Palliative care, the care given to patients when a disease can no longer be cured, is presented as a practical solution to the severe shortages in the healthcare system. Can this also be applied to patients with psychological problems, where good treatment has a chance? Martin Buijsen, Professor of Health Law at Erasmus School of Law, states to the NRC that these patients should not be written off but should be helped: “The standard of care must not be lowered - the Dutch state is obliged through international treaties to keep that level at least the same. But it has definitely declined."
A patient with psychiatric problems and an alcohol addiction had completed treatment but knew nothing about it. This concerns an IT entrepreneur who had been treated for years and was told in 2019 that his treatment was being stopped. The family was told that treatment options had been exhausted because he failed to keep appointments. After he was sent home, his care providers no longer visited him because he was labelled as a 'care avoider'.
Six months later, he was still forcibly admitted by the judge. Then, he had to come to the clinic by appointment. Admission turned out to be the only effective treatment. A confidential report drawn up by the Dutch public health service shows that there is no suitable offer for this group of patients. The report also concludes that care is limited to intervention in medical emergencies, while this group of patients actually requires long-term support. Palliative care is included in the list of desired solutions for this group. This solution would occur due to the need for a form of palliative care for the target group that wants nothing else and only further poisons the body with alcohol.
Vulnerability and ethics
Palliative care may be the best treatment for someone with serious mental health problems. However, deciding that healing is no longer possible due to the healthcare system's shortcomings and without consultation with the patient is unacceptable, according to Buijsen: “You cannot unilaterally designate those people as having completed their treatment. For this type of problem, where people have to rely on mental health care, palliative care as an imposed solution really goes too far. We tend to think that addiction is a result of the choices a person makes. That is not the case, but morally, it is much easier to dismiss it that way.” Buijsen also states that you must protect the people who cannot stand up for themselves and disappear: “This concerns the most vulnerable among the vulnerable, precisely because they are unable to look after their own interests. They have nothing, they cause a nuisance, and the care they need is terribly labour and capital-intensive. They fall overboard. Unfortunately, it is typical of the situation in the Netherlands now.” Buijsen sees that healthcare is becoming a scarcer commodity. “But that doesn't mean you cannot distribute it fairly. In the Netherlands, we are very good at naming what we do finance, but the question that no one dares to answer out loud is: who will not receive which care? And then it is politically very expedient to take care away from people who cannot resist. You can cut back on this without it being too noticeable. That is very bad.”
- Professor