Cases of euthanasia and assisted suicide reported to the public prosecutor in North Holland over 10 years

BMJ 1996; 312 doi: (Published 09 March 1996) Cite this as: BMJ 1996;312:612
  1. Gerrit van der Wal, medical inspector and professor of quality of carea,
  2. Bregje D Onwuteaka-Philipsen, health scientista
  1. a Institute for Research in Extramural Medicine, Vrije Universiteit, 1081 BT Amsterdam, Netherlands
  1. Correspondence to: Mr Onwuteaka-Philipsen.
  • Accepted 5 December 1995

Euthanasia and physician assisted suicide are still forbidden in the Netherlands and cases have to be reported to the public prosecutor as unnatural deaths. Doctors will not, however, be prosecuted if they have acted in accordance with the requirements for prudent practice.1 Before the 1980s doctors never reported such cases, but the numbers of reported cases have increased since then, from 19 in 1984 to 1318 in 1993.1 We wanted to gain insight into the characteristics of reported cases of euthanasia (including assisted suicide): which physicians perform it and with what kind of patients?

Methods and results

Data were collected from each reported case of euthanasia in the province of North Holland (2.3 million inhabitants) from 1984 to 1993. The source was reports compiled by the public prosecutor when a doctor reported a case to the coroner or the police. These reports always included a doctor's report and a coroner's report and sometimes reports from the doctor who gave a second opinion, a living will, or a report by the Medical Inspectorate. Among others the following variables were registered: the doctor's specialty and the patient's sex, age, and diagnosis. Diagnoses were classified according to the International Classification of Diseases (ICD-9). We grouped the diseases on the basis of their occurrence among the reported cases of euthanasia.

From 1984 to 1993, 1707 cases of euthanasia were reported. The number of cases reported increased from 1 in 1984 to 426 in 1993. Most cases were reported by general practitioners (74%). Specialists and nursing home physicians reported fewer cases (22% and 3%). There were more male patients than female (57% v 43%). The average age was 62 years for men and 65 years for women (SD 15 years). Table 1 shows that 78% of the cases concerned patients with cancer and 9% patients with AIDS.

To compare the number of cases of euthanasia with the total number of deaths due to a specific disease, we derived data on the total number of deaths in North Holland per diagnosis per year from Statistics Netherlands. From 1984 to 1993, 0.82% of all deaths were due to reported cases of euthanasia (table 1). The percentage of cases of euthanasia was higher for patients with AIDS (13.41%), multiple sclerosis (5.35%), amyotrophic lateral sclerosis (4.08%), and cancer (2.26%). It was particularly low for patients with diseases of the circulatory system (0.05%).

Table 1

Diagnoses for reported cases of euthanasia and assisted suicide (n=1707) compared to diagnoses for all deaths (n=206777) in North Holland 1984-93 (values are numbers and rounded percentages)

View this table:


This is the first study of this scope that provides insight into the characteristics of cases of euthanasia reported to the public prosecutor. One limitation is that it deals only with reported cases of euthanasia and therefore does not extend to the “dark numbers”—cases that were not reported. Nevertheless, our results may apply also to unreported cases since an earlier study found no differences in age, sex, and diagnosis between cases of euthanasia reported by general practitioners and those cases they did not report.2

The increase in the number of reported cases may be due to an increased willingness of patients to seek doctors' help with euthanasia, although earlier research suggests that at least part of the increase is due to doctors' increased willingness to report cases.2

The proportion of all deaths due to euthanasia varies greatly between different diseases. If death does not come unexpectedly, the decision to perform euthanasia apparently depends greatly on the extent to which intolerable and hopeless suffering are experienced. This study provides some evidence that this differs not only between patients but also between diseases.


  • Funding The Euthanasia Research Foundation.

  • Conflict of interest None.


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