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<title>Jan wilde graag euthanasie, zijn psychiaters aarzelden. ‘Ik laat je niet in de steek’, zei zijn zoon</title><meta data-n-head=ssr name=viewport content="width=device-width,initial-scale=1"><meta data-n-head=ssr data-hid=ogimage name=og:image property=og:image content=https://kijkverderstatic.volkskrant.nl/kijkverder/v/2023/euthanasie-bij-mensen-die-psychisch-zijn-uitbehandeld~v763897/media/ac06c268e0b6d3460bd1a531dcd9f022.jpg><meta data-n-head=ssr data-hid=ogurl name=og:url property=og:url content=https://www.volkskrant.nl/kijkverder/v/2023/euthanasie-bij-mensen-die-psychisch-zijn-uitbehandeld~v763897/><meta data-n-head=ssr data-hid=ogsitename name=og:site_name property=og:site_name content="Volkskrant Kijk Verder"><meta data-n-head=ssr data-hid=twittercard name=twitter:card content=summary_large_image><meta data-n-head=ssr data-hid=twittersite name=twitter:site content=@volkskrant><meta data-n-head=ssr data-hid=twitterimage name=twitter:image content=https://kijkverderstatic.volkskrant.nl/kijkverder/v/2023/euthanasie-bij-mensen-die-psychisch-zijn-uitbehandeld~v763897/media/ac06c268e0b6d3460bd1a531dcd9f022.jpg><meta data-n-head=ssr data-hid=description name=description content="Na een levenslange worsteling met ernstige depressies verklaarde zijn psychiaters dat Jan uitbehandeld was, maar de euthanasie die hij zo graag wilde kreeg hij niet. ‘De medische wereld heeft niets voor mijn vader willen doen’, zegt zijn zoon Jeroen. ‘Ik neem ze dat erg kwalijk.’"><meta data-n-head=ssr data-hid=ogdescription name=og:description content="Na een levenslange worsteling met ernstige depressies verklaarde zijn psychiaters dat Jan uitbehandeld was, maar de euthanasie die hij zo graag wilde kreeg hij niet. ‘De medische wereld heeft niets voor mijn vader willen doen’, zegt zijn zoon Jeroen. ‘Ik neem ze dat erg kwalijk.’"><meta data-n-head=ssr data-hid=ogtitle name=og:title content="Jan wilde graag euthanasie, zijn psychiaters aarzelden. ‘Ik laat je niet in de steek’, zei zijn zoon"><link data-n-head=ssr rel=canonical href=https://www.volkskrant.nl/kijkverder/v/2023/euthanasie-bij-mensen-die-psychisch-zijn-uitbehandeld~v763897/><meta name=darkreader content=114bdc1c9a40421ba2251259ba5fe05e>
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http-equiv=content-security-policy content="default-src 'none'; font-src 'self' data:; img-src 'self' data:; style-src 'unsafe-inline'; media-src 'self' data:; script-src 'unsafe-inline' data:; object-src 'self' data:; frame-src 'self' data:;"><style>
/* This Source Code Form is subject to the terms of the Mozilla Public
* License, v. 2.0. If a copy of the MPL was not distributed with this file,
* You can obtain one at http://mozilla.org/MPL/2.0/. */
/* Avoid adding ID selector rules in this style sheet, since they could
* inadvertently match elements in the article content. */
:root {
--grey-90-a10: rgba(12, 12, 13, 0.1);
--grey-90-a20: rgba(12, 12, 13, 0.2);
--grey-90-a30: rgba(12, 12, 13, 0.3);
--grey-90-a80: rgba(12, 12, 13, 0.8);
--grey-30: #d7d7db;
--blue-40: #45a1ff;
--blue-40-a30: rgba(69, 161, 255, 0.3);
--blue-60: #0060df;
--body-padding: 64px;
--font-size: 12;
--content-width: 70em;
--line-height: 1.6em;
}
body {
--main-background: #fff;
--main-foreground: #333;
--font-color: #000000;
--primary-color: #0B83FF;
--toolbar-border: var(--grey-90-a20);
--toolbar-transparent-border: transparent;
--toolbar-box-shadow: var(--grey-90-a10);
--toolbar-button-background: transparent;
--toolbar-button-background-hover: var(--grey-90-a10);
--toolbar-button-foreground-hover: var(--font-color);
--toolbar-button-background-active: var(--grey-90-a20);
--toolbar-button-foreground-active: var(--primary-color);
--toolbar-button-border: transparent;
--toolbar-button-border-hover: transparent;
--toolbar-button-border-active: transparent;
--tooltip-background: var(--grey-90-a80);
--tooltip-foreground: white;
--tooltip-border: transparent;
--popup-background: white;
--popup-border: rgba(0, 0, 0, 0.12);
--opaque-popup-border: #e0e0e0;
--popup-line: var(--grey-30);
--popup-shadow: rgba(49, 49, 49, 0.3);
--popup-button-background: #edecf0;
--popup-button-background-hover: hsla(0,0%,70%,.4);
--popup-button-foreground-hover: var(--font-color);
--popup-button-background-active: hsla(240,5%,5%,.15);
--selected-background: var(--blue-40-a30);
--selected-border: var(--blue-40);
--font-value-border: var(--grey-30);
--icon-fill: #3b3b3c;
--icon-disabled-fill: #8080807F;
--link-foreground: var(--blue-60);
--link-selected-foreground: #333;
--visited-link-foreground: #b5007f;
/* light colours */
}
body.sepia {
--main-background: #f4ecd8;
--main-foreground: #5b4636;
--toolbar-border: #5b4636;
}
body.dark {
--main-background: rgb(28, 27, 34);
--main-foreground: #eee;
--font-color: #fff;
--toolbar-border: #4a4a4b;
--toolbar-box-shadow: black;
--toolbar-button-background-hover: var(--grey-90-a30);
--toolbar-button-background-active: var(--grey-90-a80);
--tooltip-background: black;
--tooltip-foreground: white;
--popup-background: rgb(66,65,77);
--opaque-popup-border: #434146;
--popup-line: rgb(82, 82, 94);
--popup-button-background: #5c5c61;
--popup-button-background-active: hsla(0,0%,70%,.6);
--selected-background: #3E6D9A;
--font-value-border: #656468;
--icon-fill: #fff;
--icon-disabled-fill: #ffffff66;
--link-foreground: #45a1ff;
--link-selected-foreground: #fff;
--visited-link-foreground: #e675fd;
/* dark colours */
}
body.hcm {
--main-background: Canvas;
--main-foreground: CanvasText;
--font-color: CanvasText;
--primary-color: SelectedItem;
--toolbar-border: CanvasText;
/* We need a true transparent but in HCM this would compute to an actual color,
so select the page's background color instead: */
--toolbar-transparent-border: Canvas;
--toolbar-box-shadow: Canvas;
--toolbar-button-background: ButtonFace;
--toolbar-button-background-hover: ButtonText;
--toolbar-button-foreground-hover: ButtonFace;
--toolbar-button-background-active: SelectedItem;
--toolbar-button-foreground-active: SelectedItemText;
--toolbar-button-border: ButtonText;
--toolbar-button-border-hover: ButtonText;
--toolbar-button-border-active: ButtonText;
--tooltip-background: Canvas;
--tooltip-foreground: CanvasText;
--tooltip-border: CanvasText;
--popup-background: Canvas;
--popup-border: CanvasText;
--opaque-popup-border: CanvasText;
--popup-line: CanvasText;
--popup-button-background: ButtonFace;
--popup-button-background-hover: ButtonText;
--popup-button-foreground-hover: ButtonFace;
--popup-button-background-active: ButtonText;
--selected-background: Canvas;
--selected-border: SelectedItem;
--font-value-border: CanvasText;
--icon-fill: ButtonText;
--icon-disabled-fill: GrayText;
--link-foreground: LinkText;
--link-selected-foreground: ActiveText;
--visited-link-foreground: VisitedText;
}
body {
margin: 0;
padding: var(--body-padding);
background-color: var(--main-background);
color: var(--main-foreground);
}
body.loaded {
transition: color 0.4s, background-color 0.4s;
}
body.dark *::-moz-selection {
background-color: var(--selected-background);
}
a::-moz-selection {
color: var(--link-selected-foreground);
}
body.sans-serif,
body.sans-serif .remove-button {
font-family: Helvetica, Arial, sans-serif;
}
body.serif,
body.serif .remove-button {
font-family: Georgia, "Times New Roman", serif;
}
/* Override some controls and content styles based on color scheme */
body.light > .container > .header > .domain {
border-bottom-color: #333333 !important;
}
body.sepia > .container > .header > .domain {
border-bottom-color: #5b4636 !important;
}
body.dark > .container > .header > .domain {
border-bottom-color: #eeeeee !important;
}
body.light blockquote {
border-inline-start: 2px solid #333333 !important;
}
body.sepia blockquote {
border-inline-start: 2px solid #5b4636 !important;
}
body.dark blockquote {
border-inline-start: 2px solid #eeeeee !important;
}
.light-button {
color: #333333;
background-color: #ffffff;
}
.dark-button {
color: #eeeeee;
background-color: #1c1b22;
}
.sepia-button {
color: #5b4636;
background-color: #f4ecd8;
}
.auto-button {
text-align: center;
}
@media (prefers-color-scheme: dark) {
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<body class="moz-reader-content content-width6 reader-show-element sans-serif container line-height4 dark" style="display: block; padding: 24px;"><h1 class=reader-title>Jan wilde graag euthanasie, zijn psychiaters aarzelden. ‘Ik laat je niet in de steek’, zei zijn zoon</h1><div id=readability-page-1 class=page><div id=__nuxt><main> <div> <article><div class> <div data-nroftype=block-text-1><p>Als Jeroen de slaapkamer binnenloopt, ziet hij ze liggen op het bed. Twee reusachtige, glimmende flessen. Tachtig kilo per stuk wegen ze, en ze zijn gevuld met helium – een dodelijk gas als het zuiver wordt ingeademd.</p>
<p>Het is 26 november 2021, twee uur in de middag. ‘Mijn vader keek me aan’, zegt Jeroen, ‘en hij zei: het is zover.’</p>
<p>Een paar weken daarvoor heeft zijn 67-jarige vader Jan de gasflessen met een gammel steekkarretje naar zijn appartement gesleept, midden in de nacht, om geen argwaan te wekken bij de buren.</p>
<p>Vandaag zal Jeroen een van de moeilijkste dingen doen die hij ooit heeft gedaan. Zijn emoties heeft hij uitgeschakeld: hij mag geen fouten maken. Hij kijkt toe terwijl zijn vader tussen de twee flessen op het strak opgemaakte bed gaat liggen. Even later drukt Jeroen het knopje in van de GoPro-camera aan het voeteneinde. Record.</p></div><div data-nroftype=block-text-2><p>Tien minuten geleden namen ze afscheid op de bank. Op de foto lacht zijn vader, zijn blik is ontspannen.</p>
<p class>Zijn vader installeert zich, precies zoals ze hebben gerepeteerd. Jeroen haalt even adem. ‘Het is goed zo, pap’, zegt hij. ‘Als je zover bent, dan is dit het. Dan kun je het nu doen.’</p>
<p class>Zijn vader knikt.</p></div><div data-nroftype=block-note-1> </div><div data-nroftype=block-newgrid-1><ul></ul></div><div data-nroftype=block-chapter-1><h2 class>Lang wachten</h2></div><div data-nroftype=block-text-3 class><p class>In 2021 registreerde het Centraal Bureau voor de Statistiek 1.859 zelfdodingen in Nederland. Daarvan waren ten minste 709 mensen onder behandeling van de ggz. Een van hen was Jan.</p>
<p>Toch was zelfdoding juist níét wat hij wilde. Tijdens zijn leven zette hij alles op alles om in een andere statistiek terecht te komen: die van de euthanasie.</p>
<p>Het was hem bijna gelukt. Sterker nog, hij voldeed aan alle criteria. Maar zijn psychiaters trokken uiteindelijk hun handen van hem af, zegt zijn zoon Jeroen, die contact opnam met <em>de Volkskrant</em>. ‘De medische wereld heeft niets voor mijn vader willen doen’, schreef hij. ‘Ik neem ze dat erg kwalijk.’</p>
<p class>Jaarlijks wordt in Nederland 115 keer euthanasie uitgevoerd bij mensen die ondraaglijk psychisch lijden – nog geen anderhalf procent op het totaal van 8.720 euthanasieën.</p>
<p class>Het aantal verzoeken ligt vele malen hoger: volgens schattingen vragen per jaar zo’n tweeduizend psychiatrisch patiënten hun arts om hen te helpen hun lijden definitief te beëindigen. Maar onder psychiaters bestaat grote huiver om hieraan mee te werken. De weerstand zou volgens de vorige wetsevaluatie zelfs zijn toegenomen. In 1995 vond 53 procent van de psychiaters het ‘ondenkbaar’ om ooit euthanasie uit te voeren, in 2016 was dit gestegen naar 63 procent.</p></div><div data-nroftype=block-newgrid-2><ul></ul></div><div data-nroftype=block-text-4><p class>Het gevolg is dat psychiaters patiënten die dood willen al jaren in groten getale doorverwijzen naar het Expertisecentrum Euthanasie – voorheen de Levenseindekliniek. Maar daar zijn inmiddels enorme wachtlijsten ontstaan. Het centrum, dat slechts zeven deeltijdpsychiaters in dienst heeft, krijgt jaarlijks bijna 800 verzoeken van mensen die psychisch lijden. De wachttijd is daardoor hoger dan ooit: ruim twee jaar, en voor sommige patiënten zelfs drie jaar. Een ‘onmenselijk’ lange tijd, aldus het centrum. En elk jaar neemt het aantal wachtenden toe.</p>
<p>Voor sommigen duurt dat te lang. Met enige regelmaat komt het voor dat mensen op de wachtlijst zelfmoord plegen.</p></div><div data-nroftype=block-text-5><p>Minister Ernst Kuipers van Volksgezondheid onderkende onlangs de ernst hiervan. ‘Er moet worden voorkomen dat een euthanasietraject bij uitzichtloos psychisch lijden dusdanig ingewikkeld en langdurig wordt dat sommige mensen suïcide als enige uitweg zien’, schreef hij de Tweede Kamer in maart.</p>
<p><em>De Volkskrant</em> reconstrueerde de zaak van Jan, die na een verzoek aan zijn psychiaters op de wachtlijst van het Expertisecentrum belandde, en uiteindelijk een einde aan zijn leven maakte. Zijn verhaal wordt verteld door zijn zoon, en op belangrijke delen ondersteund door zijn medisch dossier, mails, video- en audio-opnamen, zijn dagboek en een hulpverlener. Ook zijn psychiaters spraken zich uit.</p>
<p>Wat houdt psychiaters tegen om patiënten die uitzichtloos en ondraaglijk lijden euthanasie te verlenen? Tegen welke dilemma’s lopen ze aan? En waarom verandert de psychiatrie zo traag op dit gebied?</p></div><div data-nroftype=block-chapter-2><h2>Openhartig</h2></div><div data-nroftype=block-text-6><p>Aan de houten tafel in zijn huiskamer zit Jeroen (42), universitair docent en auditor in de technologische sector. De afgelopen uren heeft hij gepraat over zijn vader – openhartig en direct. Nadat zijn vader was overleden nam hij zich één ding voor: hij wil psychiaters ervan overtuigen dat euthanasie hoort bij goede zorg. Het afgelopen jaar sprak hij meermaals op congressen van psychiaters. Na afloop vroegen geschrokken psychiaters aan hem: ‘Dat is toch niet bij óns gebeurd?’</p>
<p>Hij vertelt bewust tot in detail over de laatste momenten van zijn vader. ‘Wat ik heb gezien, was bruut’, zegt hij. ‘Maar als iedereen wegkijkt, dan ziet niemand waar het pijn doet. Ik wil dat we het hierover gaan hebben. Ik wil laten zien in wat voor een harde, schrale wereld je terechtkomt als professionals blijven zeggen: wij helpen mensen met een doodswens niet.’</p>
<p>Net als zijn vader is Jeroen analytisch en daadkrachtig. Het liefst wil hij met zijn volledige naam in de krant, maar omdat hij zijn kinderen nog niet met dit onderwerp wil confronteren, doet hij dat niet.</p>
<p>Op een vrijdagavond in 2020 drukt zijn vader hem na een bezoek zijn huissleutels in de hand. ‘Je weet maar nooit’, zegt hij. Later die avond belt Jeroen hem op. ‘Pap’, zegt hij. ‘Ik heb een gek gevoel bij die sleutels, is dit wat ik denk dat het is?’</p></div><div data-nroftype=block-newgrid-3><ul></ul></div><div data-nroftype=block-text-7 class><p class>Vanaf dat moment wordt het onderwerp voor het eerst in hun leven bespreekbaar: het verlangen naar de dood.</p>
<p class>‘Als ik in mijn auto rijd en ik kijk naar de bomen’, zegt zijn vader tegen hem, ‘dan zie ik die als objecten waar ik tegenaan kan rijden of waar ik aan kan hangen.’</p>
<p>Jan heeft een bipolaire stoornis en worstelt al zijn hele leven met ernstige depressies. Hij was financieel directeur bij Univé, werkte bij Shell, bij de NAM. Ook was hij bijna vijftien jaar wethouder in een grote stad, waar hij een dierentuin en een voetbalclub van de ondergang redde.</p>
<p class>‘Elke ochtend om 6 uur stond de chauffeur voor de deur’, zegt Jeroen. ‘Mijn vader was superslim en georganiseerd, en hij werkte 70 tot 80 uur per week zodat er in zijn hoofd zo min mogelijk ruimte over was. Hij gebruikte paardenmiddelen om te functioneren: slaappillen, antidepressiva, lithium, antipsychotica, kalmerende middelen. Hij voelde altijd onrust, kon nergens van genieten. Als hij ’s avonds thuiskwam, voelde hij zich ellendig tot hij zichzelf weer verdoofde.’ Zijn depressies hield hij tijdens zijn werkende leven altijd verborgen voor de buitenwereld, ook voor zijn beide zoons.</p></div><div data-nroftype=block-text-8><p>Maar nu, na zijn pensioen, heeft hij niets meer te verliezen.</p>
<p class>Zijn vader zegt dat hij dit leven niet meer wil, maar dat hij niet weet wat hij moet doen. Op zijn 25ste hing zijn tweelingbroer zich op in de schuur van hun ouders. Twee broers vonden hem, terwijl Jan onderweg was naar huis. Het allesoverweldigende schuldgevoel, de vraag of hij iets had kunnen doen om zijn dood te voorkomen – het zou hem nooit meer loslaten.</p>
<p>‘Ik weet hoe het is’, zegt hij tegen Jeroen. ‘Ik wil jullie daar niet mee opzadelen.’</p></div><div data-nroftype=block-newgrid-4><ul></ul></div><div data-nroftype=block-text-9><p class>Vele gesprekken later doet Jeroen zijn vader uiteindelijk een belofte. ‘Ik zei: als dit echt is wat je wilt, dan ga ik je steunen. Dan ben ik er voor je. Desnoods zoeken we de randen van de wet op of nemen we enig risico, maar ik laat je niet in de steek. Zelfs als je uiteindelijk besluit om aan een boom te gaan hangen, dan nóg ben ik erbij. Maar alsjeblieft, doe het niet alleen.’</p>
<p>Aan de keukentafel zwijgt Jeroen even.</p>
<p>‘Weet je’, zegt hij schor, ‘anders had ik hem misschien gevonden in een bos.’</p></div><div data-nroftype=block-chapter-3><h2>Wegduiken</h2></div><div data-nroftype=block-text-10><p>Alle mogelijke medicijnen en behandelingen zijn bij Jan geprobeerd. ‘Telkens werd zijn medicatie aangepast en aangepast’, zegt Jeroen. ‘Totdat er nog maar één ding over was: elektroshocks.’</p>
<p>In de zomer van 2021 brengt Jeroen zijn vader naar de kliniek, waar hij onder narcose elektroconvulsietherapie krijgt. ‘Hij zei: ik moet dit minstens zes keer ondergaan – daarna is er niks meer.’</p>
<p>Het loopt op niets uit, en bovendien wordt zijn geheugen erdoor aangetast. ‘In mijn ogen was het een mensonterende methode’, zegt Jeroen. ‘Als ik hem na afloop ophaalde, vroeg hij: Wát heb ik vandaag gedaan?’</p>
<p>Bij psychiater J. die hem behandelt bij een grote ggz-instelling in het noorden van het land, heeft Jan volgens zijn eigen dagboek dan al meermaals gevraagd of ze hem wil helpen met euthanasie. ‘Antwoord was NEE’, schrijft hij. ‘Als het moeilijk wordt, duiken ze allemaal weg.’</p>
<p>Maar dan bedenkt hij een plan.</p></div><div data-nroftype=block-text-11><p>Het is september 2021 als hij met een map onder zijn arm binnenloopt bij de kliniek. In de map zitten onderzoeken en informatie over euthanasie. Voorop staat één zin: <em>To be or not to be</em>.</p>
<p>In de behandelruimte pakt Jan zijn stukken bij elkaar. Jeroen en zijn moeder zitten erbij. Tegenover hen nemen twee psychiaters plaats: J. en A. Beiden willen om privacy- en veiligheidsredenen niet met hun hele naam in de krant. Psychiater A. is er die zomer bijgekomen als tweede behandelaar.</p>
<p>Jan zit erbij als een bestuursvoorzitter in een boardroom. ‘Mijn vader had zijn hele leven vergaderd met raden van commissarissen’, zegt Jeroen. ‘Hij ging er goed voor zitten en zei: Zo, welkom, fijn dat jullie er allemaal zijn. We moeten opschieten, we hebben maar een uur de tijd.’</p>
<p>Hij begint met het feit dat de electroshocks geen effect hebben gehad. Jeroen: ‘Hij zei tegen de psychiaters: Even vaststellen, <em>for the record,</em> ben ik hiermee uitbehandeld? Graag een ja of een nee.’</p></div><div data-nroftype=block-text-12 class><p>Na enige discussie bevestigen de psychiaters dat dit klopt, dat ze geen behandelmogelijkheden meer zien.</p>
<p class>‘Mijn vader zei: Móói, dan ligt dat vast’, vertelt Jeroen. ‘En vervolgens begon hij puntsgewijs de andere eisen voor euthanasie af te lopen.’ Een voor een bevestigen de psychiaters wat iedereen in de kamer eigenlijk allang weet: hij voldoet aan alle eisen.</p>
<p class>Jeroen: ‘Hij zei: Nou, dan ben ik door – dan kom ik volgens mij in aanmerking voor euthanasie.’</p>
<p class>In de kamer is het lang stil.</p></div><div data-nroftype=block-newgrid-5><ul></ul></div><div data-nroftype=block-text-13 class><p class>‘De psychiaters bléven maar naar elkaar kijken’, zegt Jeroen. ‘Uiteindelijk zei J.: ‘Ik denk dat je gelijk hebt, Jan.’ Daarop beloofden ze de euthanasie in gang te zetten. Mijn vader glimlachte en gaf hun allebei een hand. Hij zei: ‘Ik ben jullie zo dankbaar, dit was de beste uitkomst van deze vergadering.’’</p>
<p class>Tegenover <em>de Volkskrant </em>bevestigen psychiaters J. en A. dat ze toezegden de euthanasie te gaan regelen. Psychiater J. vertelt dat ze erg op Jan gesteld was en omschrijft hem als een ‘charmante, zeer slimme man met een sterke wil’. Ze zegt dat Jan tijdens de therapieën herhaaldelijk tegen haar heeft gezegd dat hij dood wilde. ‘Ik heb meermaals gedacht: die zie ik niet meer terug.’</p>
<p>Toch lijken ze van hun eigen belofte te schrikken. ‘Ik voelde me heel erg overvallen’, zegt psychiater J. ‘We werden voor het blok gezet.’</p>
<p>‘Eigenlijk had hij zijn plan al klaar’, zegt psychiater A. ‘Het was net of hij even onze goedkeuring kwam halen.’</p>
<p>Psychiater J.: ‘Ja, een vinkje.’</p></div><div data-nroftype=block-chapter-4><h2>Onwetendheid en angst</h2></div><div data-nroftype=block-text-14><p>In de bijna achthonderd brieven die jaarlijks binnenkomen bij het Expertisecentrum Euthanasie (EE) van mensen met psychische klachten keert één boodschap telkens terug. ‘Mensen zeggen en masse: ik wil dood, maar ik word niet serieus genomen’, vertelt Kit Vanmechelen, psychiater bij EE. ‘In de brieven lees je over psychiaters die zeggen: je bent hier in de spreekkamer om over het leven te praten. Of: als jouw enige perspectief de dood is, ben je hier aan het verkeerde adres.’</p>
<p>Vanmechelen vertelt dat ze regelmatig psychiaters aan de telefoon krijgt die vertellen dat hun patiënt is uitbehandeld. ‘Zo’n psychiater zegt dan: ik dacht, ik bel eens naar Kit om te horen wat een goed moment is om hem naar jou door te verwijzen.’</p>
<p>Vanmechelen schudt haar hoofd. ‘Ik zeg dan: lieve collega, u kunt het ook zelf doen, met onze hulp. O, zegt die vervolgens, nou, nee, dat liever niet, ik heb het nog nooit gedaan, en ik heb al twintig jaar geen spuit meer gezet.’</p>
<p>Ze pauzeert even. ‘Veel psychiaters denken: hoe houd ik euthanasie buiten de deur? En als het tóch op hun bord ligt, dan denken ze: hoe krijg ik het er zo snel mogelijk weer vanaf? Het is onwetendheid. En angst. En die voeden elkaar. Er zijn zelfs psychiaters die denken dat ze zelf geen euthanasie uit mogen voeren.’</p></div><div data-nroftype=block-newgrid-6><ul></ul></div><div data-nroftype=block-text-15><p class>Ook betekent euthanasie een risico: als niet aan de criteria is voldaan, bestaat de kans dat de zaak bij justitie belandt, al gebeurt dit vrijwel nooit. Vanmechelen, van wie binnenkort het boek <em>Laat me gaan</em> uitkomt, zucht. ‘Ik begrijp de weerstand wel. Maar soms denk ik: verdomme, hebben jullie nu ballen of niet?’</p>
<p>In de richtlijn van de Nederlandse Vereniging voor Psychiatrie (NVvP) staat dat een psychiater een euthanasieverzoek van zijn patiënt zo veel mogelijk zélf moet onderzoeken en uitvoeren, en dat het vanuit moreel en professioneel oogpunt ongepast is dat dit ‘wordt uitbesteed aan een nieuwe arts waarmee het contact opnieuw moet worden opgebouwd’.</p>
<p>Maar psychiaters houden zich hier nauwelijks aan.</p>
<p>Het afgelopen jaar daalde het aantal psychiaters dat euthanasie uitvoerde: van 51 psychiaters in 2021 naar 32 in 2022. Het grootste deel van de 151 euthanasieën bij ondraaglijk psychisch lijden laten ze over aan andere artsen, zoals huisartsen.</p></div><div data-nroftype=block-text-16><p>‘Ik ben meermaals gebeld door huisartsen die na weigering van de psychiater zeiden: ik ga het zelf wel doen’, zegt Vanmechelen. ‘Ze konden het niet aanzien.’</p>
<p>‘Wij moeten in ons vakgebied een enorme discussie gaan voeren’, zegt psychiater Sisco van Veen van het Amsterdam UMC, ‘rondom de vraag: hoe gaan wij om met de dood? Waar ligt de grens? Wanneer stoppen we met behandelen? Wanneer wordt de dood een reële optie?’</p>
<p>Van Veen spreekt namens de Nederlandse Vereniging voor Psychiatrie en kan niet op de casus van Jan reageren. Wel vertelt hij over de worstelingen van psychiaters met euthanasie. ‘De allermoeilijkste vraag voor een psychiater is: wanneer is het lijden uitzichtloos?’, zegt hij. ‘‘Uitbehandeld’ is een term die psychiaters eigenlijk liever vermijden, want ook als herstel geen optie meer is mag je iemand niet laten zitten. Je kunt bijna altijd nog iets voor iemand doen. Er is altijd nóg een behandeling te verzinnen. Maar op een gegeven moment moet je durven zeggen: we kunnen je niet meer beter maken.’</p></div><div data-nroftype=block-text-17><p>Er zijn allerlei aanwijzingen, zegt Van Veen, dat we als psychiaters nu te lang doorbehandelen.</p>
<p>Maar er is ook een andere kant, vertelt hij. Psychiaters hebben soms dagelijks mensen in hun spreekkamers die dood willen. Ze worden opgeleid om suïcide te voorkomen. Van Veen: ‘Veel psychiaters zeggen, wij praten heel váák over de dood. Maar praten over de dood als reële uitkomst van de behandeling – dat doen we nog niet veel. De wet eist ook van ons dat we zeer terughoudend zijn. Euthanasie is geen recht dat de patiënt op kan eisen, en het is geen plicht voor de arts.’</p>
<p>De omslag is moeilijk te maken, zegt hij. ‘Je bent tijdens een behandeling bezig om mensen beter te maken, om perspectief te bieden. Om dan over te gaan naar de gedachte: oké, nu gaan we je helpen met sterven – dat is superingewikkeld.’</p>
<p>Maar niks doen kan gevolgen hebben.</p></div><div data-nroftype=block-text-18><p>‘Ik denk’, zegt Vanmechelen, ‘dat we in Nederland het aantal suïcides met honderden per jaar kunnen verminderen als wij als psychiaters bereid zijn om meer euthanasieën uit te voeren bij mensen die psychisch lijden.’</p>
<p>Uit onderzoek blijkt dat elke suïcide zo’n 135 mensen raakt: 15 tot 30 mensen uit de directe omgeving zijn psychisch ernstig beschadigd, een grotere groep vrienden en kennissen wordt fors negatief beïnvloed. Bij euthanasie is de schade voor nabestaanden aanzienlijk minder.</p>
<p>‘De meeste mensen die geen euthanasie krijgen, suïcideren zich niet’, zegt Van Veen. ‘Maar een klein deel doet dat wél. Ik vind dat wij ons als psychiaters daartoe moeten verhouden.’</p></div><div data-nroftype=block-chapter-5><h2>Vacuüm</h2></div><div data-nroftype=block-text-19><p>Na het gesprek met de ggz is Jan opgelucht. Maar de belangrijkste vraag hangt dan nog in de lucht: wie gaat dit eigenlijk doen?</p>
<p>Psychiater J.: ‘Ik heb tegen Jan gezegd dat ik er wel achter stond, maar dat ik het zelf niet zou kunnen doen. Ik vond het niet prettig om zijn leven te beëindigen. Ik ben geen dokter geworden om mensen dood te maken. A. en ik hadden allebei ook nog nooit een euthanasie gedaan. Ik ben misschien een schijterd, maar ik vond het heel erg spannend.’</p>
<p>De psychiaters sturen Jan naar zijn huisarts, in de veronderstelling dat zij het wel kan overnemen. Maar die piekert er niet over. ‘De huisarts was christelijk’, zegt Jeroen. ‘Mijn vader kwam daar bijna nooit. Ze kende hem nauwelijks.’</p>
<p class>En vanaf dat moment gaat het mis.</p></div><div data-nroftype=block-newgrid-7><ul></ul></div><div data-nroftype=block-text-20><p class>‘Mijn vader begon de ggz om duidelijkheid te vragen: welke arts zou het nou gaan doen en wanneer?’, zegt Jeroen. ‘Wat was er nog nodig? Hij belde, mailde en ging langs, maar ze bleven vaag. Hij kreeg gewoon geen antwoorden. Maar ze wilden ook niet zeggen dat ze zich terugtrokken. Hij kwam in een vacuüm terecht.’</p>
<p>In de weken erna gebeurt er eigenlijk niets, zegt Jeroen. Alleen de huisarts reageert: ze stelt voor dat Jan zich inschrijft bij het Expertisecentrum Euthanasie, en dat ze een spoedprocedure probeert te regelen.</p>
<p>Achteraf kunnen de psychiaters tegenover <em>de Volkskrant</em> niet goed uitleggen wat ze in deze periode hebben gedaan. Ze spreken zichzelf meermaals tegen in het interview. Zo zegt psychiater A. dat ze bezig waren ‘het protocol’ te volgen. Volgens dit protocol zouden ze op dat moment in fase 2 moeten zitten: de ‘beoordelingsfase’. Daarvoor moet een onafhankelijke psychiater worden geraadpleegd. Psychiater J. beweert eerst dat ze daartoe een brief heeft verstuurd, maar later zegt ze dat ze dat niet zeker weet. Ook wil ze de brief ‘vanwege privacy’ niet laten zien. Jeroen zegt nooit van deze brief te hebben gehoord. Uiteindelijk zegt psychiater A. dat ze nooit een onafhankelijke psychiater hebben gevonden.</p>
<p>Wel stellen J. en A. dat Jan zélf verwarring zaaide, doordat hij via verschillende wegen zijn doel probeerde te bereiken. ‘Er ontstonden meerdere stromen’, zegt psychiater J. erover. ‘Wij waren bezig, de huisarts, het Expertisecentrum. Dat heeft ruis veroorzaakt.’</p></div><div data-nroftype=block-text-21><p>Jeroen laat indringende mails zien van zijn moeder, zijn broer en een vriend aan de psychiaters – allemaal zeggen ze bang te zijn voor zelfmoord. ‘Er is nog geen enkele actie ondernomen’, schrijft zijn moeder, ‘met als gevolg dat Jan steeds meer in paniek raakt en begint te zoeken naar een andere uitweg. Hij is zijn vertrouwen kwijt in de toezeggingen die door u gedaan zijn.’</p>
<p>Ook Jeroens broer, een politieagent, benadert A. en J. ‘Het idee dat mijn vader het wachten niet langer volhoudt en zelfstandig een einde aan zijn leven zal maken, maakt mij verdrietig’, schrijft hij. ‘In mijn jarenlange werkervaring als politieagent heb ik veel nare dingen meegemaakt, en gezien wat het met de nabestaanden doet als een familielid suïcide pleegt.’</p>
<p>‘Ze hebben nooit antwoord gehad’, zegt Jeroen. ‘Op geen enkele manier.’</p>
<p>De psychiaters bevestigen dit. ‘Jan was onze patiënt en verder hadden we ons beroepsgeheim’, zegt J.</p></div><div data-nroftype=block-newgrid-8><ul></ul></div><div data-nroftype=block-text-22><p class>‘Ziet er hopeloos uit’, schrijft Jan in zijn dagboek op 11 oktober. Als hij tegen psychiater A. zegt desnoods naar de rechter te stappen, krijgt hij van hem de volgende dag een folder over de euthanasieprocedure van de instelling toegemaild. ‘Dit verzin je toch niet’, schrijft Jan. ‘Een euthanasieverzoek afdoen met een folder.’</p>
<p>Van het Expertisecentrum Euthanasie krijgt hij een teleurstellend bericht: hij komt op de wachtlijst – het betekent minstens twee jaar wachten, met slechts 10 procent kans dat zijn verzoek wordt ingewilligd. In zijn wanhoop begint Jan dan de optie te onderzoeken waar hij zich al zo lang tegen verzet: zelfdoding. Dit noemt hij ‘plan B’. Hij bestelt handboeken, bekijkt instructievideo’s, gaat naar bouwmarkten. ‘Het spijt me zo voor mijn dierbaren’, schrijft Jan in zijn dagboek. ‘Maar ik wil geen depressies meer.’</p>
<p>‘Mijn vader maakte een inschatting’, zegt Jeroen. ‘Hij zei: de huisarts wil niet, de ggz durft het niet, en het Expertisecentrum gaat het niet binnen twee jaar doen.’</p>
<p>Eind oktober belt Jan zijn zoon. ‘Jeroen’, zegt hij. ‘Ik heb een datum en een tijd. Het wordt 26 november, twee uur ’s middags. Ben je erbij?’</p></div><div data-nroftype=block-chapter-6><h2>Wachtlijst</h2></div><div data-nroftype=block-text-23><p class>In de zeven jaar dat psychiater Kit Vanmechelen voor het Expertisecentrum Euthanasie werkt, sprak ze honderden mensen met een euthanasiewens. Aan 35 van hen verleende ze euthanasie. Meermaals moest ze voor patiënten uit ggz-instellingen uitwijken naar vakantiehuisjes, zegt ze. ‘Ggz-instellingen willen niet dat wij euthanasie uitvoeren op hun terrein, omdat het andere patiënten op ideeën kan brengen. Ze zijn bang dat het ‘besmettelijk’ is. Ik ken geen enkele ggz-instelling waar dit mag. Kijk, ik snap dat het niet in de huiskamer kan, maar ze weigeren om een ruimte beschikbaar te stellen. En ja, dan eindigen we dus soms op een vakantiepark.’</p>
<p>Toch ziet ze dat er iets verandert in het vakgebied. Dat sommige psychiaters openstaan voor verandering. Op congressen zitten de zaaltjes over dit onderwerp voller dan een paar jaar geleden.</p>
<p>Dat moet ook wel, want met zeven deeltijdpsychiaters in het expertisecentrum kan de wachtlijst nooit worden weggewerkt. ‘Er zijn gewoon niet meer psychiaters te vinden’, zegt bestuurder Sonja Kersten van het EE. ‘Er is een tekort in het hele land.’</p></div><div data-nroftype=block-text-24><p>De omslag moet dus plaatsvinden in het veld. Om dat te bewerkstelligen is inmiddels een landelijk netwerk opgericht. ‘Het streven is’, zegt psychiater en voorzitter Radboud Marijnissen, ‘dat elke patiënt met een persisterende doodswens of euthanasieverzoek deze binnen de ggz kan bespreken. Een gebrek aan kennis of expertise mag nooit een reden zijn voor terughoudendheid.’</p>
<p>Ook het Expertisecentrum zette in 2015 een dienst op met consulenten. ‘Wij nemen bij een euthanasieverzoek altijd contact op met de behandelaar’, zegt bestuurder Kersten. ‘En dan vragen we of die het niet zelf kan doen, met onze hulp. Het gaat moeilijk en traag, maar we zien echt beweging in het veld. Sommige psychiaters zeggen dat ze zich schamen voor het gemak waarmee ze in het verleden doorverwezen naar ons. Steeds meer ggz-instellingen zijn eigen beleid hiervoor aan het ontwikkelen.’</p>
<p>Toch zijn er van de ruim 300 instellingen voor gespecialiseerde ggz-zorg in Nederland volgens bronnen pas ongeveer tien die beleid hebben ingevoerd op het gebied van euthanasie binnen de eigen organisatie.</p>
<p>Vanmechelen: ‘Tegen psychiaters zeg ik weleens: je hebt alle pillen en therapiemodules nu twee keer gehad, misschíén ben je een goede dokter als je eens durft te luisteren naar de echte hulpvraag van je patiënt. Sommige artsen zijn in tranen dan.’ Een enkele keer gebeurt het, zegt ze. ‘Dan heb ik aan het eind van een traject een psychiater die ‘om’ is. En die bij zijn volgende patiënt zegt: ik laat je niet in de steek.’</p></div><div data-nroftype=block-chapter-7><h2>Voorstel</h2></div><div data-nroftype=block-text-25><p>Nadat Jan zijn psychiaters over plan B heeft verteld, gebeurt er iets onverwachts: ze komen alsnog met een voorstel.</p>
<p>Half november laat psychiater J. hem ineens weten dat A. en zij eventueel tóch bereid zijn om het euthanasietraject in te gaan binnen de ggz-instelling. Het zal minstens een half jaar duren en ze bieden verder geen garanties. Jan kijkt er sceptisch naar. Menen ze dit? Of proberen ze zich in te dekken, voor het geval hij zelfdoding pleegt? In zijn dagboek reageert hij geïrriteerd. ‘Ggz had niets te bieden’, schrijft hij.</p>
<p>‘De brief van de psychiater bood geen enkele zekerheid’, zegt Jeroen. ‘Mijn vader had geen geduld meer. Hij zei: ik wil niet langer voor de gek gehouden worden, ik neem de regie in eigen hand.’</p>
<p>‘Het was toen al te laat’, erkent psychiater J. achteraf.</p>
<p>‘Hij had zijn datum al in zijn hoofd’, zegt A. ‘Al het andere ging hem te langzaam.’</p></div><div data-nroftype=block-newgrid-9><ul></ul></div><div data-nroftype=block-text-26><p class>In die dagen neemt Jan voorgoed afscheid van zijn psychiaters, twee maanden na zijn officiële verzoek. Hij omhelst psychiater J. en geeft A. een hand. Psychiater J., met wie Jan tijdens de behandelingen een goede band had, is emotioneel: ‘Ik vond het echt verschrikkelijk dat ik hem moest laten gaan. Heel naar.’</p>
<p>‘Het is gewoon jammer dat iemand er op deze manier uitstapt’, zegt A. ‘Maar ja, af en toe laat de patiënt het overleg niet toe. En dan sta je machteloos. Het proces vraagt grote zorgvuldigheid en dat kost tijd. Euthanasie is geen kwestie van: u vraagt, wij draaien.’</p></div><div data-nroftype=block-chapter-8><h2>Afscheid</h2></div><div data-nroftype=block-text-27><p>Op vrijdagochtend 26 november schrijft Jan voor de laatste keer in zijn dagboek. ‘Ik ben er klaar voor’, staat er. ‘Het zal in één keer raak zijn.’</p>
<p>Alles komt op Jeroen aan vandaag. Hij is de enige van de familie die het aandurft om tot het allerlaatste moment aan zijn vaders zijde te staan. Dat is niet zonder risico: als justitie denkt dat hij zijn vader op enige wijze heeft geholpen, kan hij worden vervolgd voor hulp bij zelfdoding – een misdrijf waar drie jaar cel op staat. Daarom legt hij alles op beeld vast.</p>
<p>‘Geef Jeroen de kracht’, schreef zijn vader in zijn dagboek, ‘en laat het geen trauma worden.’</p>
<p>Met zijn handen op zijn rug gaat Jeroen naast het bed van zijn vader staan. Hij weet dat hij hem niet meer aan mag raken – ook niet als het misgaat.</p></div><div data-nroftype=block-text-28><p>‘Dan ga ik het nu doen’, zegt zijn vader. ‘Tot ziens. Bedankt voor alles.’</p>
<p>De heliumtank gaat open. Jeroen kijkt toe terwijl zijn vader de plastic zak over zijn hoofd trekt. Drie dagen geleden hebben ze emotioneel afscheid genomen op het strand – vandaag zijn ze alleen bezig met handelen.</p>
<p>Door het plastic kijkt hij zijn zoon aan. Hij steekt zijn hand op en zwaait.</p>
<p>Jeroen vertelt dat zijn vader niet lang daarna wegzakt en buiten bewustzijn raakt. ‘Na een paar minuten begon het verstikkingsproces’, zegt hij. ‘Dat was niet mooi om te zien.’</p>
<p>Heel even denkt Jeroen dat het misgaat. Hij blijft naar zijn vader kijken tot hij niet meer beweegt.</p></div><div data-nroftype=block-chapter-9><h2>Geen spijt</h2></div><div data-nroftype=block-text-29 class><p class>‘Van tevoren’, zegt Jeroen, ‘wilden mensen mij beschermen. Ze zeiden: je gaat je hele leven niet meer slapen als je dit meemaakt. Zelfs mijn vaders huisarts vroeg me of ik wel wist wat ik deed. Of ik het wel aankon om mijn vader zo te zien sterven. Ik zei: maar íémand moet het doen, als jullie dit allemaal niet willen.’</p>
<p class>Sommige familieleden vinden het nog altijd moeilijk dat ze niet bij het einde konden zijn. Dat ze Jeroen alleen moesten laten. Bijna allemaal hebben ze machteloos afgewacht, in een straal van een paar honderd meter van het huis. Jeroens oom stond buiten op de stoep, zijn tante huilend op haar balkon. Zijn broer zat even verderop in zijn auto, omdat hij zich zijn vader wilde herinneren zoals hij was.</p></div><div data-nroftype=block-newgrid-10><ul></ul></div><div data-nroftype=block-text-30><p class>Na het overlijden vulde het appartement zich met politie. Drie uur lang werd Jeroen verhoord. ‘Het forensisch team bekeek de opnamen’, zegt hij. ‘Eén rechercheur was zichtbaar ontdaan. Bij het weggaan zei ze met tranen in haar ogen: wat mooi dat jullie dit zo voor je vader hebben kunnen doen.’</p>
<p class>Ondertussen, zegt Jeroen, stonden de heliumtanks te sissen op het balkon. ‘Het duurde dagen voordat ze leeg waren.’</p>
<p class>Nu, anderhalf jaar later, mist Jeroen zijn vader nog elke dag. ‘Ik heb er geen moment spijt van’, zegt hij. ‘Het alternatief was vele malen erger. Het leven was voor hem niet meer te doen. Mijn vader kon niet langer wachten, dat is waar. Maar van de medische professionals had ik iets anders verwacht. Zij weten als geen ander hoe zwaar psychisch lijden kan zijn. We hebben met euthanasie zo’n mooi systeem in Nederland. Gebruik dat dan ook. Laat patiënten niet vallen.’</p></div><div data-nroftype=block-note-2> </div><div data-nroftype=block-note-3><h3>Verantwoording</h3> <p>De Volkskrant bericht in beginsel terughoudend over zelfdoding. Voor dit artikel maakte de redactie een uitzondering: de verslaggevers noemen en beschrijven een methode, waarbij ze zo spaarzaam mogelijk zijn met details. De krant is van mening dat deze beschrijving in dit geval functioneel is, omdat het de enige manier is om te laten zien wat de gevolgen kunnen zijn voor mensen die zo erg lijden dat zij wanhopig zijn, en het daarvoor opgetuigde systeem hen niet kan helpen. Psychiaters J. en A. spraken met toestemming van de familie met <em>de Volkskrant</em> over Jan.</p></div> </div> </article> </div></main></div></div><style>.single-file-highlight-yellow, .single-file-highlight-yellow-mode ::selection { background-color: #ffff7c !important; color: black !important; } .single-file-highlight-pink, .single-file-highlight-pink-mode ::selection { background-color: #ffbbb6 !important; color: black !important; } .single-file-highlight-blue, .single-file-highlight-blue-mode ::selection { background-color: #95d0ff !important; color: black !important; } .single-file-highlight-green, .single-file-highlight-green-mode ::selection { background-color: #93ef8d !important; color: black !important; } span.single-file-highlight-yellow, span.single-file-highlight-pink, span.single-file-highlight-blue, span.single-file-highlight-green { display: inline !important; } .single-file-highlight-hidden { background-color: inherit !important; color: inherit !important; } .single-file-mask { all: initial; 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