Dickinson Students Research End-of-Life Care in Netherlands, U.S.

Students who took part in Dickinson's spring 2022 Mosaic centering on death, dying and end-of-life care in the U.S. and the Netherlands.

Mosaic course offers global research opportunity

by MaryAlice Bitts-Jackson

Dickinson’s 2022 trip to the Netherlands was far from a typical spring-break experience.

“While many of our fellow Dickinsonians were boarding planes destined for sunny beach towns, our group of 11 undergrads was embarking on an eight-day research trip examining how the Dutch manage, of all things, death and dying,” says Conor Wagner ’24, a biochemistry & molecular biology major. “We signed up to spend our spring break diving deeply into a topic that most American college students try to avoid like early-morning classes.”

The trip was an integral part of Dickinson’s 2022 Dutch Mosaic, Managing Death and Dying in Cross-Cultural Perspective. Like all Dickinson Mosaics, this course included opportunities to research and learn in class, in the local community and abroad. And while end-of-life care and decisionmaking may be an uncommon subject for undergrads to study, for students interested in exploring careers in health, medicine and mental health, it may be just what the doctor ordered.

Connecting with experts

Students participated in hands-on activities and spoke with students in the nursing program at the University of Rotterdam.

Students participated in hands-on activities and spoke with students in the nursing program at the University of Rotterdam.

The Dutch Mosaic was led by Susan Rose ’77, Charles A. Dana Professor of Sociology and director of community studies and Mosaics. Before traveling abroad, students explored the philosophy, ethics, culture and economics of health care in the West and abroad, both through readings and interactions with experts in medicine, ethics and policy.   

These included Heather Sung P’24, a palliative-care physician, and founder of PalliMD; Amy McKiernan, assistant professor of philosophy and director of the Ethics Across Campus & the Curriculum initiative; and  Jim Hoefler, professor of political science and an expert on U.S. end-of-life decision-making and policy.

Once abroad, the students connected with doctors, nurses, Dickinson alumni who are studying at the University of Utrecht, as well as community leaders, scholars, educators, organizational leaders and others working and studying related fields. “That led to deep, memorable conversation about comparative health practices,” says Izzy Ferrazza ’24 (pre-health, anthropology).

Highlights included opportunities at the Rotterdam University of Applied Science, where they met with nursing students, participated in hands-on exercises and discussed the nature of patient-practitioner interactions. The students also explored the roles of the arts and spirituality in end-of-life caregiving, cultural differences with regard to how pain is regarded and treated and more. Sightseeing and group excursions added to their understanding of local culture.

Funerals, reimagined

Ashes arranged in the shape of a heart at the Zuyen cemetery in Breda, Netherlands.

Ashes arranged in the shape of a heart at the Zuyen cemetery in Breda, Netherlands.

Ferrazza, who intends to pursue a career in medicine/health science, especially enjoyed visiting a funeral home, cemetery and crematory that offers families private, 24/7 access to the deceased, pre-internment, as well as customized ceremonies. She was impressed by the establishment’s sustainable practices—chemical-free coffins and remains allow for 10-year plot rentals that conserve the land—and also the fact that members of a local Dutch community will pool resources to help pay for burials and services for those who are indigent. Also noteworthy: The Dutch must opt out of organ donation, rather than opt in, as in the U.S., resulting in more healthy samples for transplant patients.

“Everything about it is modern—architecture, values and cemetery grounds. I was simply overwhelmed by the amount of care offered to both the living and the deceased,” Ferrazza says.

The beauty and thoughtful landscaping of the cemetery made a lasting impression on Carmen Canino ’22 (biochemistry & molecular biology), particularly regarding an area where cremated remains are scattered under distinctive trees. “The trees provide families with a landmark for where their loved one's ashes were scattered and a sense of the time that has passed since a family member passed away,” she says.

Presentation by experts during the students' trip to the Netherlands.

Presentation by experts during the students' trip to the Netherlands.

Lasting effects

So was this nonconventional spring-break trip well worth it? The students say they expect these experiences to enrich their future personal experiences around end of life—and to help them in their careers.

Wagner’s biggest lesson relates to palliative sedation—a practice commonly used in the Netherlands to alleviate suffering but not commonly used, outside of hospice contexts, in the U.S. “I now have a much broader perspective, and I'm far better prepared to ask the tough questions, advocate for my patients and pursue positive change for people who are in the important part of the journey that is the end,” he says.

Ferrazza most appreciated the holistic approach to caregiving she discovered and Netherlands practitioners’ focus on the quality of one’s experiences at end of life. Canino is thinking deeply about research on assisted-living facilities, the sense of community she witnessed among caregiving team members and between health-care providers and patients and the beauty and comfort that patients, loved ones and care providers can cultivate together at end of life.

And, as Ferrazza and Canino note, these insights can do more than help only those who work in, or plan to work in, related professions. They also can enrich the end-of-life decisionmaking and experiences we all will one day face.

“I highly recommend doing personal research on this topic, especially if you're scared of just the idea of death and dying,” she says. “These are the people who could benefit from this the most.”


Published April 15, 2022