A few weeks ago I said to my mother: "I feel that Dad will not live long." She was shocked by that..., even though he is 90.

And now we're in the middle of it, and not suddenly. His body is worn out..., he doesn't want to live anymore..., he goes of and on into the hospital..., he wants euthanasia..., but yes, his heart is strong and the lungs are good..., so whether the GP will cooperate with the request of my Dad, that is still very much the question.

My father has a very advanced form of skin cancer on the upper body and head. The hospital has indicated that they are out of treatment, they can't do anything for him anymore. In addition, his knees are worn out, so it is difficult to walk and sometimes he falls, his eyes and ears are function badly, one eye can no longer be completely closed, because of some TIA's he has had, his hands are shaking so he must have an apron and must be fed and he can't wash/dress himself, he is difficult to understand because of the TIA's he has had.

And so it happens that I take care of my father one morning. My mother hears me come in and says, "Oh, you're a little earlier, okay, then you can rub his skin with ointment today." I swallow as I enter the bedroom. My father sits there, on the bed, without clothing, his eye half sewn and fur and blue from the operation, his upper body and head full of skin cancer spots and large bruises from the times he has fallen. I put on a glove and smear its skin that itches so terribly, the ointment gives relief, I dress him and do some small jobs here and there...

When I look at my father like that, I see the transience of existence..., there is no escape... and we are the next generation, then it's our turn...

My father sits on the bed..., he'll let everything happen..., no resistance..., no shame..., there is surrender..., surrender to the state of affairs ánd the desire to end his life: let death come..., I am ready for it..., my body is worn out..., my life has been good, now it is time to go.
 Yes, that is the energy of my father: a very ordinary man, who has become very fragile and vunerable over the years.

I talk with my father and mother about my father's desire for euthanasia. During the second or third conversation I ask my father without any detours: "Do you really want to die, Dad? You don't have to die, if you want to stay alive, that's okay, we'll take care of you." Yes, I know that, I am grateful for that, says my father, but I want euthanasia, it doesn't work anymore. Okay, I say, realize well that you are the one who must make clear to the GP that there is hopeless and unbearable suffering. Do you understand that, Dad? Yes I understand. Okay, Dad, what do you say when the doctor for example asks you if you are in pain? Well, then I say that it is not that bad..., you get used to pain. Yes, Dad, that is true, you get used to pain, and once again you don't have to die, but if you want to die, then you have to convince the GP that it is not working for you anymore. He understands the message.

The GP comes a few days later. I indicate that I want to link our conversations about euthanasia with her. The GP is not open to it, even though I had mentioned earlier that week that we wanted to talk about euthanasia during her home visit. She says, "I will first talk to your father, you are going very fast." Then she literally turns away from me and my mother and addresses the word to my father.

My father has understood the message from our conversation, which took place earlier in that week: he is on the move. And on a certain moment he comes out, he tells the doctor that he wants euthanasia. And then he names all complaints (sometimes difficult to understand) and consequences of the complaints from which he wants to die. In the background my mother and I watch and listen to my father. He's going to stand for it..., he pulls everything out of the closet to make it clear that he wants euthanasia.

During the conversation it becomes clear how the GP is in it, she doesn't want to cooperate: there is no file structure (in her opinion), although my father is member of the Dutch association for euthanasia for some years, and there is no question of an incurable disease in the sense that my father will die within 2 weeks to 6 months. In addition, she sees it as her task to ensure that the patient's final stage of life is as harmonious as possible by supporting the patient with medication and care. Passive or active euthanasia is not an option for her. And that's her right to see it like that.

After the interview, we decide to switch on the end-of-life clinic.

Well, what is hopeless and unbearable suffering? Who is going to decide about that? Who determines what is hopeless and what is unbearable suffering? Is there hopeless and unbearable suffering if you can hardly leave the door because your knees are worn out and the chance of a fall is great? Is there hopeless and unbearable suffering if you have to be cared for, washed and fed by third parties every day? Is there hopeless and unbearable suffering if the wounds of the skin cancer don't heal anymore (the skin is too thin), the itching is intense and you can't scratch, because otherwise you have to go to the hospital again to stop the umpteenth bleeding? Is there hopeless and unbearable suffering if the senses function poorly, your hands shaking constantly and social contacts outside the door are virtually impossible?

They are subjective data, that is true: what one experiences as hopeless and unbearable can be very different for another. That also makes it so difficult. Can someone else really judge about that? Judge about what you experience and feel?

And the strange thing is that my father, in addition to the request for euthanasia, still enjoys in his way. Especially of the food (one of the few pleasures that are still possible), even if it has to be fed. I do understand it. That is also what I admire in my father. He wants to die, but if the wish is not honored, then he surrenders: not as a victim, but from a basic fact that everything goes as it goes.

What else can you do? my father says. I can express my wish, but if it's not possible, then you surrender to that..., it's like it is.

Beautiful to be part of this process, I see surrender, a surrender that is neither happy nor sad. A surrender to the situation as it is. A surrender to life and death that is approaching, because yes ..., there is a time of coming and a time of going.

The procedure with the end-of-life clinic starts. After a few weeks comes the long-awaited statement from the end-of-life clinic and an independent physician, who evaluates the application for euthanasia:
'Yes, there is hopeless and unbearable suffering due to the accumulation of old age disorders.'

Pa feels relief and is grateful now that the end is in sight.

During one of the exchanges with the doctor of the end-of-life clinic, I ask him how he looks at active euthanasia. I say: 'Quite a few GPs indicate that they view active euthanasia as an act by which they kill someone, what is your view of that?' The doctor of the end-of-life clinic says: "I see euthanasia as a medical act to give the patient a dignified end of life."

Beautiful..., well..., that is a completely different perspective..., it is just how you look at it...

It's nice that the end-of-life clinic exists, that people can go there if the GP doesn't want and can't support the request for euthanasia.

Share the blog..., if it feels like that, so that the elderly among us can take this information in (quite a few older people don't know about the existence of the end-of-life clinic).

PS: My father received euthanasia on January 13, 2018.
A few weeks before his death I read a version of this blog to them (father/mother and at a later time the whole family). His reaction: "You described that very nicely..., you have to publish it so that the elderly among us know that they can go to the end-of-life clinic if their GP
doesn't want tot cooperate ." I will do so, Dad.

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