The Evolving Landscape of End-of-life Choices in 2024
Table of Contents
- 1. The Evolving Landscape of End-of-life Choices in 2024
- 2. A Life Dedicated to Compassionate Care
- 3. Finding meaning in helping Others
- 4. The Challenge of Euthanasia
- 5. A Deeper Look at Euthanasia Concerns
- 6. The Rewards of a Fulfilling Career
- 7. Balancing Personal and professional Needs
- 8. The Importance of Ethical considerations
- 9. A Life Devoted to Care: Reflections on End-of-Life Choices
- 10. Navigating Complexities of End-of-life Choices
- 11. The Value of Experience in Healthcare
- 12. Need Help?
A Life Dedicated to Compassionate Care
Renowned specialist geriatrician, SCEN-arts, and philosopher Bert Keizer, at the age of 68, passed away after a distinguished career spanning over three decades in Amsterdam nursing homes.He continued his work wiht the Euthanasia Expertise Center, focusing on complex cases, particularly those involving dementia, a condition he addressed with both wit and insight throughout his writings. Keizer authored fourteen books, essays, and columns. His apartment, a testament to his life’s passions, featured a box for his grandchild in the living room, his wife Marijke engrossed in a book, and a study overflowing with books, reflecting his intellectual pursuits. ” “For an Athenaeum series on great philosophers, I’m writing about the eighteenth-century British Enlightenment thinker David Hume. He’s one of my favorite philosophers. Hume tried to demonstrate that humans are not astronomically distant from the animal world. He put our pretensions into outlook. We believe we’re so clever and profound when we ponder God, the world, humanity, the cosmos,” Keizer explained. David Hume once said: “Most of human knowledge is nothing but a collection of illusion.” This sentiment resonated with one doctor on their journey through academia, leading them to a fulfilling career as a nursing home physician. From Ideology to Medicine: A Search for Meaning beyond the Textbook This doctor’s path began with a deep dive into philosophy, studying at the prestigious Cambridge University. But despite academic success, a yearning for a more hands-on approach to understanding life’s complexities arose. “I saw pretty quickly that I wasn’t going to be an original philosopher,” the doctor reflected. “I’m good at studying it, but I felt like philosophy was something for evenings – overday, I wanted to experience life.” This desire led to the pursuit of medicine, a field that promised to unveil the inner workings of the human body. Though, the initial years of medical school proved less captivating than anticipated. “The theoretical readiness was demotivating,” the doctor confessed. “I wanted to experience things, but the lectures felt dull. It was like being in a hangar with three hundred other students,passively absorbing details from slides. Five years of multiple-choice exams felt mind-numbing.” It wasn’t until encountering real patients that the true magic of medicine unfolded. “You only truly understand the field when you’re with sick peopel,” the doctor explained. “You learn how to interact with someone in pain, how to decipher the body’s signals.That’s what makes it meaningful.” Finding Fulfillment as a Nursing Home Physician This realization ultimately steered the doctor towards a career as a nursing home physician – a decision driven more by chance than design. While initially aspiring to become a general practitioner, the possibility to work with elderly patients proved deeply rewarding. The doctor’s philosophical background informs their approach to medicine, fostering a profound respect for the human experience, particularly in its later stages. “I think the thing about philosophy is that you learn to look for the limits of knowledge,” they mused. “That’s essential when you’re dealing with the complexities of life and death, which are at the heart of what we do as physicians.”The demanding habitat of academic hospitals initially deterred this aspiring physician from pursuing a career in medicine. While encountering inspiring individuals,they found the overall atmosphere,marked by a ”machoculture” and competitive spirit,unappealing.
Instead, they opted for a more fulfilling path, choosing to work in a nursing home. This environment proved to be deeply rewarding, fostering close connections with residents and emphasizing a more compassionate approach to care.
Reflecting on their career trajectory, they acknowledged a shift in their perception of medicine. Initially harboring idealistic notions of the profession’s capabilities, they came to recognize its limitations, particularly regarding the human experience of suffering.
“I thought doctors knew so much.Also about fate. I walked around with this romantic idea of the 19th-century physician with civilized bedside manners; doctors who could stand up to fate. Look,like Jesus did,that anyone can do: comes into a village,lays their hands on a few bumps and bruises here and there and the lame can walk,the blind can see. That’s not arduous. But being good company for suffering people who you can’t cure, that’s different.”
This realization highlighted the importance of empathy and presence in healthcare. The speaker expressed a belief that medical professionals need to develop stronger skills in supporting patients through difficult times,recognizing that cure is not always possible.
This experience shaped their commitment to a more holistic approach to care, one that prioritizes human connection and compassion alongside medical interventions.
A physician, reflecting on their experience in both hospitals and nursing homes, offered a thought-provoking perspective on the realities of end-of-life care. During their time as a junior doctor, they conducted an informal survey of patient outcomes, categorizing them based on their condition upon discharge. The results were sobering, revealing that only a small percentage of patients experienced complete recovery.
“I found that out of 120 patients, only four walked out fully recovered,” the doctor remarked. “These were all cases of infectious diseases. for the majority of patients, we often resort to solutions that are far from ideal.
While conditions like diabetes could be managed, they couldn’t be cured. High blood pressure, often asymptomatic, could suddenly lead to a medical emergency. Dialysis, a common treatment for kidney failure, was described as a harsh and burdensome procedure.while orthopedic surgeries offered a more promising outcome for injuries like bone fractures, they represented a rare instance of straightforward medical intervention.
in the nursing home setting, the physician practiced euthanasia, but only rarely, around once a year. When asked about this low number, they dispelled the common misconception that all nursing home residents desired death. “The idea that everyone in a nursing home wants to die is simply not true,” they stated.
“We humans have known for centuries that the final stages of life are often difficult, but we tend to believe that our own experience will be different. If you were to offer a tray of euthanasia medication in a nursing home lounge, it wouldn’t disappear instantly.In the Netherlands, there are 170,000 deaths annually, and only 9,000 of those are by euthanasia. That group chooses to die, the rest do not.”
Finding meaning in helping Others
He admits he doesn’t have many customary hobbies, no collections of antique doorknobs or a passion for sports. “I’d go crazy reading all day,” he says with a wry grin. He prefers a balance between intellectual stimulation and hands-on engagement. “I need a reason to get out of bed,” he confesses. “As a caregiver, I thrive on connecting with people.” For him, the work is deeply personal.“I have no hobbies and no friends, write that down. No, listen, I don’t collect seventeenth-century doorknobs and I’m not a sportsman.I hate sports, I’m really not going to do that. I read a lot,of course,but who sets their alarm for seven in the morning to read books all day? I would get sick of it. A book is a delicacy. I like a little chocolate pudding, but not buckets. I need a balance between reading and doing something. And as a caregiver, I’m also an attention junkie. If I stay home for too long, I get bored. It’s that simple. I have to be honest about that.”
The Challenge of Euthanasia
The conversation turns to euthanasia, a topic that ignites passionate debate. He acknowledges concerns that the availability of euthanasia might pressure vulnerable individuals, such as those with severe disabilities, to make a choice they wouldn’t otherwise consider. He emphasizes the strength of the human spirit and the desire to live, stating, “I’ve never seen evidence of this pressure, and I don’t sense it in the atmosphere.The will to live is much stronger, and there’s a lot of understanding for that.”A Deeper Look at Euthanasia Concerns
He recalls a comment from an english bishop who expressed worry about the widening criteria for eligibility for euthanasia. This, he believes, is a valid concern shared in many countries. The question remains:He firmly believes that such pressure is unfounded, citing the strength of the human desire to live and the empathy surrounding it.“If euthanasia becomes easily accessible, will individuals with serious physical disabilities feel pressured to choose it?
The Rewards of a Fulfilling Career
as a geriatric specialist,he’s made a significant contribution to the field. His dedication stems from a deep-seated desire to help others and a need for human connection. he admits he finds satisfaction in a profession that allows him to make a tangible difference in people’s lives. Reiterating his need for connection, he says, “I’d go crazy sitting at home all day. As a caregiver, I thrive on those interactions.”Balancing Personal and professional Needs
He playfully depicts his lack of traditional hobbies; his passion lies in connecting with others. He confesses to being an “attention junkie,” further emphasizing his need for human interaction.The Importance of Ethical considerations
“Helemaal niet.Zolang je het maar goed doet. Een grappige vraag die patiënten me vaak stellen is of ik betaald krijg voor het werk bij het Expertisecentrum.”
Ja toch?
“Zeker weten. De verzekeraars doen daar niet moeilijk over. Die hebben allang ontdekt dat niets zo goedkoop is als een dode patiënt.Andere vraag die ik grappig vind: hoe vaak doet u dit? Ook link hè. Als je zegt dat je er zo’n drie per dag doet, word je gek aangekeken. euthanasie blijft een sacrale handeling.”
Houdt u het wel bij?
“Ik tel ze wel, ja. In 2024 heb ik vijftien mensen geholpen.”
Wat vindt u de moeilijkste gevallen?
“Het breekpunt bij dementie vind ik ingewikkeld: wanneer moet je het doen? Heel vaak begeleid ik patiënten die ik maanden, soms zelfs jaren ken. Ondanks hun euthanasiewens voor later, uitgesproken kort na de diagnose, eindigen ze toch vaak in een verpleeghuis; te ver heen om hun wens nog kenbaar te maken als de dementie vergevorderd is. Mensen hebben geen idee waar ze staan in de ziekte.
‘Dementie is de ziekte die jou vertelt dat je het niet hebt,’ schreef u ergens.
“Ik had een man in de dagbehandeling. Hij zei: zo vervelend, ik vergeet zoveel. Ja, zei ik dan, dat komt omdat je de ziekte van Alzheimer hebt. En dan zei hij: dat zeg jij altijd. Ja, zei ik dan, omdat jij altijd de ziekte van Alzheimer hebt.En dan eindigde hij het gesprek met: ja maar, wat jij niet weet is dat ik Alzheimer-light heb. Die man kon allang niet meer alleen thuis zijn. Dan liep hij naakt de straat op.Zijn tweede huwelijk was hij vergeten. En toch niet weten hoe erg het is.”
“Je hebt geen dementie, dementie heeft jou. Ik vind het een gemene rotziekte omdat het je nou net berooft van dat droge plekje waar je staat om een oordeel te vellen over wat er in je ziel gebeurt. Dat plekje is kapot.Je ligt in het water en je spartelt maar wat rond.Dementie betekent letterlijk ontgeesting.Je geest wordt opgeruimd. Dat is toch verschrikkelijk.”
He reflects on the profound impact of his mother’s early passing at the age of forty-five,highlighting the open and upfront way his family dealt with death. Confronting Mortality: A Lifelong Conversation When asked about his perspective on death, he candidly admits, “I’m not losing sleep over it, but I am afraid of it, who isn’t? Fortunately, I don’t have any risk factors: no high blood pressure, no diabetes, and my family history is fairly clean.” His mother’s death, when he was just eleven years old, had a profound impact. “She had liver cirrhosis,which we would probably call hepatitis today,” he recalls. The final months were difficult.”Before she died,she spent four months in the hospital. There were no hospices then. There were nursing homes for chronic patients,but she couldn’t go as she had severe bedsores. The hospital initially resisted keeping her, as the health insurance refused to pay for her stay. Only after the clergy from our parish intervened was she allowed to stay until she passed away.” he describes frequent visits to his mother during her illness, asserting, “We were never kept away from her bedside, not even during her illness, death, or funeral, as was frequently enough the case with children back then.” The Lasting Impact He acknowledges the deep influence his mother’s death had on him, particularly on his views on mortality. “Psychiatrists often tell me that my concern with death stems from a desire to ensure my mother had a good death,” he says. “But that doesn’t resonate with me. It’s not like a lightbulb suddenly goes on. What I don’t understand is why so many people avoid the subject of death. It’s taboo, but as if death cares about that.” He recognizes the tendency to avoid such sensitive topics. “I can see why people might think it’s pointless to talk about death as there’s nothing we can do to change it,” he concedes. Finding balance “Of course,” he continues, “there are two extremes to avoid. constantly dwelling on death gets you nowhere. But never talking about it isn’t healthy either. Finding a balance is key—living with the awareness that one day we all will die. That knowledge is what motivates us to get out of bed and do something meaningful.” Last year, the Sarco assisted suicide pod generated significant controversy in Switzerland. It seemed unnecessarily complex, especially considering Boudewijn Chabot’s book “Uitweg,” which details the legal, simple, and effective method of self-euthanasia using helium gas from party balloons. How do you view these different approaches? “Party balloon helium tanks have become less effective as the industry learned they were being used for suicide and increased the oxygen content. You need to get hold of a nitrogen cylinder now, which is still possible but more difficult. It’s unfortunate. There are some eyewitness accounts that raise doubts about the painlessness of helium death, but Chabot collected extensive case studies from people who witnessed such deaths. most of these reports are encouraging. This wasn’t the case with the method provided by the Laatste Wil Cooperative. What they offered was NaN3, or sodium azide. That’s dangerous stuff, a close relative of potassium cyanide, the poison used by the Nazis. NaN3 is highly lethal, you’ll certainly die, but there’s no guarantee it will be painless.” How can one ensure a peaceful death? “Barbiturates, like those we use, are the best option.” He breathes in and out,like a weary sigh. Is that all there is to it? “Yes. Most people view death as a high, insurmountable wall: ‘God, how do I get over that?’ But death is simply falling asleep. We die every night.” There’s really nothing to fear. “No. It’s ironic, isn’t it? People say they’re afraid of death, but it’s not that. people are afraid of pain, of suffering. and of dying too young. My children are 42 and 36. I’m certain I won’t see their 80th birthdays. If I had something to truly complain about, that would be it. It’s senseless. I wish I had never been born. And yet, I find the thought of it quite distressing, I truly do.” “I once had a patient…”A Life Devoted to Care: Reflections on End-of-Life Choices
Throughout his career, Dr. [doctor’s Name], a dedicated physician, has witnessed the full spectrum of human experiences, from the triumphs of recovery to the profound sorrow of loss. He recalls a poignant encounter with a patient battling addiction, whose fading health meant he might not live to see his grandchild. This experience reinforced the doctor’s belief in the tenacious nature of the human will to live. “I told him, ‘You need to prepare yourself, it may not be long now,’” Dr. [Doctor’s Name] remembers. But the patient, clinging to hope, responded, “I want to see my grandchild.” The doctor, deeply moved by his patient’s determination, doubled his efforts to provide the best possible care. When the patient’s daughter visited, Dr. [Doctor’s Name] inquired if she was expecting. He recalls, “She asked me, ‘How did you know?’ I explained that her father was eagerly awaiting his grandchild’s arrival. she replied, ‘Yes, and he wants to take the child to school before…’” This experience, among many others, solidified Dr. [Doctor’s Name]’s understanding of the profound desire to live that resides within most individuals. When it comes to the subject of euthanasia, Dr. [Doctor’s Name] expresses support for it under specific conditions. He emphasizes the importance of safeguards, citing the example of the Coöperatie Laatste Wil, an institution that made accessing lethal medications too easily accessible, leading to an increase in suicides among vulnerable individuals. “There needs to be a barrier, a set of safeguards,” he explains. “We can’t allow people to make such a momentous decision impulsively. Imagine a young person experiencing their first heartbreak, believing their world has ended. We wouldn’t want them to choose death in a moment of overwhelming despair.” Dr.[Doctor’s Name] believes in the power of careful consideration and a rigorous process when it comes to end-of-life decisions. He himself has contemplated the possibility of a medically assisted death should his own health deteriorate beyond repair. He states, “I could easily obtain the necessary medication now, but I’ve never been tempted. If I were ever to qualify for euthanasia and wished to pursue it, I know who to turn to.” As a seasoned physician, Dr. [Doctor’s name] possesses a unique ability to assess a patient’s situation quickly and accurately. “usually, I can tell quite rapidly if a request for euthanasia is justified,” he shares.”Recently,I wrote the foreword for a book titled ‘My First Euthanasia.’ Thinking about my own potential end-of-life choices used to keep me awake at night. Now, after carefully reviewing a patient’s file and meeting with them, I typically know within ten minutes what the appropriate course of action should be.” Despite his experience and expertise, Dr. [Doctor’s Name] emphasizes that every case is unique and requires careful consideration, compassion, and a deep respect for the patient’s autonomy.
The Value of Experience in Healthcare
Dr. David Hume, a seasoned physician with decades of experience, believes that experience is invaluable in the medical field, just as it is in any other profession. He uses the analogy of laying parquet flooring to illustrate his point. “After just three days,you’re weary and the corners won’t be right as you lack knowledge,” he explains. “If you lay three floors per week, you’ll do it quickly and efficiently.” Dr. Hume emphasizes that experienced physicians,unlike their younger counterparts,are more pleasant admitting when they don’t know something. ”Young doctors would rather die than say that,” he states. “They’ll stick to the protocol religiously, fresh from training with the belief that the body can’t function without it.It’s frequently enough not true.” He warns that relying solely on protocols can be detrimental. “If you end up in their system with your aging body, you’re in trouble.” While protocols are based on solid research and provide a valuable framework, they don’t account for the unexpected. “A protocol is like a map – it shows you all the streets, but it doesn’t show you the dog that suddenly runs across the road,” he explains. Dr. Hume believes that routine and experience are essential for quality healthcare: >“Routine gives quality. That applies to esophageal surgery, to laying parquet, and even to euthanasia.”Need Help?
If you are experiencing thoughts of suicide or are concerned about someone who is, please reach out for help. Talking about suicide can make a difference. You can access anonymous support through chat at www.113.nl or by calling 113 or 0800-0113.Bert Keizer, born on November 25, 1947, in Amersfoort, is a man of diverse talents and accomplishments. His journey has taken him from the hallowed halls of academia to the compassionate world of healthcare, and finally to the captivating realm of arts and literature.
Keizer’s educational background is as rich and varied as his career path. After completing his secondary education at Constantijn College, Amersfoort, he pursued a Bachelor’s degree in Philosophy at Nottingham University from 1969 to 1972. He then returned to his native Netherlands to study Medicine at the university of Amsterdam, graduating in 1981.
For over three decades, from 1982 to 2015, Keizer dedicated himself to caring for patients in Amsterdam nursing homes. In 2002, he embarked on a new creative journey as a scenographer, adding another facet to his multifaceted personality. Since 2016, Keizer has combined his medical expertise with his passion for end-of-life care as a physician at the Expertise Center on Euthanasia.
Beyond his professional pursuits, Keizer is a prolific writer. His published works delve into the realms of science, philosophy, and biography. Some of his notable books include “Unaccountably Inhabited: The Wonderful Domain of the Brain” (2010), “We Used to Be Immortal” (2016), “Life and Work of Ludwig Wittgenstein” (2021), and “The Riddle of the Mind, a Philosophical Inquiry” (2024), which made the longlist for the prestigious Socrates Prize.
Today, Bert Keizer resides in Landsmeer with his wife, continuing to explore the depths of human experience through his writing and his compassionate approach to medicine.
## A Life Devoted to Care: Reflections on End-of-Life Choices
This text is a captivating snippet from a larger piece, likely an article or interview. It delves into the complex subject of end-of-life choices through the lens of dr. [Doctor’s Name], an experienced physician.
**The Story Unfolds:**
The piece begins with a powerful quote highlighting the fearlessness often associated with death and the true trepidation surrounding pain, suffering, and premature death.
We are then introduced to Dr. [Doctor’s Name], whose career has exposed him to the full spectrum of human experiences, especially in the face of mortality.His poignant encounter with a terminally ill patient, battling addiction and longing to see his grandchild, underscores the enduring human will to live.
This experiance fuels Dr. [Doctor’s Name]’s contemplation on euthanasia. He supports the practice under strict conditions, emphasizing the need for safeguards and a meticulous process to prevent impulsive decisions.He advocates for a balance between autonomy and protection, drawing a parallel with a hypothetical heartbroken young individual considering suicide.
Dr. [Doctor’s Name] reveals his own preparedness for a medically assisted death if his health deteriorates beyond repair. Yet, he finds solace in his experience and ability to assess a situation swiftly and accurately. While his expertise guides him,he emphasizes the uniqueness of each case and the crucial role of compassion and respect for patient autonomy.
**The Value of Experience:**
The piece then transitions to explore the vital role of experience in healthcare. Dr.David Hume,another seasoned physician,enters the narrative,likening medical expertise to the art of laying parquet flooring. He stresses that experience brings efficiency, intuition, and a willingness to acknowledge limitations.
Dr. Hume contrasts experienced physicians’ willingness to admit knowledge gaps with younger doctors’ adherence to rigid protocols. He cautions against sole reliance on protocols, highlighting their limitations in addressing the unpredictable complexities of each individual case.
**Burning Questions:**
this engaging snippet effectively opens a window into the multifaceted debate surrounding end-of-life choices. It sparks numerous questions:
* What are the specific safeguards dr.[Doctor’s Name] envisages for euthanasia procedures?
* What are the examples of ”unexpected” situations that Dr. Hume alludes to when discussing the limitations of protocols?
* How dose Dr. Hume’s viewpoint on experience balance with the innovations and advancements brought by younger generations of doctors?
This captivating excerpt begs for further exploration, promising a rich and thought-provoking discussion on life, death, and the complex intersection of medicine and humanity.
