Intended for healthcare professionals

Feature End of Life Care

Fear of assisted dying: could it lead to euthanasia on demand or worsen access to palliative care?

BMJ 2019; 364 doi: (Published 26 February 2019) Cite this as: BMJ 2019;364:l852

Read our collection of articles on assisted dying

  1. Angelika Albaladejo, independent journalist
  1. Los Angeles, USA
  1. angelikaalbaladejo{at}

As the Royal College of Physicians in the UK polls its members on assisted suicide, Angelika Albaladejo finds nuance in experiences of “help to die” laws in the Netherlands and Oregon

For about two decades physicians have been legally helping patients to die in the Netherlands and the US state of Oregon (box). Some doctors have decried a “slippery slope” toward more permissive practice, endangering vulnerable people and reducing access to palliative care. However, evidence of more nuanced experiences shows that end of life care has improved across the board. No evidence supports the claim that health systems favor assisted deaths for cost reasons.

Theo Boer, an ethicist on a Netherlands euthanasia review committee from 2005-14, tells The BMJ that gauging patients’ suffering is a subjective process, which has led to increasingly broad interpretation and application of the law in that country.1

He initially supported the law because he thought that people seeking euthanasia would almost exclusively be terminally ill patients. He still supports it to an extent, he says, because of “large democratic support,” but he worries that “euthanasia to prevent a terrible death” is shifting to “euthanasia to prevent a terrible life.”

The numbers of requests and deaths in the Netherlands have increased nearly every year since legalization in 2002, for no clear reason. In 2012, 4188 people had help to die. In 2017, 6585 (4.4%) of all deaths were by euthanasia.2 Almost 90% of euthanasia patients (5893) had had incurable conditions diagnosed, such as cancer, neurological disorders, and cardiovascular or pulmonary disease, or a combination.

The current controversy in the Netherlands concerns patients with advanced dementia or psychiatric conditions who choose euthanasia. In 2017 these patients numbered three and 83, respectively.

Pushback from doctors

A 2017 survey of 1456 Dutch doctors who responded found that most (82%) would …

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