The Netherlands should think radically differently about its corona approach, say professors Rudi Westendorp and Marli Huijer. They argue for a national corona agreement, in which saving lives is no longer the only important goal. “We have to learn to accept again that death is part of life.”
Rudi Westendorp was briefly ‘skipping’ when he read an interview with Marli Huijer this spring. Huijer, former general practitioner, professor of public philosophy and former Thinker Laureate, was one of the few scientists in favor of reconsidering the lockdown measures into which the Netherlands had plunged.
Westendorp, professor of geriatric medicine and living in Denmark for six years, was pleased with the heartfelt cry of Huijer, who argued for a good discussion of how much we want to sacrifice as a society to save the lives that corona costs.
Westendorp fully agrees with her. Corona can stay with us for years, he says, and if it is not corona, another pandemic awaits us in the long run. After Sars and Mers, Covid-19 is already the third coronavirus to have surfaced in a relatively short period of time. “It is inevitable. There are more and more people who travel more and more. They exchange viruses and bacteria at a rate that is no longer compatible with the biology of our body. ”
He warns that we should not expect miracles from a vaccine. “If it comes soon – we’ve been looking for an HIV vaccine since the 1980s. There is a lot of skepticism, not everyone will want a vaccination. Moreover, a vaccine will not protect everyone. ”
Westendorp: “Nowadays it is mainly people of old age or poor health who are fatally affected. Every deceased person from corona dies on average several years prematurely. You don’t want that to happen to yourself, nor would I want my mother to die of corona. But does what we are doing now justify the massive damage done to our economy, the hospitality industry, cultural sector, so many other medical care that is being delayed? No.”
Huijer: “The population is growing and people are getting older. Due to their reduced resistance, a virus can strike very hard among the elderly. As an elderly person, you must realize that it is not in the common interest to pull out all the stops to save you as an individual, at maximum cost. We are no longer used to dealing with such an acute form of dying. People who develop cancer or cardiovascular disease often live for years. Young people are no longer used to seeing someone die. Life expectancy has increased by ten years since the 1950s. But there are limits to this growth. We cannot ignore the fact that it can be a bit less for a few decades. We must learn to accept again that death is part of life. ”
Westendorp: “That is very humane, but it is also an overdue right of self-determination. Too little thought is given to what we do it for and at what cost. Also for you as a person. As if medical intervention always improves quality of life. ”
Westendorp. “I am proud of that. Because we talk openly about the end of life in the Netherlands, many vulnerable elderly people are no longer put on artificial respiration. That has prevented Italian situations with overflowing ICs. But we must also enter into an honest conversation with other groups. There are people of 43 years with a broken body, because they have been ill for years. They may still be alive, but biologically at the end of that. Then you have to accept that there are no more realistic treatment options. Sometimes I see things go wrong with the family: they think that mother should be saved. The elderly themselves are often wiser. They come from another time, when life expectancy was lower and life was only feasible to a limited extent. Perhaps there is the pain that the Netherlands is now feeling: we think we can determine how life works. As if there should be no more death! As if there should no longer be an economic crisis! And if it does occur, someone has to hang. ”
Huijer: “There are many doctors who love to pull out all the stops. That is such a human response. But all those good intentions don’t always lead to the right thing being done. When something is wrong with one of my children, a tiger comes up in me too and wants to protect them. But that’s what I got my thinking ability for. The individual interest of my children can conflict with the collective interest. ”
Westendorp: “I don’t blame anyone – not the cabinet, not the IC physicians – that we jumped into the assistance stand. But can’t we even talk to each other about what goal we want to achieve at what price? ”
Westendorp: “Our individualistic culture. We reason from the ego. Prime Minister Mark Rutte sees society as the sum of those individual interests. Older people think they should be protected. Young people that they have the freedom to do whatever they want as long as it doesn’t harm others. We are not addressed on the basis of the idea that we are responsible for society as a whole. ”
That is different in Denmark. The culture shock was great for Westendorp when he settled in Copenhagen six years ago. Used to thinking from the ego, he soon realized that the Danes thought he was too “noisy and idiosyncratic”.
“I found out that as a Dutchman I didn’t really have an eye for the environment I was in. I really couldn’t get there in Denmark with that attitude. ”
Denmark is currently less affected by the second wave. In fact, everything is open, including the catering industry, and hospitals can easily overcome the corona problem. Westendorp was a member of the Danish Outbreak Management Team during the first wave, but has since relinquished his place to behavioral experts, who advise on how to keep the Scandinavian country out of trouble this fall and winter.
Huijer: “I notice that in Denmark there is always a lot of deliberation. I can imagine that this tradition – involving society in current problems – makes people much more inclined to also think from the perspective of others, rather than just themselves. In the Netherlands we have an individualistic, neoliberal, more competitive culture. That is beneficial for our performance in sports or culture, for example, but in the case of a common problem such as a virus, it is not at all beneficial. If you are not used to putting yourself in the position or thinking of another, you are probably not that willing to protect the other. ”
Westendorp and Huijer note that in the Netherlands – now that addressing the individual about his responsibility is proving to work less and less well – there is a tendency to switch to more authoritarian policy. If you don’t want to hear, just feel. Huijer thinks it is a “weakness bid”.
She and Westendorp argue that an important step is being skipped: allowing the population to discuss the path that the country should take. “I think there should be a corona agreement,” says Westendorp. “Young people have a problem, the elderly have a problem. So why not let them talk to each other? ” Huijer: “Put the dance teacher, the director of the Concertgebouw, Famke Louise, Klaas Knot of the Nederlandsche Bank and others around the table. In the Netherlands you constantly see polls and opinions. But an opinion is very different from the widely supported outcome of a good conversation. ”
That widely supported outcome, ie the National Corona Agreement, still has to be implemented. Westendorp: “Typically Dutch, that things go wrong there. The ink is not yet dry, when someone shouts again: yes, you have decided that, but I disagreed. Then you end up with our extended right to self-determination. We really have to learn to start thinking more from the we. ”
Such a corona agreement will also have to be about how the generations can be separated more. In the Netherlands many more grandparents look after their grandchildren than in Denmark, which has excellent childcare. How are we going to solve that?
Huijer: “Small children are not so contagious that they are a major risk factor. This is different for 15 to 30-year-olds, where the virus is very common. Engineers, artists and students can come up with all kinds of creative ideas to separate that group from the elderly. Think of concerts and cinema shows for people under 40. The elderly are very afraid that they will become pariahs, but you can also turn it around: everyone who has partied will receive a sticker: stay away from me for a while. ”
Westendorp: “In December I was with colleagues in London, a melting pot. A lady in a headscarf refused to shake my hand. I was angry! Until I realized that this rejection once originated in a culture where shaking hands often led to infections. Why not wash our hands together as a new greeting ritual from now on? ”
Westendorp: “The days when a thousand doctors gathered at a conference in Milan to go back to work in their own hospital the next day are over. Going shopping in Paris, flying to Ischgl for a week of winter sports and from the après ski bar straight to the Brabant carnival: these are the patterns that cause the virus to strike. Corona is an STI: a socially transmitted disease. If you shut down social traffic completely, the virus will no longer multiply. But that is very drastic, nobody wants that. ”
So we have to moderate ourselves, according to Westendorp. Just as AIDS ended free sex in the 1980s, he believes corona will end our “social promiscuity.” Free social intercourse, in which we come together at a rapid pace in changing groups, is, according to him, over for good.
Huijer: “I don’t agree with that. In a city like Amsterdam – even despite corona – there is still an incredible amount of sex. People are not monogamous at all. But they often do it with a condom. This minor intervention has prevented the virus from spreading so easily; not much has changed in behavior. I think it is going way too far to restrict all social interaction. Have people who have taken risks put on a mask to prevent them from infecting others. ”
Westendorp: “I agree, but then we have to start thinking about a ‘social condom’. In Japan you don’t dare not wear a face mask if you’re snotty. Danes stay at home so as not to infect others. We must also move towards such customs in the Netherlands. Corona will not disappear. Just like AIDS, it still is. But with small interventions in social interaction, we could make the risks manageable. “