Laura King | (TNS) Los Angeles Times

AMSTERDAM — Travel can be exhilarating or awful, and like it or not, we all leave footprints. Of course, some tourists tread more heavily than others, leaving residents swearing, slack-jawed or just shaking their heads.

In this busy European travel season, here are some things tourism professionals and local people would like you to know, so you won’t be that tourist.

Buy locally made items

“Don’t just purchase cheap souvenirs,” said Lony Scharenborg, who manages a merchants’ association for Amsterdam’s Nine Little Streets, a picturesque shopping area in the canal district.

“Remember that the people who live here need their bakeries and their grocery stores. Pick up something from there.”

You’re a guest, so act like it

“A city is not only monuments and marbles; it is people,” said Giovanni Andrea Martini, a City Council member in Venice.

“Show respect and coexist.”

In another overburdened destination, Emma Martin of Spain’s Turisme de Barcelona also said a little consideration goes a long way. She urged visitors to think of themselves as “temporary but integral” citizens.

During big events, consider an alternative locale

In Paris this summer, plenty of locals fled the Olympics influx, while some travelers deferred their visits or found last-minute bargains.

Another example: Scotland’s historic capital of Edinburgh is even more jam-packed than usual during the Festival Fringe in August, but Malcolm Roughead, chief executive of VisitScotland, points out that lesser-known parts of the country are “filled with hidden gems.” The moral: Whenever possible, get off the beaten track.

Think sustainability, especially with transportation

“Choose sustainable options if you can — come by train, use an electric vehicle, use public transport when in the city, use a bicycle,” said Charel van Dam, marketing director for the Netherlands Board of Tourism and Conventions. “Stay longer in the same place — less movement is always better.”

In every big European city, and in many smaller ones, there are travel apps to help you avoid bottlenecks.

Be curious — and friendly

“I’m happy when people ask me about cheese — but very happy when they ask me about other things, about life here!” said Spyros Chalikias, 39, who works in a tourism-focused cheese shop in central Amsterdam.

When you can see you’re part of the problem …

“If you see that huge line at that TikTok place, think of the impact in a tiny street, and maybe take your business elsewhere,” said Scharenborg.

Try to help local causes

German tourist Manuela Pietsch, 52, from Heidelberg, attended a recital in Amsterdam’s Westerkerk, a 17th century church, with her voluntary donation earmarked to help with restoration of its historic Duyschot organ. “It makes me feel good to be part of this,” she said. “And it was a wonderful recital!”

In many European destinations, history is painful

“Yes, you can mention the war,” said Jan Katzmarczyk, who has been conducting walking tours in Berlin for 13 years, including of many notorious Nazi sites. He urges visitors to be direct in their queries, but not accusatory toward the current generation. “We’ll take the blame, but not the shame,” said Katzmarczyk, pointing out that virtually all of Germany’s wartime leaders are long dead.

No, it’s not like home

That’s why you’re traveling! So bear in mind: There won’t be air conditioning everywhere, especially in smaller and older European hotels. Carry small coins for public restrooms (although many will let you use a credit card for the tiny charge).

Many restaurants may expect you to order bottled water instead of providing a free glass of tap water. Ice may be hard to come by. Brush up on tipping etiquette, which varies from one European country to another — although tips are almost always less than is expected in the U.S.

Adapt! As in, bring a plug adapter to charge your devices

USB sockets are a relative rarity, especially in older accommodations, and chances are slim the hotel will have an adapter to lend you.

“I can’t tell you how often Americans ask,” said the receptionist at one moderately priced Paris hotel, who did not want her name used because her employer wouldn’t approve. “Sometimes I want to say, ‘Oh, yes — let me just go out back and pluck one off the tree where they grow.’”

Don’t take things out on service workers

They’re trying to do their jobs and help you. Try to work with them and find solutions for that canceled flight or overbooked hotel. Document what happened — save texts, emails and proof of payment. When it’s all over, write a calm note, and chances are pretty good that the airline or cruise line or tour operator will try to make it up to you.

Leave the obvious jokes alone

If a particular place name sounds hilarious to English speakers, you can bet local people are tired of having that pointed out by giggling visitors.

And don’t do pretend German accents, said Katzmarczyk — “It sounds mostly terrible.”

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©2024 Los Angeles Times. Visit latimes.com. Distributed by Tribune Content Agency, LLC.

Debby Waldman | (TNS) KFF Health News

In the 18 months after Francine Milano was diagnosed with a recurrence of the ovarian cancer she thought she’d beaten 20 years ago, she traveled twice from her home in Pennsylvania to Vermont. She went not to ski, hike, or leaf-peep, but to arrange to die.

“I really wanted to take control over how I left this world,” said the 61-year-old who lives in Lancaster. “I decided that this was an option for me.”

Dying with medical assistance wasn’t an option when Milano learned in early 2023 that her disease was incurable. At that point, she would have had to travel to Switzerland — or live in the District of Columbia or one of the 10 states where medical aid in dying was legal.

But Vermont lifted its residency requirement in May 2023, followed by Oregon two months later. (Montana effectively allows aid in dying through a 2009 court decision, but that ruling doesn’t spell out rules around residency. And though New York and California recently considered legislation that would allow out-of-staters to secure aid in dying, neither provision passed.)

Despite the limited options and the challenges — such as finding doctors in a new state, figuring out where to die, and traveling when too sick to walk to the next room, let alone climb into a car — dozens have made the trek to the two states that have opened their doors to terminally ill nonresidents seeking aid in dying.

At least 26 people have traveled to Vermont to die, representing nearly 25% of the reported assisted deaths in the state from May 2023 through this June, according to the Vermont Department of Health. In Oregon, 23 out-of-state residents died using medical assistance in 2023, just over 6% of the state total, according to the Oregon Health Authority.

Oncologist Charles Blanke, whose clinic in Portland is devoted to end-of-life care, said he thinks that Oregon’s total is likely an undercount and he expects the numbers to grow. Over the past year, he said, he’s seen two to four out-of-state patients a week — about one-quarter of his practice — and fielded calls from across the U.S., including New York, the Carolinas, Florida, and “tons from Texas.” But just because patients are willing to travel doesn’t mean it’s easy or that they get their desired outcome.

“The law is pretty strict about what has to be done,” Blanke said.

As in other states that allow what some call physician-assisted death or assisted suicide, Oregon and Vermont require patients to be assessed by two doctors. Patients must have less than six months to live, be mentally and cognitively sound, and be physically able to ingest the drugs to end their lives. Charts and records must be reviewed in the state; neglecting to do so constitutes practicing medicine out of state, which violates medical licensing requirements. For the same reason, the patients must be in the state for the initial exam, when they request the drugs, and when they ingest them.

State legislatures impose those restrictions as safeguards — to balance the rights of patients seeking aid in dying with a legislative imperative not to pass laws that are harmful to anyone, said Peg Sandeen, CEO of the group Death With Dignity. Like many aid-in-dying advocates, however, she said such rules create undue burdens for people who are already suffering.

Diana Barnard, a Vermont palliative care physician, said some patients cannot even come for their appointments. “They end up being sick or not feeling like traveling, so there’s rescheduling involved,” she said. “It’s asking people to use a significant part of their energy to come here when they really deserve to have the option closer to home.”

Those opposed to aid in dying include religious groups that say taking a life is immoral, and medical practitioners who argue their job is to make people more comfortable at the end of life, not to end the life itself.

Anthropologist Anita Hannig, who interviewed dozens of terminally ill patients while researching her 2022 book, “The Day I Die: The Untold Story of Assisted Dying in America,” said she doesn’t expect federal legislation to settle the issue anytime soon. As the Supreme Court did with abortion in 2022, it ruled assisted dying to be a states’ rights issue in 1997.

During the 2023-24 legislative sessions, 19 states (including Milano’s home state of Pennsylvania) considered aid-in-dying legislation, according to the advocacy group Compassion & Choices. Delaware was the sole state to pass it, but the governor has yet to act on it.

Sandeen said that many states initially pass restrictive laws — requiring 21-day wait times and psychiatric evaluations, for instance — only to eventually repeal provisions that prove unduly onerous. That makes her optimistic that more states will eventually follow Vermont and Oregon, she said.

Milano would have preferred to travel to neighboring New Jersey, where aid in dying has been legal since 2019, but its residency requirement made that a nonstarter. And though Oregon has more providers than the largely rural state of Vermont, Milano opted for the nine-hour car ride to Burlington because it was less physically and financially draining than a cross-country trip.

Francine Milano with her husband, Kris Brackin. She would’ve preferred to travel from her home in Pennsylvania to neighboring New Jersey for medical aid in dying, but it is allowed there only for state residents. Instead she has arranged to die in Vermont, one of two states that explicitly allow medical aid in dying for nonresidents. (Eric Harkleroad/KFF Health News/TNS)

The logistics were key because Milano knew she’d have to return. When she traveled to Vermont in May 2023 with her husband and her brother, she wasn’t near death. She figured that the next time she was in Vermont, it would be to request the medication. Then she’d have to wait 15 days to receive it.

The waiting period is standard to ensure that a person has what Barnard calls “thoughtful time to contemplate the decision,” although she said most have done that long before. Some states have shortened the period or, like Oregon, have a waiver option.

That waiting period can be hard on patients, on top of being away from their health care team, home, and family. Blanke said he has seen as many as 25 relatives attend the death of an Oregon resident, but out-of-staters usually bring only one person. And while finding a place to die can be a problem for Oregonians who are in care homes or hospitals that prohibit aid in dying, it’s especially challenging for nonresidents.

When Oregon lifted its residency requirement, Blanke advertised on Craigslist and used the results to compile a list of short-term accommodations, including Airbnbs, willing to allow patients to die there. Nonprofits in states with aid-in-dying laws also maintain such lists, Sandeen said.

Milano hasn’t gotten to the point where she needs to find a place to take the meds and end her life. In fact, because she had a relatively healthy year after her first trip to Vermont, she let her six-month approval period lapse.

In June, though, she headed back to open another six-month window. This time, she went with a girlfriend who has a camper van. They drove six hours to cross the state border, stopping at a playground and gift shop before sitting in a parking lot where Milano had a Zoom appointment with her doctors rather than driving three more hours to Burlington to meet in person.

“I don’t know if they do GPS tracking or IP address kind of stuff, but I would have been afraid not to be honest,” she said.

That’s not all that scares her. She worries she’ll be too sick to return to Vermont when she is ready to die. And, even if she can get there, she wonders whether she’ll have the courage to take the medication. About one-third of people approved for assisted death don’t follow through, Blanke said. For them, it’s often enough to know they have the meds — the control — to end their lives when they want.

Milano said she is grateful she has that power now while she’s still healthy enough to travel and enjoy life. “I just wish more people had the option,” she said.

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(KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs of KFF — the independent source for health policy research, polling and journalism.)

©2024 KFF Health News. Distributed by Tribune Content Agency, LLC.