The Netherlands, a world pioneer in the regulation of euthanasia in 2002, points for the first time to a factor that may contribute to its increase: shortcomings in the healthcare system. In particular, problems in the care of complex mental health cases and the lack of staff in home care for the elderly and terminally ill. In the 24 years the law has been in force, cases have risen from 2,000 in 2003 to 10,000 in 2025, when it accounted for nearly 6% of all national deaths.
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The warning that the pressure on the healthcare system “may indirectly favor or reinforce euthanasia wishes” appears in a scientific report prepared at the Government’s request to evaluate the increase experienced since its application was authorized, as well as that of assisted suicide at a patient’s request. There are other elements of greater weight than health cuts, such as population aging and greater patient autonomy, who want to exercise more control over their life and death. But although euthanasia is evaluated every five years, it had not been analyzed until now why it was increasing.
The study was carried out by the Radboud University Medical Center, in the city of Nijmegen, in collaboration with its counterparts in Utrecht and Amsterdam, and its director, Els van Wijngaarden, says she observes “an increase in euthanasia requests that could be linked, in part, to the challenges faced in certain areas of the healthcare system.”
Until now, this challenge had been addressed in academic articles and debated by public opinion, she explains. As a specialist in end-of-life meaning and ethics, she points out, in a telephone conversation, that “these results represent an opportunity to continue investigating how potential failures in the health system can be alleviated, especially regarding psychiatric illnesses.”
The expert describes this factor as “a small piece of the overall explanation.” At the same time, she warns that health services “must balance the care provided for mental ailments for which it is difficult to provide adequate treatment, or this will become a problem.” She believes that this concerns all instances involved in healthcare: “Ensuring that we continue to invest in specialized procedures in the coming years.”
Overall, the report attributes the rise in euthanasia to a “logical consequence of adapting practice to population changes,” as the population ages and more people live longer with chronic diseases. Assisted death can only be applied when suffering is unbearable and without possibility of cure, and with the lucid and repeated request of the affected person.
Cancer has been declining in recent years among the reasons for requesting it. In the last 24 years, it has gone from accounting for nearly 90% of cases to 54%, according to this study. It is more than half of all those carried out, but other reasons have gained ground. Among them, a combination of pathologies, dementia, the accumulation of ailments typical of old age, and mental disorders.
In 2025, the RTE received 10,341 notifications: a 3.8% increase compared to 2024. Doctors who do not wish to carry it out, have doubts about the case in question, or consider themselves unprepared, can refer it to another colleague. Also, to the Euthanasia Expertise Center (Expertisecentrum Euthanasie), which handles the most difficult cases. That same year, euthanasia was performed on 174 people with one or more psychological disorders; in 2024, these cases were 219, according to the Commission that analyzes the practice of euthanasia nationwide (RTE, in its Dutch acronym). If the practitioner violates the legal criteria, in any of the cases, they can commit a crime punishable by up to 12 years in prison, but they are not obliged to practice it.
“Euthanasia is not a patient’s right, nor a doctor’s duty,” Van Wijngaarden reminds us. “It is a legal exception. An extraordinary medical practice, although the fact that people sign living wills where they write it down can create that expectation.” That is why she considers it very important to have a public debate “especially in cases of mental illness, to ensure that healthcare structures are prepared and that people have the same access to adequate resources.”
Gert van Dijk, an ethics specialist at the Royal Dutch Medical Association (KNMG), acknowledges that the report addresses “psychological problems, a very delicate issue.” And that the authors show “concern that the lack of adequate care in this field could be one of the reasons why euthanasia is requested.” He emphasizes, however, that it is “a warning, because we also know that there is some concern among citizens regarding the assistance they will receive in old age.” And he assures that palliative care “is good in the Netherlands and the level of knowledge in this field is high.”
Van Dijk speaks to EL PAÍS via videoconference alongside the elderly care physician, Mieke Draijer, a member of the KNMG board of directors. She confirms “the high standards of national healthcare, although we foresee a shortage of professionals in the future.” Due to this, some care is provided at home, “and the lack of staff worries people, although the general increase in euthanasia responds to a set of factors, in addition to that concern,” she emphasizes.
Another element highlighted by the report is the population’s emphasis on the quality of life and death, and on the fact that they increasingly want to have more control over both. “The perception of suffering is changing and personal autonomy is a very important concept in this country,” declares Van Dijk. For her part, Draijer says she has performed two euthanasias over more than thirty years of her career, and points out that “a doctor is given the opportunity to offer people a good life.” “Not a long life, but a good one,” she adds.
On all occasions, they must consult with an independent colleague before making a decision. In mental health, two doctors check if everything is in order, “and you only do it when you believe there is no other way to offer a remedy for the pain, for the agony.” “It is the last resort and it is an intense and quite complicated procedure,” Draijer acknowledges.
Van Dijk intervenes at this point to say that, in psychiatric patients, the protocol has changed “and now it is necessary for a multidisciplinary committee to examine the case so that the environment in which the affected person lives is also analyzed.” The social changes described by the report extend to the medical profession. “24 years ago, we didn’t teach them anything about euthanasia. Now, if you become a general practitioner [who perform 80% of cases], we explain everything to them,” he assures.
Both experts consider that the increase in euthanasia “is not a moral problem, but a social change.” They care that the procedure “is transparent and cautious; that doctors do the right thing and rely on their colleagues; and that the patient can choose.” Els van Wijngaarden concludes by saying that “you can only have a good euthanasia system if healthcare works correctly everywhere.”
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