Societal change behind increase in euthanasia; Doctors experience more pressure

The fact that more people are choosing to die by euthanasia is primarily due to changes in society and people’s perception of death, according to research by Radboudumc, in collaboration with UMC Utrecht and Amsterdam UMC. Population aging, pressure on the healthcare system, and increased attention to this subject in recent years also play a role in the growth. Doctors say they are experiencing more pressure from patients and loved ones when it comes to euthanasia requests.

In late March, the supervisory bodies, the Regional Euthanasia Review Committees (RTE), had received over 10,000 reports of euthanasia last year. In 1999, this figure was still around 2,000. Nowadays, about 6 percent of all deaths are through euthanasia. Doctors are required to report every case of euthanasia to the review committees.

Lead researcher and healthcare ethicist Els van Wijngaarden of Radboudumc observes that “the euthanasia law has not changed, but its application has.” Last year, cancer was the reason for euthanasia in only about half of all cases. In the late 1990s, this was still 90 percent. Other reasons, like dementia and mental disorders, increased.

Views on end-of-life suffering have changed significantly, the researchers note. Euthanasia is more frequently a topic of conversation, and religious views play an increasingly smaller role.

The report also highlights the pressure on the healthcare system. According ot the researchers, healthcare cutbacks, staff shortages in terminal and elderly care, and problems in mental healthcare can reinforce or encourage euthanasia requests. “For example, when patients notice that their quality of life is declining due to pressure on the healthcare system, this could influence their choice for euthanasia,” the researchers state.

Van Wijngaarden cannot say whether the pressure on the healthcare system directly leads to more euthanasia requests. According to her, more research is needed for that. However, she finds the shortcomings in the healthcare system alarming. "You do not want pressure on the healthcare system to go hand in hand with increasing acceptance of euthanasia." Researchers are therefore calling for further investigation into the role of that pressure.

The report also notes that doctors are experiencing increasing pressure from patients and their loved ones because euthanasia is increasingly seen as a normal way of dying. Patients are increasingly reluctant to accept when a doctor rejects a request for euthanasia, which in turn can make doctors more reluctant to allow it. The Termination of Life Review Act, which allows people to apply for euthanasia, is based on the principles of “mercy, the protectability of life, and autonomy.”

According to the researchers, that balance is shifting, with autonomy becoming increasingly important to patients. People increasingly believe they are entitled to euthanasia, even though this is not the case. “Euthanasia continues to be considered a special medical act. Many doctors experience its execution as morally burdensome, emotionally stressful, and time-consuming,” Van Wijngaarden said.
Doctors are reportedly receiving less and less understanding when they decide not to perform euthanasia after going through the procedure. "They often hear: 'I have thought it through carefully and I have arranged everything. Don't make such a fuss," said Van Wijngaarden. "Patients then have unrealistic expectations of doctors."

Researchers observe across the board that the patient's perspective is becoming increasingly important. But "euthanasia is not a standard but a very intrusive form of care. Lengthy procedures are precisely intended to ensure due care," said Van Wijngaarden. She worries that doctors are "retreating" in response to this development.

The report was presented to Minister Sophie Hermans of Public Health (VVD) on Thursday. The medical centers conducted research into the causes of the increase on behalf of the Ministry of Health. Mirjam Bikker (CU) requested that the government do so in 2024. On Thursday, she called it "alarming" that "the shortage of care contributes to the rise in euthanasia." Van Wijngaarden thinks that is "too simplistic."