Two decades of research on euthanasia from the Netherlands. What have we learnt and what questions remain?
Open accessAbstract
Two decades of research on euthanasia in the Netherlands have resulted into clear insights in the frequency and characteristics of euthanasia and other medical end-of-life decisions in the Netherlands. These empirical studies have contributed to the quality of the public debate, and to the regulating and public control of euthanasia and physician-assisted suicide. No slippery slope seems to have occurred. Physicians seem to adhere to the criteria for due care in the large majority of cases. Further, it has been shown that the majority of physicians think that the euthanasia Act has improved their legal certainty and contributes to the carefulness of life-terminating acts. In 2005, eighty percent of the euthanasia cases were reported to the review committees. Thus, the transparency envisaged by the Act still does not extend to all cases. Unreported cases almost all involve the use of opioids, and are not considered to be euthanasia by physicians. More education and debate is needed to disentangle in these situations which acts should be regarded as euthanasia and which should not. Medical end-of-life decision-making is a crucial part of end-of-life care. It should therefore be given continuous attention in health care policy and medical training. Systematic periodic research is crucial for enhancing our understanding of end-of-life care in modern medicine, in which the pursuit of a good quality of dying is nowadays widely recognized as an important goal, in addition to the traditional goals such as curing diseases and prolonging life.
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The idea that eligibility criteria in ADE regulations are gradually expanded, or that vulnerable populations are at greater risk, is not substantiated by empirical studies.
“The idea that eligibility criteria in ADE regulations are gradually expanded, or that vulnerable populations are at greater risk is not substantiated by empirical studies [14–16].”
From Trends in assisted dying among patients with psychiatric disorders and dementia in Belgium: A health registry study (2025) · cites this paper as [16]
In “What Have We Learnt?” (page unavailable), the paper says its studies found no evidence of a slippery slope and no higher frequency of euthanasia among listed vulnerable groups. It does not establish that empirical studies have failed to substantiate gradual expansion of eligibility criteria; “Interpreting the Criteria for Due Care” instead describes how courts have interpreted the boundary of unbearable suffering. (LLM, conf=0.84)
Experimental — accuracy not yet measuredIn the Netherlands, research suggests that approximately 20% of euthanasia cases are not reported to the review committees, down from 46% in 2001.
“In the Netherlands, research suggests that approximately 20% of euthanasia cases are not reported to the review committees, down from 46% in 2001 (78, 81, 82).”
From Assisted death in eating disorders: a systematic review of cases and clinical rationales (2024) · cites this paper as [82]
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“The idea that eligibility criteria in ADE regulations are gradually expanded, or that vulnerable populations are at greater risk is not substantiated by empirical studies [14–16].”
- Authors
- Rietjens, J. A. C., van der Maas, P. J., Onwuteaka-Philipsen, B. D., van Delden, J. J. M., & van der Heide, A.
- Affiliations
- Erasmus MC (NL)
- Amsterdam Public Health (NL)
- Corresponding author
- Rietjens, Judith A. C.
- Venue
- Journal of Bioethical Inquiry
- Published
- 2009-07-28
- Volume
- 6
- Issue
- 3
- Pages
- 271-283
- ISSN
- 1176-7529 (ISSN-L)
- 1872-4353
- PMC
- PMC2733179
- OpenAlex
- W2171753918
- Cited by
- 138
- References
- 48
- Citations by year
- 2026: 5 · 2025: 15 · 2024: 7 · 2023: 5 · 2022: 4 · 2021: 4 · 2020: 8 · 2019: 11 · 2018: 10 · 2017: 6 · 2016: 9 · 2015: 12 · 2014: 6 · 2013: 13 · 2012: 11
- FWCI
- 7.73
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Journal of Bioethical Inquiry (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (publishedVersion, other-oa)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion, other-oa)
- RePub (Erasmus University Rotterdam) (submittedVersion, other-oa)
- Digital Academic REpository of VU University Amsterdam (Vrije Universiteit Amsterdam) (submittedVersion)
- Pure Amsterdam UMC (submittedVersion, other-oa)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (submittedVersion, other-oa)
- DigitalGeorgetown (Georgetown University Library) (submittedVersion)
- RePub (Erasmus University Rotterdam) (submittedVersion)
- VUBIR (Vrije Universiteit Brussel) (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
- Keywords
- euthanasia, physician-assisted suicide, end-of-life care, Dutch euthanasia law, due care, review committee, opioids, quality of dying, medical education, health policy
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