of this Fellowship was with The End of Life Care Research team in Ghent University. This image doesn’t capture the sprawling footprint of the joint medical/hospital and university campus (UZ Gent – Ghent University Hospital) which was pretty overwhelming. Those who know me well will be impressed (and maybe more than a little surprised) that I allowed plenty of time to get lost and found again, and even arrived with time for a comfort stop before my meeting 😉
I met with some of the team of wonderful academics, with strong connections to Prof Ben White and colleagues at QUT in Australia who have led the way in Australia with research in the area of assisted dying. I listened to Prof Kenneth Chambaere and Dr Sigrid Dierickx reflect on the evolution of euthanasia in Belgium, which has been legal since 2002 and has some of the most inclusive, liberal euthanasia laws in the world.
The contrast between what he described as ‘thin’ legislation in Belgium, as compared with our highly prescriptive, regulated frameworks for Voluntary Assisted Dying in Australian state-based legislation, was both remarkable, and reassuring. As a bit of a leftie, it’s sometimes uncomfortable to think of our Australian society as being conservative. But in this space, I feel reassured that we’ve started with such strong frameworks to guide what is possible and how it is to be done; to build our expertise with relatively narrow scope initially. It can be a divisive perspective, particularly for those whose suffering does not fall within the eligibility criteria in Australian states, but I feel the only way to demonstrate to those in doubt in Australian society that we can do this safely, is to start with some limits while we find our way with applying these important laws and processes. But hopefully it will be more expansive and inclusive before long.
The focus here in Belgium, and indeed remaining tension, is very much about the question of euthanasia for those with ‘mental suffering’ and irremediable psychiatric illness; something that I can’t envisage being on the horizon of Australian law for some time, if ever. This is an issue the Canadians are currently grappling with in their country too, and even in more liberal and accepting societies continues to present considerable challenges. The more one considers and hears about it, the more layers that emerge to this facet of assisted dying, despite knowing that there is indeed irremediably suffering in people with chronic mental health issues.
The conversations take me back to the first season of Andrew Denton’s podcast, Better Off Dead, where he too came to Belgium and The Netherlands in 2016, before Victoria’s VAD legislation had been passed. For those unaware, it’s an insightful listen with some commendable balance.
I recall his astonishment at some of the stories he heard here and questioning whether or not he’d ‘drunk the Kool-Aid’. I’m mindful to try and hold on to some degree of curious neutrality in this, if neutrality is indeed possible.
But the parallels between the workforce issues for this group of people seeking euthanasia and our VAD workforce challenges in Australia, are not lost on me. They face what they describe as a bottleneck for people with psychiatric illness, who often have long waits to be seen and assessed by two independent psychiatrists. Despite the small overall demand, the dearth of psychiatrists working in this space is akin to our overall VAD workforce in Australia.
Meeting number 2 was with the co-founders of Vonkel Huis – directly translates to ‘Sparkle House’. Drs Lieve Thienpont and Marc Cosyns are a psychiatrist and GP respectively with warm, open hearts and a seemingly bottomless capacity for compassion and care of people seeking help in their suffering.
They had two wonderful 5th year medical students working with them on what seemed to be an elective of sorts. Both have identified a GP career pathway and the elective offered them an understanding of the service and issues around euthanasia requests of the more complex variety. They spoke to me, not about wanting to move into this work, but about being aware of services to which they would then comfortably refer patients of their own in the future. All those around the table agreed that the introduction of such an elective, and indeed discourse about euthanasia now routinely embedded in undergraduate health professional curricula is a reflection of the acceptance that this is an aspect of end of life care that all health professionals need to be aware of, regardless of where they sit on the issue.
Run and serviced predominantly by volunteers and physicians giving of their own time, Vonkel is open to anyone seeking support in their exploration of euthanasia. However 75% of their clientele come with primary psychiatric illnesses and mental suffering as the catalyst for their quest for euthanasia assessment. The bulk of all euthanasia requests and deaths in Belgium are still people who have terminal illnesses, such as cancer and neurodegenerative diseases. But this work is now considered a normal part of end of life and indeed palliative care, and is facilitated and delivered within existing care settings – primary care, treating specialty clinics, hospitals. It remains the choice of all health professionals as to whether and to what extent they are comfortable to be involved. Vonkel now services predominantly those whose cases and contexts are at the more complex end of the assessment spectrum – chronic mental illness, dementia and geriatric requests. From what I see and hear, there is nothing fast or loose about the assessment processes, which are conducted over many months and sometimes years. And many stories of people who, having felt heard and like there is a window of opportunity if it’s needed, never pursue euthanasia.
I left the warmth of this space with a bottle of sparkling wine being thrust into my hands on the way out the door – bubbly being part of the story of the foundations and name of Vonkel Huis.
This particular bottle was called ‘Groot Geluk’ which translates directly as ‘Big Luck’. In the hope that I would have exactly this over the next 9 weeks, I felt duty bound to savour it over the coming days. And frankly, being already challenged enough by what I’m dragging around in my luggage - which now includes 3 books given to me this past 2 days - that bottle was not coming with me beyond Ghent.
Now, to find a Flemish translator….
Tip of the day: For those who choose to opt for a gluten-free diet, Belgium is definitely not the place to give it a crack for the first time!
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