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The Exit Internationalist

February 4, 2021

It is time for the elderly to sacrifice themselves for the young

Jannetje Koelewijn, NRC

Psychiatrist Boudewijn Chabot (79) does not want to go to the ICU when he falls ill. More elderly people have to sacrifice themselves, he says. “Dying is part of life, that is what we have to learn to accept again.”

Boudewijn Chabot (79) believes that you can only die properly if you prepare for it. Living your dying, as the American psychotherapist Stanley Keleman wrote.

He is surprised that so few people do that. Advances in medicine, he says, lead us to believe that anyone can live well over eighty and have a right to do so. We continue to see death as a form of failure, as something to be avoided at all costs. But now with Covid-19, he says, we can no longer sustain that.

He is a psychiatrist for the elderly, known for his advice on how to die with dignity without asking a doctor for euthanasia.

He obtained his PhD in 2007 for research into “self-euthanasia” through drugs and consciously refraining from eating and drinking. In 2014 he contributed to a “guide” for doctors on how they can alleviate the suffering of people in the final phase.

He lives in Haarlem, in his grandmother’s house from 1910. It is a few days after the introduction of curfew and he says: “It is good that the strictest measures have been taken, because now we can see that they are not going to work either, or only for a short time.

The virus appears to be so flexible and creative that it resists our measures to prevent it from spreading.

Before we are vaccinated there may be a third wave.

Or there will be a new virus, for which a new vaccine has to be developed.

It is pride to think that we will get it down in the coming months, especially since we are not built to have normal contact with each other for so long. Evolution has not prepared us for that.

We tend to huddle together, especially when the need arises.

You see the resistance growing now, and I’m not talking about the riots, they are horrible. I mean the underground, partly unconscious resistance, as a result of which, according to research, three-quarters of the people with cold complaints still take to the street, into the store, and half do not allow themselves to be tested.

I sense it in myself too. I went to a cremation on Saturday, I didn’t really have to. My daughter thought it was unwise.

Yesterday I went for a walk with a friend. He had to remind me regularly that we ”- he stretches out his arm -“ should keep our distance.

Nature is stronger than leather. Physical proximity is a vital necessity. As a result, the numbers keep going up and down. ”


“It is time for the elderly to sacrifice themselves for the young.

When we go to school, they also have to go to secondary school. Students should normally attend lectures. And yes, there is a greater risk of infection and thus of death.

Then you encounter the fear of death. And death is a monster, isn’t it? At the same time, it is also something that many old people look forward to. But of course he shouldn’t come now.

“I’d rather” – he laughs – “wait a little longer, because when it comes down to it, it’s really scary.

I have been dealing with death for a long time and the idea that it could end suddenly is very familiar to me.

And yet, when I am awake at night, the thought of being completely obliterated can strike me as terrifying. Like that man from that cremation Saturday, so unimaginable. But with daylight it is still acceptable for me, as I am almost eighty. ”

But more infections lead to overloading of hospitals.

“We have to stop doing that, too, with that crazy stance on the number of patients in the ICU, at the expense of all healthcare workers who have been walking on their gums for months, and at the expense of patients with another life-threatening disease.

The number of IC beds must return to the normal level. When they are full, young people get priority over the elderly. ”

And then?

“I hear from GPs that most of them survive on oxygen, dexamethasone and antibiotics. The annoying thing is that on you cannot see how many elderly people die from Covid-19 when they stay at home.

So you do not know whether there are more or less than in the hospital. Anesthetists already said in the first wave: ventilating the elderly in the ICU? Better not.

Air is blown into the lungs under pressure and that damages the alveoli. The diaphragm of people who have died is full of scars.

I already said to my doctor last March: never go to the hospital. Do you know how it goes there? “Mr Chabot is breathing very shallow. Pulmonologist, come by. “He will have Mr. Chabot transferred to the ICU. You are powerless, defenseless. ”

Still, more old people are more likely to die if they can’t go to IC.

“Is that bad?

It is less bad than stopping the youth from physical contact with their peers.

Hopefully you will be surrounded by your loved ones and you will not be isolated as in the nursing homes during the first wave. So sadistic, that lonely dying! The doctor will ease your suffering.

General practitioners are much better at palliative care than doctors in the hospital.

What I find very interesting: the professor of geriatric medicine in Maastricht, Jos Schols, has asked people over eighty if they want to be admitted if they get Covid-19. 60% said no. Awesome!

Do they still say that if they have Covid-19?

“That is the question, yes. “Let me go”, I have learned to distrust that. And so 40% say they do want to go to hospital. 40 %!

That’s still an awful lot of people. Only part of that will become ill, and yet we will have to say to them: sorry, the IC is full, you will be treated at home.

That can be a fun revolt.

“For the elderly, dying is part of life. That is what we have to learn to accept again.

I don’t see that happening yet, because there is no political leader who dares to say that we are at a dead end and that we are paralyzing the young generations, from school-aged children to students. We undermine their zest for life and their self-confidence.

It’s just, “Come on, hang on a little longer. We’re almost there. “No, we’re not nearly there. We may not be there yet.

Someone has to say: “It is not going to work, people, we are going to break down, we have to change course, from now on our priority is with the young people.”

He gets up to get a glass of water. When he sits down again, he says: “The new Poet Laureate, Lieke Marsman, wrote in NRC last week that she was the voice of dry wood.

She has a nasty, life-threatening cartilage disease. It was a beautiful poem, but when I read it I thought: no, you are not dry wood, you are thirty, you want to live.

Accept death when you are so young? Ammehoela. She is the flower on the withered wood of the witch hazel in spring. People my age, yes, they are starting to get dry.

How Well Prepared For Your Own Death?

“Very good, but I was already at nineteen. I studied medicine in Amsterdam and I collapsed on the street. A perforated cecum was found in hospital. That was in 1960 and I was saved by antibiotics. You won’t hear me criticizing medical progress.

After that, I also survived TB, an aneurysm and open heart surgery. But this aside.

The fever was so high that I became delirious. I pulled the IV out of my arm and then got the impression that the tip of the needle had broken off. It was on its way to my heart via the bloodstream. And now it comes. I thought: then I have to die before that point reaches my heart, otherwise it will be a very painful death.

So when I was nineteen I was already working on better this than dying like that. That experience has been decisive for my conscious dealings with death. ”

How did it end?

“The nurses tied me up and sprayed me. And the fever went down. ”

As a small child you were in a Japanese camp, where death was never far away. Does that play a role?

“Speculation. But I know from my mother’s letters from the camp that I was in the hospital barracks with dysentery, separated from her and my sister. When I was six, 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 right resources and the people around me know what I want and why.

So what am I most afraid of? A brain haemorrhage, because then I cannot reach those means.

And my wife is not going to give them to me.

The fight with her is that I say: wait 24 hours, only when I am still alive can you call 112. I prefer to stay dead on the spot, but often you come to and you are distraught.

If I end up in hospital because I got something on the street, my doctor knows to get me out of there.

And if I cannot swallow my drugs, I will stop drinking.

I’ve told people around me not to give me water, even though I’m going to yell and get rebellious.

The doctor will give me palliative sedation.

Dying the way you want and not having to live unworthily is hard work, you can hear that. ”

You never think: never mind, I’ll see how it goes?

“No no. That seems easier, but I have too often seen that people then suffer from dementia. ”