Introductory note LO:
The interview below is my best-efforts translation of a recent Dutch interview with psychiatrist Boudewijn Chabot (79) in Dutch newspaper NRC.
More and more, I’m wondering whether this dilemma will become the new Great Divide (my blogs) in future societies: old & rich versus young & poor.
I’ve noticed this potential new Great Divide before in my 2019 blog: The future Great Divide between generations. Covid-19 is accelerating this development.
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NRC title: ‘It’s time that the elderly will sacrifice themselves for younger people’
NRC subtitle: Psychiatrist Boudewijn Chabot (79) does not want to go to the ICU when he gets sick. More elderly people should sacrifice themselves, he says. “Dying is part of living, that is what we must learn to accept again.”
Date: 1 February 2021
“Boudewijn Chabot (79) thinks that you can only die well once you prepare for it. Living your dying, as the American psychotherapist Stanley Keleman wrote. He is surprised that so few people do this. Following progress in healthcare, we are living in a delusion that everyone can reach 80+ and that we are also entitled to that. We continue seeing death as some kind of failure, something that should be avoided at all cost. We can no longer maintain that due to Covid-19, he says.
He is a psychiatrist for the elderly, known for his advice how to die with dignity, without asking a doctor for euthanasia. He promoted in 2007 on research for “self-euthanasia” by medicine or withering (consciously denying food and drinking), and co-wrote in 2014 on “guidance” for doctors how to relieve suffering for terminal people.
He lives in Haarlem, in his grandmother’s house from 1910. It’s a few days after the implementation of the [LO: Dutch] curfew and he says: “It’s good that the fiercest measures have been taken because now we can see that those will neither help, or only for a short while. The virus appears to be that flexible and creative that it can resist our measures against distribution. Before we are inoculated, a third wave may arrive. Or there will be a new virus, for which a new vaccine must be developed. It’s arrogant to think that we can control it over the forthcoming months, especially because we are not built for lack of having normal contact with each other over such a long period. Evolution did not prepare us for that. We are tempted to huddle together, especially in times of distress. You can see resistance growing now and I’m not talking about the riots, which are despicable. I’m referring to the underground and partly unconscious resistance, which – according to research – causes that 75% of people with common cold complaints are still out on the streets, visiting shops, and of which 50% is not testing themselves. I’m one of them. Last Saturday, I went to a funeral which was not really necessary. My daughter said it was not wise. Yesterday, I walked with a friend. He had to remind me regularly that we – while stretching his arm – should maintain a distance. Nature is stronger than rules. Physical intimacy is a necessity of life. Hence, corona statistics will continue to increase and decrease.”
So?
“It’s time for the elderly to sacrifice themselves for young(er) people. Those should go back to school on the double, including high school. Students must get normal lectures. And yes, that will increase the risk of contamination and thus fatalities. This will collide with fear of dying. And death is a monster, isn’t it. Nevertheless, many old people also look forward to dying. However, obviously not now.
“They prefer” – he smiles – “to wait for a while because it’s quite scary once it comes close. I’ve been busy with death for a very long time and the idea that it can suddenly be over is very familiar to me. But still, when I’m awake at night then the thought of being erased completely can be frightening. Like the guy’s funeral last Saturday, was so much beyond imagination. However, during daylight, it’s acceptable to me at almost 80.”
But more contaminations will cause an overburdening of hospitals
“We must also stop with that lunatic focussing on the number of patients at the ICU at the expense of healthcare employees who are operating on a shoestring for months, and at the expense of patients with another life-threatening disease. The number of ICU beds must return to the normal level. When these are full, young people are prioritised over the elderly.”
And then?
“General practitioners tell me that most people survive with oxygen, dexamethasone and antibiotics. It’s annoying that allecijfers.nl/ doesn’t show how many elderly die of Covid-19 when they stay at home. Hence, you’re unaware whether it’s more or less than at a hospital. During the first wave, anesthesiologists warned for respiration of the elderly. It’s better not to do so. Air is being pumped inside the lungs under pressure which damages the alveoli. The diaphragm of the deceased shows many scars. Last March, I said to my general practitioner: never to a hospital. You what happens there? ‘Mr Chabot breaths very superficial. Pulmonologist, please stop by.’ He will transfer you to the ICU. You are powerless, defenseless.”
Yet it’s more likely that more elderly people will die if they cannot visit the ICU
“Is that bad? It’s less bad than denying young(er) people to have physical contact with their peers. Hopefully you will be surrounded with your loved ones and you will not be isolated, like in care homes during the first wave. It’s so sadistic to die alone! The general practitioner will relieve your suffering. General practitioners are much better in palliative care than hospital doctors. Most interesting was the [answer to the] a question by Jos Schols, professor in elderly healthcare at Maastricht [University], to people of 80+, whether they want to be admitted once they get Covid-19.60% said no. Marvellous!”
Will they still say that once they have Covid-19?
“That is indeed the question. I’ve learned to distrust that ‘Just let me go’. And 40% says that they do want to go to a hospital. 40 percent! That is an awful lot of people. Only a part of them will get sick, and still we shall need to say to them: sorry but the ICU is full and you will be treated at home.”
That could result in a serious rebellion.
“Dying is part of living for the elderly. That is what we must learn to accept that again.
I don’t see that happening yet because there’s no political leader who dares to say that we are in a dead-end street, and that we are paralyzing young generations, from school children to students. We are undermining their spirit and their self-confidence. We are only saying: ‘Keep it up. We are almost there.’ No, we are not almost there. Maybe we are not even there for a long time. Someone must say: ‘It doesn’t work out this way, people, we are breaking down, we must change course, priorities are with the young(er) people as of now.’ “
He rises and takes a glass of water. After sitting again, he says: “Last week, the new National Poet, Lieke Marsman, wrote in [LO: Dutch newspaper] NRC that she is the voice of brushwood. She has an ugly, life-threatening chondropathy. It was a beautiful poem but when I read it I thought: no you’re no brushwood, you are thirty, you want to live. Accepting death at that age? When hell freezes over. She is the flower of witch-hazel‘s brushwood in spring. People of my age, yes, they are getting like brushwood.”
How well are you prepared for your own death?
“Very well, and that started at 19. Ik was studying medicine in Amsterdam and collapsed on the street. The hospital found a perforated appendicular artery. That happened in 1960 and I was saved by antibiotics. You will hear no complaints from me on medical progress. Afterwards, I survived tuberculosis, an aneurysm, and open-heart surgery. That’s another story. The fever was so high that I became delirious. I pulled out the IV from my arm because my delusion assumed that the needle’s point was broken. It was heading for my heart through my veins. And now my point. I though: I must die before the needle reaches my heart, else death would be very painful. At 19 I was already busy deciding which way to die. That experience has determined my conscious approach to death.”
What happened?
“The nurses strapped me and sedated me. Then the fever decreased.
You stayed in a Japanese internment camp as a child, where death was never far away. Is that relevant?
“Speculation. However, my mother’s letters from that camp reveal that I stayed in hospital barracks with dysentery, separated from her and my sister. At 6, after the camp, I said: when I die, I want to know where you are, and that you know where I am.”
But how do you prepare for death?
“I have the proper means at home and the people around me know what I want and why. So what am I most afraid of? A cerebral hemorrhage because then I cannot reach those means. And my wife will not give them to me. My fight with her is that I say: wait for 24 hours, if I’m still alive by then, then you may call 112. I prefer immediate death but often you regain consciousness and you’re desperate. Should I enter hospital because something happened on the street, then my general practitioner knows that he should remove from that place. If I’m unable to take my means then I’ll stop drinking. I told people around me that they should not give me water, even when I scream and get rebellious. The general practitioner will give me palliative sedation. Dying in a way that you want, and not having to live undignified is hard work, people get that.”
You never think: let it be, I’ll see it when I get there?
“No, no. It looks easier but too often I’ve seen people ailing into dementia.”
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Résumé Boudewijn Chabot
Boudewijn Chabot (b. Makassar, 1941) was trained as a psychiatrist in Rotterdam and London. He worked amongst others at the mental healthcare facility De Geestgronden in the province of North Holland.
He is known for the Chabot-ruling by the [Dutch] Supreme Court in 1994, in which he was found guilty – though without punishment – for assisting in the death of a woman of 50. The woman had refused to continue living after the death of her sons. Chabot has changed his mind about that way of helping, ie. giving her lethal medication which she took herself.
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