Doctors’ challenges in the Netherlands

Allow me to start by introducing you to the Christian Medical Fellowship (CMF) of the Netherlands. [1] CMF Netherlands traces its origins back to 1955, when it was called the Protestant Christian Doctors’ Organisation (PCAO). Despite the long history of the PCAO, over the years, it gradually became more inward-looking. Nevertheless, a dedicated group of members continued to earnestly pray for a more substantial influence by Christian physicians within society. Inspired by their visit to CMF UK, a group of visionary students conceptualised an organisation with a broader outreach. This led to a collaboration between the PCAO and these students, giving rise to CMF Netherlands. The membership saw an initial doubling from 282 in 2002 to 568 in 2017, but it has remained relatively stable since, with 15 per cent being medical students and 61 per cent being women.

Our modest yet devoted board is characterised by enthusiasm and several innovative ideas to advance our organisation. We currently employ two part-time staff members, one to support the doctors’ section and organise conferences, and the other to assist the students’ section. Additionally, we actively contribute to the International Christian Medical and Dental Association (ICMDA). Organising the ICMDA World Congress in 2014 in Rotterdam was a big job for the organising committee, but it was extremely educational. Involving local churches to act as host families proved to be a mutual success. A young doctor currently serves as the regional representative for Western Europe, while a seasoned physician has dedicated numerous years as the regional secretary for ICMDA Eurasia.

CMF Netherlands takes immense pride in its quarterly full-colour magazine In Service of Healing, [2] which delves into a wide array of themes. These include the intricacies of medical consultation, abortion and how to discuss this in the doctor’s office, preventive medicine, career development, one’s calling as a physician, the care of vulnerable patients, issues pertaining to the end of life and the concept of the ‘completed life’, and addiction.

Frequently, CMF receives requests to support missionary endeavours. However, our statutory mission primarily emphasises domestic activities. As a result, we have decided to channel our support towards select physicians and organisations abroad, typically through three-year commitments. One of the ongoing projects we support provides practical and spiritual assistance to women in Central Asia who have undergone one or more abortions. Our magazine features stories of Dutch physicians working in various corners of the globe, including Senegal in Africa and Bangladesh in Asia.

our challenges

The Dutch fellowship faces several notable challenges. One of these is the scarcity of local groups, even though the few that do exist play a pivotal role in supporting their members. Additionally, the demanding workload of medical students often impedes their participation in organised activities.

Our most significant challenges revolve around a series of ethical medical issues that persistently confront us. It is in these arenas that Christian physicians play a vital role, particularly considering the prevailing global trend of liberal thinking that is particularly robust in our nation. Here, we focus on three primary issues:

abortion

In the Netherlands, abortion has been legal since 1984, albeit under strict conditions. Recent changes have removed the mandatory waiting period and have made the abortion pill available through general practitioners rather than solely in specialised clinics. Public opinion has shifted towards viewing abortion as routine medical care, diminishing its legal scrutiny. Those who express regret about this development often face ridicule from highly watched television programmes. However, recent research indicates that the younger generation is increasingly questioning the necessity of abortion, especially when prompted by social issues such as housing and poverty.

euthanasia

Euthanasia was legalised in the Netherlands in 2002, driven by the aversion to gruesome deaths deemed inhumane. In practice, however, it is often not physical suffering but existential distress that leads to euthanasia, such as the fear of dependency or becoming a burden. Over the past two decades, euthanasia cases in the Netherlands have more than quadrupled, with shifts in indications including dementia, psychiatric problems, and an accumulation of age-related complaints. The so-called End-of-Life Clinic originated in 2012 from the Dutch Right to Die Society and counsels physicians dealing with a request for euthanasia and patients who, for whatever reason, do not get euthanasia from their own physician. The trend toward controlling the dying process is noteworthy, as five per cent of all deaths result from euthanasia, with 25 per cent of deaths occurring at home involving deep sedation. Media coverage, including instances of euthanasia against the wishes of demented patients, has not eroded support for euthanasia among the general population but has affected medical practitioners.

transgenderism

Like abortion and euthanasia, the Netherlands has been a pioneer in the treatment of transgender youth for many years. The Dutch approach, which has developed over the past 25 years, has influenced practices worldwide. Clinics for transgender youth, from Finland to Colombia, Canada to the United Kingdom, have adopted Dutch guidelines, including the use of puberty blockers, hormone therapy, and gender reassignment surgery for underage individuals. Nevertheless, growing waiting lists and reports of ‘detransitioning’ individuals who regret their transition have sparked ongoing societal and scientific debates. Related to this, there is increasing pressure on doctors to align with society’s emphasis on the rights of gay people and people of other sexual orientations.

our response

Our challenge as a Christian Medical Fellowship is to oppose these prevailing trends and to offer support to students and physicians in taking a stand. Physicians have the responsibility to bring to the forefront of public consciousness the risks associated with altering these standards designed to protect life. We must present the unadulterated facts.

Even those who are not guided by religious beliefs must recognise that a fetus is not merely a ‘lump of tissue’ to be freely discarded and that women facing the choice of abortion often do so under external pressures. Christian physicians aim to demonstrate how they provide guidance in cases of unwanted pregnancies.

Concerning end-of-life decisions, we must emphasise that this, like birth, is a unique and profound event, imbued with emotion and meaning. Palliative care allows for a space to navigate this transition, not with the aim of prolonging life indefinitely but to live meaningfully in the face of an inevitable farewell. We want to offer this expert and timely care to ease the process of facing death with dignity. Timely and compassionate communication can alleviate fear. People seek a sense of security, even if we cannot promise to eliminate all physical and psychosocial suffering.

In addressing the complex issue of gender dysphoria, we must not ignore the challenges it poses, especially to impressionable teenagers, who may be influenced by the prevailing notion that they were ‘born in the wrong body’ and subsequently enter a medical process that can result in significant physical harm without relieving their mental distress. Addressing the confusion related to gender issues, which is often rooted in widespread mental distress among young people, requires the promotion of strong family structures and positive role models. Additionally, psychological support must be available for those who need it.

CMF Netherlands does not only try to help its members form their minds about these issues but also endeavours to promote best practices through the media, even if national newspapers may sometimes overlook our submissions as having ‘little news value’. In these efforts, we maintain strong collaborations with other organisations, including a large Christian patient association and the Christian Lindeboom Institute. [3] The professor affiliated with this institute regularly contributes to our association by providing presentations and contributing to our magazine.

In all this, we acknowledge the spiritual dimension of our work. This year, CMF has initiated a national prayer campaign, complementing the prayers of local groups and individual intercessions. Our Lord Jesus Christ has set the standard for addressing complex issues while being prepared for misunderstanding, criticism, and even persecution, as elucidated by Doctor Luke (Luke 6:20-23).