© Sambodhi Prem

Euthanasia

My mother’s journey with death.

My mother died a few weeks ago after a long life of 89 years. My father had passed away three years before and about a year after he died my mom said that she’d like to live a few more years. But when she moved from the home where she and my dad had lived for over 40 years into a nursing home, her energy waned quickly and she isolated herself in her apartment. She had already been weak and had had several falls, but had not broken any bones. She still had her mental clarity which she retained up to the last moment of her life.

My mom and dad are from the Netherlands. For quite some years the Dutch have been open-minded about euthanasia. As a nation, they have had a discussion about how to end a life humanely when the chance of having a quality of life is not there anymore. That discussion started in the seventies and, slowly over time, made it possible for Dutch politicians to propose and draft legislation without being punished for it at the polling booth. In 2001 the Dutch euthanasia law came into effect. As a collective the Dutch were ready to deal with this part of life, a discussion that in other countries is so often avoided.


One day in the nursing home, when my mom was having her afternoon nap, someone had come in and had stolen her jewelry box. That left her feeling vulnerable and freaked out. This contributed to her coming to the point of realizing that she was actually wanting to leave this earth, that her complete lack of energy would not revive, and that she was ready for her death.

She would convey this to my brother and me and to the people around her in a matter of fact way, without complaint or judgement. I told her that I would not try to stand in the way by clinging to her, by wanting her to continue living for my sake. I could see that her request to end her life was genuine and a natural result of having lived a long life.

Through my meditation experience I have seen death as being a part of life and as something to be embraced and to be open-minded about. I freely talked with my mom about her wish to die and in these talks she was always practical and understanding, never panicked or irrational.

Some weeks before, I had introduced her to the practice of observing her breathing as a way to deal with situations that might be difficult for her. At first she misunderstood and referred to this as ‘controlling her breathing’. I said: “No, not controlling, but observing, like you observe a parade passing by while you are standing by the side of the road. In the same way you can observe your breathing, like a watcher standing on a hill overlooking the land.”

Over the following days she tried this method and remarked how she had noticed that she often holds her breath. I said: “Whenever you notice that, you can let go of this holding. It’s your awareness of the fact that you’re holding the breath that brings relaxation. This awareness alone is enough, there’s nothing to be worried about.” She was happy with this form of meditation that she was still able to do.

In my conversations with her I used to reminded my mom of her responsibilities by saying to her: “Just because you’re old and fragile that does not mean that you’re not my elder and that you can’t lead by example.” And: “One day I could be in a similar situation as you are in now, you have to set the right example”. She agreed. Perhaps it contributed to giving her a sense of relevance towards her family. And throughout the process of her euthanasia, she did not disappoint.


She had a talk with the nursing home physician, a woman in her early thirties, who was not comfortable with the idea of helping my mother to end her life. I realized that it’s all very well to live in a country that has put guidelines and legislation in place to facilitate a compassionate death, but you still have to find a doctor who is courageous and willing to administer this death.

Luckily such a person was found. Her name was Dr. Ellen van Buiten, a specialist in geriatric medicine. I’m not an expert on the legal requirements of euthanasia in the Netherlands, but there are laws and rules that physicians who administer euthanasia have to adhere to, as to not incriminate themselves. I will mention a few points that appear important to me:

As a person who wants euthanasia it is important to be consistent in asking for it. Wavering delays things.

The process requires several one on one talks with three physicians. The nursing staff is also consulted and involved in this process. And of course the family.

A meeting is held where the person who is going to receive euthanasia and his or her nearest family members are present. The person who will perform the euthanasia explains what will happen on the day itself.


My mother’s euthanasia was scheduled for a Monday. She had picked the same date that my father had died three years ago. In her diary she had simply written ‘Eu’. And to us, her family, she referred to her euthanasia as that as well. Open-minded as she was, to say the actual word was still difficult for her.

The Thursday before my mother’s euthanasia the whole family, my mother, my brother, his wife, my partner and myself, gathered together in my mother’s apartment in the nursing home. Also in attendance was Dr. Ellen and the doctor of the nursing home Dr. Eveline Narsten.
Dr. Ellen invited us to think about how we as a family would like to spend the last hours with our mother. She acknowledged that my relationship with my brother had not always been smooth and suggested that we each spend separately some time with my mother that Monday, as well as some time all together. My brother and I agreed that this would be good.

Dr Ellen created a loving and light atmosphere during the meeting. She placed my brother and myself close to my mother, who was sitting at her table, with my brother’s wife and my partner a little further away, as well as the nursing home physician, as there was not enough space to all sit around the table. We all could clearly hear and understand each other. Dr Ellen spoke with compassion and clarity, explaining what was going to happen the coming Monday.

The euthanasia was scheduled to take place around 10.30 am. Earlier that morning a nurse was going to place a drip in my mother’s arm through which several substances would be injected.

Euthanasia can be administered in two ways: either by drinking a liquid or by injecting it. Dr Ellen had chosen to inject, because by drinking the liquid it is required that all of it is ingested, that sometimes causes a problem for people as old as my mother.

Dr Ellen continued to explain that once the drip is in place, at first a local anesthetic is injected to numb the vein, then a substance is injected that is similar to the substance that is used to put someone under anesthetic.
Dr. Ellen said that at this stage my mother would become unconscious and she would display some irregular breathing and yawning. That is normal and there is nothing that can be done about it. (This indeed happened and lasted only for about 10 to 20 seconds.) If this would have been an operation, this would be the time when my mom would be put on a heart-lung machine to keep her alive. But because this wasn’t an operation but a euthanasia, a second substance was going to be injected that was a heart muscle relaxant that stops the heart. After this death sets in.

My mother had listened to this with a stoicism and a readiness. She was fully aware and did not in anyway have a hint of being perturbed by Dr. Ellen’s explanation of the procedure.

Dr Ellen also explained that if on Monday my mother would have changed her mind that that would be no problem at all. She made it clear that my mother was in the driving seat. However Dr Ellen did say that once the first substance was administered my mother would not be able to go back.
My mom heard all this and was fully understanding of it.

Then Dr Ellen mentioned that it sometimes happens that people who have made the decision to end their life and who are only a few days away from their euthanasia, die naturally. She said that if, before Monday, my mother would suddenly become critically ill that she will not try to bring her back. My mother agreed with this; she had already been wearing a badge around her neck for some years that forbids any caregiver to resuscitate her in case she falls critically ill and is unable to talk. A few years ago she and my dad had signed papers to that effect.

Dr Ellen told us that in the past there had been cases where the family had become upset because the person who was to receive euthanasia had suddenly died of natural causes. She said that this sometimes occurs. Being the joker of the family I asked Dr Ellen if these people had asked for their money back. There was a moment of silence before everybody started laughing. In jest my mother laughingly wagged her finger at me and Dr Ellen said to my mother: “You have just one weekend left to educate this boy!”


I visited my mom the following day and that weekend on Sunday; those were special times to talk to her and share stories. Together with my partner Sandipa we played songs for her, and she seemed to love those moments where music filled her apartment.
There was always humor amongst the deep feelings of sadness as the underlying notion was that my mother had come to a natural point in her life that her body had lost the energy to continue. It was natural that she had come to a place like this. I mentioned that to her and she agreed.

At some point my mom said that she was worried about the coming Monday. For a moment I thought she was having second thoughts. But she said: “No, I’m not worried about the euthanasia, no, not at all… but how are we all going to fit around my bed?”…
I think back on this incident with endearment. My mom used to worry about simple, practical things but didn’t seem to sweat the big stuff. I told her that she should not worry about that, that we will take care and that now was the time to let things happen as they will, to let the chips fall the way they want to fall, to let go and trust. I think she felt supported by that.

I gave her one last tip: “On Monday, before the euthanasia, try to think of something beautiful, of a moment in your life where you were filled with love, with happiness. A moment that you remember with fondness, a tender moment perhaps where all fractured parts of life had come together and had joined into a moment of joy and love.” She liked the idea of her last moments in this life to be like that.


I see it as a reward from existence to be able to live in full consciousness toward one’s own death. My mother had always taken good care of herself with eating regular meals and taking things in moderation. For forty years she had gone to a weekly gym class. When she was taken into the nursing home the doctor was amazed to learn that she was not taking any medication. All of this contributed to her clarity of mind and that was important as she was mentally well enough to give her consent for euthanasia. Once you’re too ill or too demented it is often too late to take the route of euthanasia because, in order to protect the doctor administering it, strict guidelines need to be followed and they require that the person who is receiving the euthanasia has his or her mental faculties still in tact.


The next day came fast and we arrived in the morning in time for my brother and me to have a little time with my mom separately. She told me: “I accept you as you are;” and: “You have a wonderful life together with Sandipa.” I could not have asked for a better farewell — to be blessed by my own mother like this.

My brother’s wife had brought five white roses. Each of us would give a rose to my mom and then put it on her bed, the fifth rose was from my brother’s son (my mom’s grandson) who was not present.

That morning a group of people came together in my mother’s apartment to say goodbye and to help her to let go of her body that now had so little energy left. The four of us, her nearest family, plus Dr Ellen, the nursing home physician and the head nurse, a caring man who had been in charge of the team that looked after my mother on a day to day basis.

Dr Ellen was firm and positive, creating a loving atmosphere. She had brought a large handbag, which contained a plastic bag with the syringes. She helped us arrange the chairs. Together with the head nurse I helped my mother from her chair to her bed and we grouped ourselves around it, my brother ( who is older than me) closest to her on her right hand side and Dr. Ellen on my mother’s left.

All these details are important. The drip that was administered to my mother was put in her left arm so that we as a family were able to sit at her right side. This was the side of the bed where there was most space to sit and where we would be facing the window. Had the drip been administered to my mother’s right arm it would have made it more difficult for everybody to be comfortably seated due to the layout of the room.

I have some experience with Bert Hellinger’s ‘family constellation’ work to know how important one’s position is in the family structure. It felt good that everybody had taken a physical position that was relevant to the relation they had towards my mother, that is: my brother, her oldest son, closest to her, then myself and then our partners. Both Dr. Ellen and the nursing home doctor were on the other side of my mom, facing the family.

As my mother was helped to lay on her bed Dr. Ellen asked her if she had been worrying the night before to which my mother answered that she had not and that she had slept well. She was ready.

Once my mom had been settled in her bed and her backrest was lifted so she was sitting up a little, in such a way that she could see us all, we offered our roses to her. We let her smell the roses and she enjoyed that. We laid the roses beside her. Now was the time to give her left arm for the euthanasia to start. She said: “I farewell you all”, then she closed her eyes.

The administering of the substances that were used to bring about my mother’s death were given with great love and care. Dr Ellen had numbered the syringes so as to apply the doses in the right order. The nursing home physician who was sitting next to Dr Ellen assisted her in handing her the syringes. After the second dosage my mother had some irregular breathing and some yawning, just as had been explained previously. Then my mom’s breathing fell silent and her face relaxed, her mouth a little open. She had fallen unconscious.


The last dosage was given to stop my mother’s heart. Everything had taken place in silence, a peaceful cluster of moments, all and all about 10 minutes long. We sat together in this apartment as the morning sun gathered strength, seven people witnessing one person’s point of departure. I felt like standing on a beach facing an endless ocean with so much land behind me.

We sat in silence as my mom slipped away.

I thanked Dr Ellen for giving my mom the gift of euthanasia. It takes courage for a trained health professional to acknowledge that the Hippocratic oath is in need of an update and to see that sometimes bringing death can be an act of compassion. My tears met her tears as two gratitudes merged into one.


People who have experience with meditation say that it is easy to meditate close to someone who has just left their body. That’s what I did and I can say that it is true. I closed my eyes and fell into a deep state of relaxed awareness. The world around me was there and I felt the care and consideration of my family and the professionals that had helped my mother make this transition and at the same time I was able to look inside, to observe my mind’s small concerns. The ideas of who I thought I was and my identifications — they were falling away. In that moment the things that divided me from my family did not matter, but that which united us did.


It was time for Dr Ellen to leave as her work was now finished. My mother’s body was laying on the bed, motionless, peaceful. Dr Ellen had arranged for an independent physician to come to verify her death, and to write a death certificate. Because my mother had not died of natural causes, it was a legal requirement that an independent doctor would write the death certificate. This doctor arrived and completed her task in a few minutes. A death certificate is required for many practical things, and in this situation it is required by the funeral directors who were to take my mother’s body away. They were going to take an hour to arrive. For that time we sat near my mom’s body.

The funeral personnel came and we sat silently as they were lifting my mother’s body on the stretcher and covering her with a cloth. This way her body was wheeled out of the room — a last goodbye, my tears fell as I saw the stretcher turn the corner at the end of the corridor.



Death is the Most Misunderstood Phenomenon
“Death is the most misunderstood phenomenon. People have thought of death as the end of life. That is the first, basic misunderstanding.
“Death is not the end, but the beginning of a new life. Yes, it is an end of something that is already dead. It is also a crescendo of what we call life, although very few know what life is. They live, but they live in such ignorance that they never encounter their own life. And it is impossible for these people to know their own death, because death is the ultimate experience of this life, and the beginning experience of another. Death is the door between two lives; one is left behind, one is waiting ahead.
“There is nothing ugly about death; but man, out of his fear, has made even the word, death ugly and unutterable. People don’t like to talk about it. They won’t even listen to the word death.
“The fear has reasons. The fear arises because it is always somebody else who dies. You always see death from the outside, and death is an experience of the innermost being. It is just like watching love from the outside. You may watch for years, but you will not come to know anything of what love is. You may come to know the manifestations of love, but not love itself. We know the same about death. Just the manifestations on the surface – the breathing has stopped, the heart has stopped, the man as he used to talk and walk is no more there: just a corpse is lying there instead of a living body.
“These are only outer symptoms. Death is the transfer of the soul from one body to another body, or in cases when a man is fully awakened, from one body to the body of the whole universe. It is a great journey, but you cannot know it from the outside. From outside, only symptoms are available; and those symptoms have made people afraid.
“Those who have known death from inside lose all fear of death.”
Osho, Zarathustra: A God that can Dance, Talk #16
Why are we afraid of Death?
“Why do we cling to life and why are we afraid of death? You may not have thought about it. The reason why we cling so much to life and why we are afraid of death is just inconceivable. We cling to life so much because we do not know how to live. We cling to life so much because really we are not alive. And time is passing and death is coming nearer and nearer. And we are afraid that death is coming near and we have not lived yet.
“This is the fear: death will come and we have not lived yet. We are just preparing to live. Nothing is ready; life has not happened. We have not known the ecstasy which life is; we have not known the bliss life is; we have not known anything. We have just been breathing in and out. We have been just existing. Life has been just a hope and death is coming near. And if life has not yet happened and death happens before it, of course, obviously, we will be afraid because we would not like to die.
“Only those persons who have lived, really lived, are ready, welcoming, receptive, thankful to death. Then death is not the enemy. Then death becomes the fulfillment.”
Osho, The Supreme Doctrine, Talk #9

One feels tremendously happy when one can communicate with one’s own parents.
“Wherever you are, you will feel a little guilty. You will never be able to forget it and forgive it. Parents are not just a social relationship. It is out of them that you have come. You are part of them, a branch of their tree. You are still rooted in them.
“When parents die something very deep-rooted dies within you. When parents die, for the first time you feel alone, uprooted. So while they are alive, everything that can be done should be done, so that an understanding can arise and you can communicate with them and they can communicate with you. Then things settle and the accounts are closed. Then when they leave the world — they will leave someday — you will not feel guilty, you will not repent; you will know that things have settled. They have been happy with you; you have been happy with them.
“The love relationship starts with the parents and it also ends with them. It comes to a full circle. If somewhere the circle is broken, your whole being will remain uneasy. One feels tremendously happy when one can communicate with one’s own parents. That is the most difficult thing in the world to do because the gap is so big. The parents never think that you are grown up so they never directly communicate with you. They never take account of your freedom and your spirit, your being… no respect. They take it for granted that you have listened to them.
“The gap becomes bigger and bigger. It has to be bridged. If you can bridge your relationship with your mother, suddenly you will feel that the whole earth is bridged. You are more rooted in the earth. If you can bridge your relationship with your father, you are at home with the sky. They are symbolic, representatives of the earth and the sky. And man is like a tree which needs both the earth and the sky.”
Osho , A Rose is a Rose is a Rose

PS: In many countries around the world the humane ending of a life when there is suffering without prospect of improvement, is still a taboo. I hope that this small contribution can help to demystify the process of euthanasia and to open a door to see death not as a defeat, but as something that naturally belongs to life. Given the right criteria a merciful death is a universal human right.


I would like to acknowledge Maneesha James’ work of helping people with the meditative approach to death and her Osho Sammasati Project.

A world-wide grass-roots movement around death has sprang up. At a so-called ‘Death Cafe’ you can find a place near you to discuss death with others with no agenda, objectives or themes. It is a discussion group over tea, coffee and cake, rather than a grief support or counseling session.

For privacy reasons some names in this article have been altered.