In 2002, the Netherlands became the first country in the world to legalise ‘assisted dying’ (an umbrella term that includes both euthanasia and assisted suicide). The number of reported cases has since increased almost annually (see Figure 1). It is worth noting that 2023 saw a record total of 9,068 assisted deaths. This meant deaths by euthanasia or physician-assisted suicide constituted 5.4% of all deaths in the Netherlands – a higher proportion than any other country in the world. This is in stark contrast to 2002, the first year of implementation, where there were just 1,882 assisted deaths.
To put into perspective just how prolific the practice has become in the Netherlands, had the same proportion (5.4%) of deaths in England and Wales in 2023 been assisted, there would have been 31,393 assisted deaths in England and Wales last year alone (or 86 per day).
FIGURE 1
The expansion of the law, either in letter or practice, can also be traced. While it has been legal to grant an assisted death on the grounds of psychological suffering from the outset in the Netherlands, it was exceedingly rare to do so in the first years of implementation. However, the statistics show a steady rise in such cases over recent years, with a significant increase between 2022 and 2023. Although it remains a frequently disputed and controversial criterion for assisted dying, the number of people being euthanised due to psychological suffering increased by 20% between 2022 and 2023, going from 115 to 148 respectively. On top of this, there was a 13.8% increase in people being euthanised after receiving a dementia diagnosis across the same time period, with numbers rising from 288 to 328.
As well as the impact on patients and society at large, the legalisation of euthanasia and physician-assisted suicide for those with dementia also has had substantial implications for doctors. The majority (52%) of Dutch GPs who had euthanised a dementia patient reported feeling an emotional burden after doing so. This is an unsurprising statistic given the fact that more than 47% felt uncertainty about the mental state of their patient at the time of being euthanised, and 42.9% felt pressure from the patient’s relatives to carry out the procedure.
In one case, a Dutch woman who had made an advanced directive for euthanasia should she ever get dementia was forcibly held down by her family and injected with the lethal drugs after she appeared to change her mind and want to live when the day came. The doctor involved was cleared of any wrongdoing.