THE MODEL we use in the Netherlands to make medical decisions when a person is dying is not for export, because it is founded on the typical way in which Dutch people live and communicate. Autonomy in decision- making is a fundamental issue in our society. Fortunately, we have always had, and still have, extremists on the left and on the right sides, proponents and opponents of any subject. This forces us to carry on arguing with each other about difficult problems such as religion, abortion and political issues, and about medical decisions concerning the end of life.
It is very important for physicians who are dealing with patients to reflect seriously on death and dying. We have to straighten this out for ourselves before we are able to understand the feelings of others. We therefore must accept that life and death do form a remarkable, inseparable alliance. Looking at, and dealing with, human beings who are suffering against their will gives doctors and also nurses in our country the strength to accompany those patients to the end.
In my daily practice, my patients, knowing my affinity with the subject, ask me to help them in the end, and they also give me their living will or advance directive. After this has been settled, most patients are at ease and have room to fight their illness - it is amazing that they change so when they hand over their living will.
If cure becomes purely care, you want to furnish palliative care. Palliative care is well established in our country, and it is part of regular medical care. We have 80 recognised pain clinics scattered throughout the country. But even the best care is not able to protect all the patients from agony and loss of dignity in the final stage.
That fellow human being, in her or his terminal phase, is the one who deserves our full attention and all our efforts. As a compassionate physician, you cannot let your patient down. This implies that sometimes you have to end that life, or provide the final medication - but only at the explicit wish of the person involved. …