Euthanasia in the Netherlands: how it actually works

That distinction is not academic. It explains why the process is slow, why it depends on a single doctor's judgement, and why "I have a wilsverklaring" is not the same as "I will be granted euthanasia." This longread walks through the law, the criteria, the people involved and what the most recent statistics actually say.

What the law allows, and what it does not

The 2002 Act covers two situations: euthanasie (the doctor administers a lethal substance) and hulp bij zelfdoding (assisted suicide — the doctor prepares the substance and the patient takes it themselves). Both fall under the same legal regime. Both must be performed by a doctor; assistance by a non-doctor remains a criminal offence.

The Act does not give patients a right to euthanasia. It gives doctors a defence against prosecution if they meet six due care criteria and report the case. A doctor who does not feel personally able to perform euthanasia — for moral, religious or clinical reasons — is free to decline. Patients whose own huisarts (general practitioner) declines can approach Expertisecentrum Euthanasie (the Centre of Expertise on Euthanasia, founded by the NVVE in 2012 as the Levenseindekliniek), which takes referrals from across the country.

The six due care criteria

The Act lists six zorgvuldigheidseisen. All six must be met. The Regionale Toetsingscommissies Euthanasie (RTE — Regional Euthanasia Review Committees) test each reported case against them after the fact.

1. A voluntary and well-considered request from the patient (vrijwillig en weloverwogen verzoek). The patient must be wilsbekwaam (mentally competent), free from outside pressure, and the request must be sustained over time, not the product of a single bad day.
2. Unbearable suffering with no prospect of improvement (ondraaglijk lijden zonder uitzicht op verbetering). The suffering can be physical or, in narrowly defined circumstances, psychological. "No prospect of improvement" is a medical assessment, not the patient's own conclusion.
3. Information about the patient's situation and prognosis. The doctor must have informed the patient about their condition and what to expect.
4. No reasonable alternative. Doctor and patient together must have concluded that there is no other reasonable solution. If a treatment exists that could meaningfully relieve the suffering, even if the patient does not want it, this criterion may not be met.
5. Consultation with at least one other independent doctor — in practice, a SCEN-arts (independent consulting physician trained under the Steun en Consultatie bij Euthanasie in Nederland programme). The SCEN-arts examines the patient and the file and gives a written opinion on whether the criteria are met. The opinion is non-binding, but a treating doctor who proceeds against it carries a heavy burden of justification.
6. Medically careful execution (medisch zorgvuldige uitvoering). The procedure follows the KNMG/KNMP guideline on lethal medication and dosage.

Meeting all six is not a checklist exercise. The KNMG (Royal Dutch Medical Association) describes euthanasia as an "uiterst middel" — a last resort — to be considered when patient and doctor both feel that suffering cannot reasonably be relieved by any other means.

Who decides, and how long it takes

The decision rests with the treating doctor, almost always the huisarts who has known the patient for years. This is a deliberate feature of the Dutch system: continuity of care is what makes the long, sustained-request criterion testable. A new doctor who meets the patient for the first time cannot easily judge whether a request is "well-considered" or whether suffering is "unbearable" in the context of that life.

There is no statutory minimum period between request and procedure. In practice, the process takes weeks to months. Conversations begin long before any formal request. The doctor builds a written record. Once the doctor is willing to consider the request seriously, they bring in a SCEN-arts. The SCEN-arts visits the patient, usually once, and writes their opinion. If both doctors are satisfied, a date is set — often days, sometimes weeks ahead, depending on the patient's wishes and condition.

For patients whose own doctor declines, Expertisecentrum Euthanasie has its own process, which is typically longer. Their teams pick up cases that other doctors will not — psychiatric suffering, advanced dementia, patients without a long-standing doctor — and the assessments are correspondingly thorough. Waiting times of many months are common.

What the numbers show

The RTE publishes a Jaarverslag (annual report) every spring, with case-by-case statistics for the previous calendar year. The most recent figures show continued, gradual growth.

• In 2024, the RTE received 9,958 reported cases — about 5.8% of all deaths in the Netherlands [RTE Jaarverslag 2024].
• In 2023, there were 9,068 reports — 5.4% of all deaths.
• In 2025, the RTE received 10,341 reported cases — confirming the continued, gradual growth.

The trend is upward but not dramatic. The RTE attributes the long-term trend to a combination of an ageing population, increased awareness and the gradual normalisation of euthanasia as a recognised end-of-life option.

The breakdown by underlying condition is consistent year on year. The vast majority — roughly 86% in 2024 — concern serious physical illness, with cancer dominating, followed by neurological diseases (such as ALS and Parkinson's) and cardiopulmonary conditions. Smaller but closely scrutinised categories include dementia (around 400 cases per year) and psychiatric suffering (around 200). A growing but still small category is duo-euthanasie, where two partners are granted euthanasia at the same time; in 2024 there were 54 such cases. [unverified for 2025 specifics — full breakdown not yet available in this fetch.]

The RTE finds the overwhelming majority of reports to meet all six criteria. Cases judged not to meet them are rare — historically a handful per year — and are referred to the Public Prosecution Service (Openbaar Ministerie) and the Healthcare Inspectorate (IGJ) for further consideration.

The wilsverklaring, and what it cannot do

A euthanasieverklaring (euthanasia directive within an advance directive) is a written statement, drafted in advance, that asks for euthanasia under specified future conditions — most often, advanced dementia. It carries weight, but it does not bind the doctor. The doctor must still be able to reach personal conviction that all six criteria are met at the moment of the procedure, including unbearable suffering and a sustained, voluntary request.

For dementia, the gap between document and decision is the central tension. A patient who wrote, ten years earlier, "if I no longer recognise my children, I want euthanasia" may by then no longer be able to confirm or refuse anything. Doctors and the RTE handle these cases case by case, and a small but contested body of jurisprudence has built up around them. The 2020 Hoge Raad (Supreme Court) decision in the so-called "koffie-arrest" confirmed that a clear, recent and well-discussed advance directive can be a sufficient basis for euthanasia in advanced dementia, but the bar remains high and individual judgement remains central.

This is why a wilsverklaring written in isolation, never discussed with the huisarts, is rarely useful in practice. The document is the start of the conversation, not its substitute.

What "a complete request" looks like

In NVVE and KNMG materials, a complete euthanasia request is described less as a form and more as a body of evidence built up over time. It includes:

• A written request from the patient, in their own words, dated and signed.
• A medical file documenting the diagnosis, prognosis, treatments tried, and the patient's response.
• Notes from multiple conversations between patient and doctor, recording how the request developed.
• Where relevant, a euthanasieverklaring covering future loss of capacity.
• The independent SCEN-arts report.
• A written report from the doctor to the RTE after the procedure, with the SCEN-arts opinion attached.

The patient's role is the first three. The rest depends on the doctor's willingness to engage.

After the procedure

Euthanasia is not a natural death. The treating doctor cannot sign the standard verklaring van overlijden (death certificate) confirming a natural cause. Instead, they call the gemeentelijke lijkschouwer (municipal forensic doctor), who attends, examines the body and the file, and notifies the RTE. The body is released for burial or cremation once the lijkschouwer's report is complete, usually the same day. The RTE then conducts its review in the weeks that follow. The funeral itself proceeds normally.

In the app

In the Personal Portal you draft a euthanasieverklaring as part of your wilsverklaring, record the date you discussed it with your huisarts, and keep the contact details of your doctor and any SCEN-arts involvement. The app structures the documents and conversations the law expects, so that the start of the process is not a paperwork emergency.

Join the beta ->

Closed beta — access by invitation.

Sources

1. Regionale Toetsingscommissies Euthanasie — annual reports (Jaarverslagen) and case publications, including the most recent 2025 figures and the 2024 Jaarverslag. https://www.euthanasiecommissie.nl
2. NVVE — Nederlandse Vereniging voor een Vrijwillig Levenseinde, public information on the law, advance directives and Expertisecentrum Euthanasie. https://www.nvve.nl
3. KNMG — Royal Dutch Medical Association, professional guidance on euthanasia, the role of the huisarts and the SCEN consultation. https://www.knmg.nl