This article appeared in De Andere Krant on 23 May 2026, edition 21

Intervention in the dying process, including palliative sedation, has increased enormously in recent years. In the Netherlands, the number now exceeds 50,000 people per year. The ‘Landelijk Expertisecentrum Sterven’ (National Expertise Centre for Dying), a Dutch organisation, which celebrates its tenth anniversary this year, advocates instead for a natural dying process. “Our expertise centre is an increasingly powerful countervoice that emphasises the importance of attention and space for natural dying. In my view, that is urgently needed,” says founder Ineke Visser.

The ‘National Expertise Centre for Dying’ was founded ten years ago by former hospice coordinator Ineke Visser (63). In her work, she experienced how death and everything that comes with it often confronts people painfully with powerlessness and uncertainty. “There is a great need for an approach to the dying process rooted in trust rather than fear,” she explains, “including from a professional perspective. Natural dying means that discomfort, pain and emotions are welcomed and everything may be felt, while a safe and familiar foundation is offered. This creates the opportunity to work things through, to speak one’s mind, and to take leave of life with dignity. It can lead to a profound inner transformation, both for the dying person and for those left behind.”

The general definition of palliative sedation is ‘the deliberate lowering of consciousness in a terminally ill patient in the final stage of life, with the aim of relieving unbearable suffering’, as stated on the website of the National Expertise Centre for Dying. The percentage of palliative sedation has increased over the past ten years, from 19.9 percent in 2015 to 27.5 percent in 2024, according to Statistics Netherlands (Centraal Bureau voor de Statistiek, CBS). Where does this increase come from?

“The government has invested a great deal of money in campaigns to raise the profile of palliative care,” Visser explains. “Palliative care includes proactive care planning — conversations between healthcare professionals and their patients in which the available options are clearly explained: euthanasia, palliative sedation, stopping eating and drinking, and so on. In those conversations, natural dying is no longer mentioned at all! This is one of the reasons why more and more people are asking for palliative sedation. If it is not the dying person themselves, it is the family who struggles with their loved one’s dying process, or the doctor who wants to contribute something.”

The National Expertise Centre focuses on spreading awareness of the importance of natural dying. “With time, attention and good care — including adequate pain management — intervention is often unnecessary,” Visser argues. “We live in a culture that likes to believe life is something we can control, including dying. As a result, we tend to avoid the pain, discomfort and emotions that the dying process brings with it — but suffering serves a purpose. ‘Suffering purifies,’ people used to say. If you have gone through periods of suffering in your life, you become more compassionate towards others who also suffer. It develops empathy and depth, humility and resilience. Dying is part of life. Intervening too quickly can disrupt the dying process. If we can let go of the resistance and tension around death, that also improves quality of life. Throughout life we continually face great and small losses, through which we learn to accept, to go with the flow, and to let go. Death may well be our greatest teacher.”

The Expertise Centre has no religious background. Visser: “Our approach is free from any form of religion or dogma. Dying is a universal event. We draw on all existing sources of knowledge available on the subject, including the thinking of Elisabeth Kübler-Ross and Pim van Lommel, both pioneers in the field of end-of-life care and grief processing. This knowledge can dispel a great deal of fear and strengthen trust in the process.”

Visser is pleased with what the National Expertise Centre for Dying has achieved over the past ten years. “My vision was that we would establish a firm place in society — hence the substantial name. That has succeeded. Our online community ‘Living with Dying’ is growing exponentially. Both professionals and people personally confronted with the dying process find each other there to exchange experiences and information and draw inspiration. My book ‘Licht op sterven’ is also doing very well.” In Licht op sterven, Visser shares her insights into the dying process and takes the reader through the profound meaning that the end of life can hold.

The training courses and workshops of the National Expertise Centre for Dying train participants to become end-of-life carers in the broadest sense of the word. “We teach people to understand that death is more than a physical or mechanical matter. In reality, the dying process takes place on seven levels. I give shape to this, among other ways, through my Seven-Layer Approach® to dying. Becoming an end-of-life carer is a deeply personal process, because every participant is confronted with their own fears and beliefs around dying and death. A good end-of-life carer is attentive to the needs of the dying person. My own mother is now 88, and when the time comes, I will be privileged to guide her through her final phase. She did say: ‘As long as we don’t have to have difficult conversations.’ My mother primarily needs practical help, and I respect that.”

How does Visser envision the next ten years? “With our expertise centre, we stand on the threshold of a new chapter, with the goal of reaching not thousands of people but a multiple of that. With our team and the online platform ‘Living with Dying’, we now have more than enough capacity to do so. My personal challenge is to become more visible in communicating my vision that we are essentially spiritual beings. There is far more between heaven and earth than we can measure and know. It would not surprise me if a collective shift towards more intuitive and natural living and dying were to come soon. If our National Expertise Centre for Dying has contributed to that in some small way, then our mission will have been accomplished.”

Sanne Burger
sanneburger.com