Greg Dobbs, co-founder and publisher of BoomerCafé, has been traveling across Europe to report for HDNet’s World Report about two major issues of relevance to Americans. In his spare moments, Greg has jotted some notes and observations to share with family and friends:
October 2009, from somewhere over Europe…. sometimes perhaps on it…. and in all likelihood for the last part of the letter, high above the Atlantic, heading home …
Dear Family and Friends,
I am starting this letter on a flight from Amsterdam to London. But it’s a short distance and thus a short flight, and since I have a few more planes and trains ahead of me before heading home, I’ll write this as I go along and don’t really know where the final words will be composed.
With a team from HDNet, we’re here in Europe shooting two programs: the first is on the Dutch healthcare system, which is probably about the closest thing to where the United States probably is going in the controversial process of reforming American healthcare. The second is on the issue of assisted suicide. That part of the trip is motivated by a constitutional challenge from assisted suicide advocates in the state of Montana (with another possibly pending in Connecticut), and is taking us to the United Kingdom, which has had contentious battles about the prosecution of those who help their loved ones to commit suicide, and Switzerland, which has the world’s most liberalized laws. We’ll go to Montana for that part of the story once we get home again….and I learn to ride a horse.
It’s a good trip. Not just because both are meaty stories to which we can do justice in the documentary-style format of our “World Report” program on HDNet, but because….well, look at my agenda: the Netherlands, the United Kingdom, and Switzerland. I mean, what’s wrong with that?!? Each is a nation with good food, unique and interesting culture, and wide command of English (although, in the spirit of My Fair Lady, one does run into Brits who require a bit of translation). Since most of my trips abroad take me to places that haven’t quite caught up to our comfortably civilized ways at home, a trip like this is a treat. By way of contrast, a few years ago a man in Peru, who decades earlier had spent a year in the United States, told us that the most important thing he learned from his time in America was the definition of a civilized country: it is a place, he said, where when you go to a restroom, you don’t have to carry in your own toilet paper. Let’s just say, throughout each of these European nations, you don’t have to carry in your own toilet paper!
Before I tell you about our stories, I’ve got to tell you about survival in the Netherlands, or for you old-timers who just can’t let go, Holland. As some of you know, I love riding bikes. At home I have a mountain bike on which I’ve crawled up and barreled down steep trails in Colorado and climbed and descended in total terror (don’t tell the guys I go with) along sheer limestone cliffs in the mountain-biking capital of Moab, Utah. And, I have a road bike, on which I’ve climbed 12,000-foot mountain passes with no shoulder between the road and the drop-off, and ridden several times in century events— most recently just the middle of last month amongst the trucks and busses of a sea-level city named New York. But none of those experiences comes closest to being my most dangerous encounter with a bike; that came in the Netherlands, this week…. every time I tried to cross the street!
Holland, you see, is a nation of bikes. Not because it has the right weather for biking— every day we were there it was cold and grey and damp. But because it is flat. I mean… FLAT. It’s almost as if the landscape lies flat on its back; bridges are the only hills (“Netherlands” in fact means “low lands.” Because they are). That doesn’t make for the most interesting biking in the world, because while sometimes it’s nice to ride from here to there without a mountain pass in your way, after a while you can get bored with the monotony of the horizon from flat roads and the unchanging pace on the pedals. But it does make for relatively easy biking. Or at least it would, if people had relatively easy bikes. The Dutch don’t. Most have relics that look like they’re made of iron; I picked one up and it felt heavier than my two bikes combined with Carol’s thrown in too. That’s because they’re not climbing, they’re just riding. So they have these simple upright bikes built of iron with generator lights and spring seats and baskets in front to carry their groceries and sometimes their kids, even their dogs.
That’s all just fine. The trouble is, bicyclists have godlike status; bikes are kings and they rule the roads. If you like to ride like I do, you might not think that sounds so bad. But I wasn’t a bicyclist there; I was a pedestrian. And bikes in the Netherlands trump everything else: trams, cars, pedestrians. They don’t just have bike lanes like ours, where a broken white line punctuated by a stenciled bicyclist defines the corridor. No, they have their own passageways, usually separated by narrow elevated islands from the cars on one side and the sidewalks on another. But these passageways for bikes look just like the sidewalks. Every time you come out of a building, or cross the street from one corner to another, first you alight from the sidewalk by crossing the island to the bike lane, then from the bike lane across another island to the street, then back across the other bike lane and finally to the sidewalk on the opposite side.
And the bikes don’t stop for anybody. Which means that drivers in their cars, hoping to turn right, have to look sharply over their shoulders to ensure that a bike heading in the same direction isn’t barreling straight along in the bike lane. And that pedestrians like me have to look both ways (bikes are going both ways in most lanes) before stepping into and across a bike lane at our peril. The experience reminded me of a man Carol and I knew from New York. He went to London on business twice every year for decades. Yet after all those visits, one day he forgot himself and looked left instead of right when he stepped off a curb and got killed by a bus. My guess is, had he gone instead to Amsterdam on a regular basis rather than London, he wouldn’t have survived even as long as he did.
Maybe that’s a good segue to the new healthcare system in the Netherlands, which is less than three years old. I don’t even know if it covers foreigners who get sick or hurt (by bikes, for instance) while visiting— I didn’t think of that question in all the interviews I did and only came up with it while writing this sentence (the story of my life and probably true for many journalists; it happens to me a lot. Kind of like having an argument but only thinking of your best retorts right after you walk away!). I do remember that when we lived in London (okay, so I’m not quite ready to begin my description of Dutch healthcare), a friend visiting from the States hurt her leg and we had to take her to the hospital where, because of the National Health system there, she got full treatment without paying a penny. You can argue of course that the taxpayers had to pay and you’d be right but still, it demonstrates the simplicity of getting healthcare.
Britain is what’s called a “single payer” system where the entirety of publicly-financed healthcare is available to everyone in the country. It’s the “safety net” concept and it’s far far far from perfect, mainly because it always depends on a piece of the pie in the national budget. When money is tight, so too, probably, is the quality of healthcare. However, we had the option while living there of paying extra, or of applying our employer-purchased or personally-purchased insurance to private healthcare, and we did. But we also used the National Health from time to time— for example, when Jason was born, we did it with a private doctor in a private hospital (the same one in which Princess Diana bore her sons). But pre-natal and post-natal care (including home visits, believe it or not) was provided by the state in the interest of nipping problems in the bud. For something like the first year, we even got a bi-monthly check (or “cheque” as they say there) meant to be used for milk. The funny part is, it was always addressed only to Carol, in keeping with the British conviction that if the father got his hands on the milk money, he’d drink it down at the pub. T’was, for me, a very dry period in my life.
But back to Holland. No matter whether foreigners are covered there, our program is about healthcare for the Dutch themselves, and how it works. The answer is, not perfectly (even its most ardent advocates call it a work in progress), but from almost everyone’s point of view, it works pretty darned well. Why? A few reasons: 1) It is universal, meaning, everyone has it. 2) The insurance companies are private. When it comes to the controversial concept in the American debate about a “government option,” government in the Netherlands isn’t involved in the insurance business. 3) When you apply for insurance, the company to which you apply cannot turn you down. Pre-existing conditions? No worries, come on down! 4) When the companies take on a high-risk patient, the government subsidizes them for doing so from something called the Risk Equalization Fund. 5) All kids to the age of 18 have coverage paid not by the families but by the government, from employer contributions not unlike ours. 6) Coverage puts a heavy emphasis on preventive healthcare, so when an illness is just starting, the insurers spend a little at an early stage instead of a lot later on.
Now, here’s the part that some will find most objectionable but I’m not sure how to avoid it if universal coverage is the goal: 7) The government sets the rules, which really means it issues the mandates for what you might call the “minimal” insurance policy to which everyone is entitled for a minimum monthly premium (which still covers an awful lot). But here’s the counterbalance to that). The insurance companies, which have to offer that minimal policy for a mandated price, also offer supplemental policies with whatever additional benefits they want to offer at whatever prices they think they can get. If I’m a consumer, I can shop around for these supplemental benefits and let the companies compete for my business, and if an insurance company doesn’t like me (because, say, the insurer sees risk, which in my case makes him a pretty smart fellow!), it can turn me down. An example: we had a “fixer” in the Netherlands, a freelance journalist we hired to help us arrange our interviews and just get around. She told me her family has supplemental insurance and I asked how she chose which company’s policy to buy. Her answer was, she has two young teenagers and one company offered particularly comprehensive orthodontic care, so that’s the one she picked. Finally: 9) The Dutch pay roughly half of what we Americans (those of us with health insurance at all) pay.
That might lead you to ask, how do they do it? Believe me, we didn’t hear any horror stories about long waits for elective surgery or horrible experiences with the quality of healthcare, the kinds of things many Americans fear if we go to a system in our country that mirrors, say, Canada (with the government acting as sole insurer) or Britain (all depending on a piece of the pie in the national budget). Government’s function in the Netherlands is twofold: collecting the funds for subsidies, and setting the rules for minimal coverage.
Otherwise, it’s the private insurance companies that ensure the quality of care, because with the need to compete directly for the business of every citizen, they are motivated to try to offer better supplemental policies than their competitors, at better prices. The way they can best do that is by negotiating for the best deals with the providers: doctors, hospitals, and so forth. Truth be known, there is some fear that the system will drive prices down to the point where the only way for medical providers to survive is to diminish the quality of the service; reducing staffing, for example, in hospitals. But so far, it seems to be more a fear than a reality, and when I interviewed the Minister of Health, he told me that’s one of the things in this “work in progress” that they’re trying to prevent.
Since I still want to tell you about our “assisted suicide” story, which at this point in the occasional composition of this letter we’ve already started shooting— I’m typing this part right now on a train north from London to Leeds— I’ll finish with an anecdote about the Dutch healthcare system. The law requires that every insurance company accepts all comers, and that every citizen applies. But in keeping with human nature, about one percent of the people don’t. Maybe it’s because they prefer to take their chances…and maybe it’s just because they prefer to spend their money on Heineken. Well, if they get caught, which sometimes happens when suddenly they need costly medical care and think they can get away with applying for insurance for the first time, they have to pay not only the sum total of the premiums they’ve skipped, but a 30% penalty on top of that.
It sounded a bit steep to me, so I asked the health minister how they could justify that. His answer was logical— maybe not acceptable to every political persuasion, but logical. For one thing, part of the rationale for universal coverage in the first place is that when someone without insurance needs medical attention, those who have it end up paying (shades of the U.S.). For another, the whole concept of insurance— especially when it’s provided solely by private companies— is that you pay for a long time but might or might not ever take advantage of your coverage; that is part of the way insurance companies make their money. Therefore, the people who have dodged the mandate in the Netherlands to buy insurance have, in effect, cheated the insurance companies of the easy profit they would have made while these people were healthy.
The U.S. surely won’t end up with a system just like the Dutch, but if we do come up with any change at all, we probably shall pull more elements from their system than from any other.
We also could do worse than to pull one of their culinary traditions into our own: “rijstofel” (RYE-shtah-full). Actually it’s from Indonesia, where the Dutch were the colonial power for a century-and-a-half… although when I was in Indonesia in January, I never ate anything that came close to what I ate in Amsterdam. I knew to look for it because thirty years ago, when we went with some visiting friends to Holland, we had a rijstofel I never forgot, but never have been able to duplicate. It’s kind of a smorgasbord of tastes and ingredients, with fish and lamb and pork and poultry and beef. Lots of sauces, lots of rice, one of those meals like a shared Chinese feast where every bite is better than the last one. We had it twice. (I might as well tell you the name of the place, for those who might some day visit Amsterdam. It is “Kantjil” at Spuistraat 291. Phone 020 620 0994. (www.kantjil.nl)
Okay, time (in a manner of speaking) for “assisted suicide.” In the culture of media-driven labels and modern politics, advocates for liberalized laws on assisted suicide don’t actually call it assisted suicide; they call it “assisted dying.” But they’re one and the same thing. What you shouldn’t call it though is “euthanasia.” Why not? Because it’s not, and for those who don’t know (which included me until about two weeks ago when I started reading about it), that’s the first distinction to explain. Assisted suicide means, someone assists. In other words, if you’re the one who wants to kill yourself, I’m the one who gets you the poison, or hands you the plastic bag, or drives you to the bridge. On the other hand, euthanasia means the “assister” actually conducts the act. So again, if you’re the one who wants to die, I’m the one who puts the poison in your mouth, or puts the bag over your head, or pushes you off the bridge.
It may sound like an academic difference until you think about some of the people who want to commit suicide. Because of disease or paralysis, they are literally unable to do it by themselves; one of the most compelling books I’ve ever read is called The Diving Bell and the Butterfly. It is a true story about a guy in France— in fact it is by the guy— who had the worst kind of stroke and could not breath on his own, nor talk, nor touch, nor control a single movement from his temple to his toes. It was the classic case of a man who can think trapped inside a body that’s inert. The only thing over which he had any control was one eyelid, which he could blink voluntarily. With the patient help of friends who held a board with all the letters of the alphabet arranged in order of their frequency of use in French, that is how he laboriously dictated the book. Surely there are plenty of people on this planet with terrible disabilities who, like most of us, want to live every day they are granted and get unlimited joy out of life. If you’re reading this letter, you probably read my last one about the young motivational speaker born with no arms or legs. He exemplifies the ability to be positive despite disabilities.
But some aren’t so positive, and if you think ‘But for the grace of God go I,’ who can condemn them?! The problem for them is, they can’t necessarily put themselves out of their misery alone. They cannot take the poison without help…. or pull the bag over their heads or jump off the bridge. Back in my ABC days I did a story on what was then just a ballot initiative to legalize assisted suicide in Oregon, and I interviewed a man whose wife had been painfully and completely disabled and wanted to die. Ultimately, they tried all sorts of things to enable her to carry out the final act, to avoid having him prosecuted for murder. But she was physically unable to do it. So ultimately, he carried out what I’d call a mercy killing. With his wife’s consent, he put a plastic bag over her head until she suffocated. Which I call an unnecessarily tragic way to die. But which prosecutors call murder.
Just about everyplace where assisted suicide is legal— which includes the two American states of Oregon and Washington where voters have approved it— euthanasia is not. But here’s another concept worth contemplating, and in a way it’s at the heart of the advocates’ arguments: suicide most places these days is not illegal, yet helping someone carry it out is.
There are several reasons why, and while personally I support the idea of assisted suicide, I think the reasons are rational. For one thing, there has to be some sort of control over the means of the assisted death. Thankfully, few of us are experts in the act of killing, and we might end up either helping in a way that prolongs the person’s pain in the process, or botching it and simply leaving the suicidal individual alive but in even worse shape than before. For another thing, there has to be a way— at least a law— to prevent anyone from assisting in someone else’s suicide for his or her own personal gain. Certainly in cases where, say, one spouse helps another, there is personal gain— the inheritance of money, the sole assumption of home ownership— but the important thing prosecutors have to ask is, was that the motive for helping with the death, or was the assister compelled by compassion?
We went to Great Britain to ask about those issues. Britain has had laws against assisted suicide for almost fifty years. But when prosecutors have investigated cases after the fact, they often have compassionately excused people who could show that they were only helping relieve some kind of unbearable suffering. However, it has always been on a case-by-case basis, with no guarantee that next time, a husband who helps his wife take her life won’t be nailed for some form of murder.
Enter 46-year-old Debbie Purdy. She is a vital, vibrant, vivacious woman in the Yorkshire city of Leeds who has had Multiple Sclerosis for more than a decade. There are cases of MS where it never takes a heavy toll, but also cases where those who suffer it slowly slide into permanent states of pain and total disability. Sadly, Debbie is on the latter course. Understanding what she does about MS, she knows that clinically the odds are high that her condition today, where she is stuck in a wheelchair and her skin burns and her eyesight is blurry, will worsen.
But that’s not all that scares her. She also knows that sometimes the MS weakens people’s musculature to the point where they cannot swallow, which not only means they can’t eat but they also can’t inhale and exhale on their own without gasping violently for every breath; they could suffocate without artificial assistance. Debbie Purdy doesn’t want it to go that far. Right now she is full of life and full of joy and spent the hours she dedicated to us in her Leeds home with sea-blue eyes bright with excitement and an infectious smile permanently flashing across her face. But while we did talk about things that make her happy, we mostly talked about her deterioration, and her death. When you are sitting almost knee-to-knee with someone who’s telling you that she probably will want to die before her time, with her husband helping her every step of the way, it’s chilling.
It’s chilling because it’s not just academic. As Debbie’s MS worsens, her joy will end. That’s when she wants to die. The problem is, if she can’t be positively sure that her husband won’t be prosecuted for helping her, she’ll take her life before she’s ready but while she can still do it by herself. That would cheat her of immeasurable time with a quality of life she still treasures. Yet as her MS spreads its impairment, the door to carry out her suicide alone is closing.
And that is why she went to court, eventually getting a decision last month by none less than the House of Lords— the ultimate authority on British law— that ordered the Director of Public Prosecutions (like the boss of district attorneys) to issue guidelines about who he’d prosecute for assisted suicide and who he wouldn’t. The guidelines weren’t a total victory for advocates in the United Kingdom— they want it legalized. But the chief prosecutor gave them a green light of sorts. He said that if someone helps someone else to die for compassionate reasons, and with the consent of the person committing suicide, and not for personal gain, it will be allowed.
But— and here’s the catch— it still will not be allowed on British soil. Just as there is only a small handful of states in the U.S. that allow assisted suicide, there is only a handful of western nations that allow it, and of them all, Switzerland has the least restrictive laws, which is why Switzerland is where we ended our trip. The most restrictive law everywhere else is that it pertains only to residents. But not in Switzerland. You can travel to Switzerland from wherever you live and legally have help when you kill yourself. What’s more, unlike Oregon and Washington and a couple of other countries, which require a doctors’ consensus that someone has a terminal condition, in Switzerland a suicide can be assisted simply (as if anything about it is simple) if someone is enduring “unbearable suffering.”
That can be a slippery slope. In my mind, Debbie Purdy with her degenerative disease qualifies, as does someone with a grave disease or an injury that promises a low quality of life, but where to draw the line? Someone who hates his disability— blindness maybe, or paralysis— but isn’t actually in decline, let alone pain? Someone with severe depression? Or mental illness? How about a businessman whose enterprise has gone bankrupt? Or a young woman who has broken up with her boyfriend? Or a teenager who got failing grades in school and fears his parents’ wrath? There are suicides every day under those conditions; should it be legal to help them carry it out?
In Switzerland, the only thing the law specifically proscribes is death for the purpose of personal gain. That’s why, every time there’s an assisted suicide in Switzerland, the prosecutor of the canton (the region) investigates. But I interviewed the prosecutor in the canton of Zurich and he said they’re really looking only at two things: motive, and method, which means ensuring that the suicide is only “assisted” and not an act of euthanasia.
If it was chilling talking with Debbie Purdy about planning her own death, it was equally chilling talking with the founders of the two organizations in Switzerland that help people like Debbie carry them out, especially when one of the interviews was in front of a bed in a room where three days earlier there had been a death and the day after, another was scheduled. One interview was in Lausanne, the French-speaking part of the country, and the other— the one in front of the bed— was near German-speaking Zurich. Both are older men (who am I to talk?) who are committed to what they consider the right to kill yourself when you’re ready.
One organization is called EXIT, the other DIGNITAS (which is Latin for dignity, since the whole concept is about death with dignity). Interestingly, Exit only helps Swiss people carry out their suicides. When I asked the French-speaking founder, himself an ENT doctor, why, he explained that there is more than enough demand in his own country and he simply doesn’t have the resources to help anyone from without its borders. Dignitas, on the other hand, only helps people from abroad.
But both organizations do what they do pretty much the same way. Someone applies, there are consultations (including conversations about whether there is some alternative to suicide), and eventually the “applicant’s” wish is provisionally granted. In the case of Exit, a team goes to the applicant’s home. The family is welcome to be there at the end. In the case of Dignitas, the applicants and whoever wants to be with them come to headquarters near Zurich.
A doctor’s consent is required, although not to affirm that someone is fit to die. The doctor is needed to prescribe the poison that will kill them. When the day comes, the suicidal patients first are given an anti-vomiting medication, then a lethal dose of the barbiturate Sodium Pentobarbital, which puts them into a deep coma and then brings their breathing to a halt. And they are gone. The head of Exit told me that when people object to what he does, he points out that by expediting a peaceful death, he is preventing a violent one. When you think about people who take up a gun or jump off a bridge or hang from a rope, his argument does not sound irrational.
The other argument against assisted suicide, of course, is a moral one. Generally it takes the shape of, “Who are you to play God?” The head of Dignitas (a human rights lawyer) had an answer for that, which wouldn’t end the argument but also, to me, makes sense. What he said was, he’s not killing anybody. He’s only helping them to kill themselves, and to do so of their own free will. In fact for the prosecutor’s sake he documents every suicide on video, and the very last question he asks someone, literally as the cup of poison is close to their lips (or, in some drastic cases, their gastric tubes), is, “You can still stop. Do you want to stop, or do you want to die?” Last year, 196 people said, “Die.”
I don’t have a moral objection to any of it. But I appreciate the genuine passion of those who do. I suppose the only thing to say is, if it’s not for you, don’t ever do it. Of course that’s not a ironclad argument, mainly because if you do object on moral grounds, you might believe that anyone who helps someone else die is actually committing murder. It falls into the category of debates about abortion and capital punishment and stem cell research….which means I can just leave it hanging out there because I’m surely not going to convince anyone with this letter.
That brings me, if you’ll excuse the grim pun, to the final chapter. In London, we interviewed a guy named Edward Turner. Which leads to another short digression. It was fun for me when we pulled up to Turner’s home on Fitzroy Square, just east of the West End, because back when I was based in London, and we had to do some kind of on-camera standup late in the evening with a London background, we went the half-dozen blocks from the ABC bureau to Fitzroy Square, because its buildings have elegant Edwardian facades, and at night are illuminated.
But it wasn’t much fun talking with Edward Turner. He is the treasurer of an organization in the UK that is pushing for laws permitting assisted suicide, and he comes to the issue with personal experience. Early in this decade, his father died of a degenerative neurological disease, and by the end, as Edward bluntly put it to me, although his lungs were still sucking in air, his father was no more than “a rotting stinking corpse.” He died in great pain and great indignity. So when his mother came down with a similar disease just a couple of years later, she said she didn’t want to die as her husband had. Edward promised her that she wouldn’t. When the time came, Edward and his siblings took their mother to Zurich, where she took her poison and forever fell asleep.
The Turner siblings weren’t arrested but they could have been. They had assisted their mother before ever leaving home by buying her plane ticket to Switzerland. Then they took her to the airport in London, pushed her wheelchair into the airplane, pushed it off in Zurich, and delivered her to the place of her death. The only thing they didn’t do was hold the cup from which she took her last drink. Earlier in this letter, when I used the phrase “but for the grace of God go I,” I didn’t mean it in a religious sense. What I meant was, this could be any of us. If I ever get to the point where life is only something to painfully and fearfully endure, I hope I’ll be able to end it on my terms. And if someone I love gets to that point and they want my help, I hope I’ll be able to help them. It is horrible to contemplate any of this, and hopefully only hypothetical, but without laws that enable us to make such choices, it may be even worse.
In my work, I have seen a lot of life but also a lot of death. I am lucky that it hasn’t laid me low with Post Traumatic Stress Syndrome, but it has affected me as it must. What it has left me believing is, death is not just the end of life, it is a part of life. Anyway, as Woody Allen once said, “No one gets out of this life alive.”
On that cheery note, I wish everyone well because, while many people every day go through unpleasant stages of life, life in our world is good. As predicted, I am signing off somewhere over Greenland and will probably send this from the first stop in Washington DC. What I saw online before leaving Switzerland was, it’s snowing in Colorado. Ski resorts open soon. Like I said, life is good.
PS: Since I gave you all a restaurant recommendation for Amsterdam, I might as well be globally impartial and do the same for Zurich and London. In Zurich, there is an old armory right at the heart of the most charming part of the city that has only been around since five years before Columbus. But trust me, the food is fresh. And deliciously Swiss. It is “Zeughauskeller,” at Bahnhofstrasse 28a, phone 044 211 2690, www.zeughauskeller.ch. And, London. Mind you, anyone London-bound can send to me for “Greg’s Guide to London,” but I had a particularly wonderful experience this week at a French restaurant called “Le Cellier du Midi.” It was wonderful because the restaurant is in Carol’s and my old neighborhood of Hampstead, and we used to go to this place when we lived in London. The wonderful thing is, after all these years, it is just as good as it ever was. 28 Church Row, London NW3. 020 7435 9998. www.LeCellierDuMidi.com.
Read Greg’s new book “Life in the Wrong Lane,”
available at bookstores everywhere.
Category: Boomer Lifestyle