Euthanasia in the Netherlands: ~5 % of Deaths in 2023 — What Does It Mean?

In 2023, official review committees in the Netherlands received just over 9,000 notifications of euthanasia (active life-ending on request or assisted suicide). Given that the total number of deaths that year was around 169,000, the euthanasia cases represent about 5.4 % of all deaths.

That figure — around one in twenty deaths — is remarkably high by global standards. But it merits a careful, contextual view: how reliable is it? How does it compare to other countries? Are there any parallels?

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Accuracy & Reporting: Caveats and Considerations

• Reported vs. Actual Cases
  The 5 % figure is based on notified cases. Some argue that a fraction of cases go unnotified or fall into grey areas. Nevertheless, the Netherlands has a long-established reporting and review system, and many analyses treat the official numbers as broadly credible.

• Definitions & Legal Framework
  These deaths are voluntary, physician-assisted euthanasia or assisted suicide, under strict conditions defined by Dutch law. They do not include passive end-of-life choices (withholding treatment, palliative sedation, foregoing life-prolonging measures). Because of this, comparisons with other countries must distinguish between active interventions and broader end-of-life decisions.

• Trends Over Time
  The share of euthanasia deaths in the Netherlands has increased over past decades. In earlier years it was much lower than 5 %.

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How Does the Netherlands Compare Internationally?

Very few jurisdictions approach anywhere near 5 % of deaths via legally sanctioned euthanasia or physician-assisted suicide.

Belgium

Belgium legalized euthanasia shortly after the Netherlands. Over time, its rates have climbed, but remain lower proportionally. In 2023, Belgium reported around 3,400 euthanasia cases — relative to its population and total deaths, that share is below the Dutch level.

Canada

Canada’s medical assistance in dying (MAID) program has grown rapidly. In recent years, assisted deaths have accounted for about 4 % or slightly more of all deaths nationwide. That makes Canada the closest comparator, though still somewhat lower than the Dutch figure.

U.S. States (Oregon, Washington, etc.)

In Oregon, under the Death With Dignity Act, assisted suicide is legal under narrow conditions. The rate, however, is extremely low in proportion to overall mortality—on the order of 0.1 % or less of all deaths.

Switzerland, Germany, etc.

• Switzerland permits assisted suicide but not active euthanasia.
• Germany has decriminalized assisted suicide in certain circumstances, but the scale is far smaller relative to total deaths.

Unique Cases & Mental Health Grounds

The Netherlands also stands out because it permits euthanasia (with strict safeguards) for psychiatric suffering, dementia, and advance directives, in exceptional cases. In 2023, there were more than one hundred cases attributed to psychiatric disorders. This makes the Dutch framework broader than most other countries.

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Implications & Ethical Questions

• Normalization & Slippery Slope Concerns
  When over 1 in 20 deaths proceed via euthanasia, critics raise the possibility of expanding eligibility, pressure on vulnerable patients, or social acceptance of death as an option.

• Safeguards and Oversight
  The Dutch system includes review committees, mandatory reporting, second opinions, and legal criteria. Violations are rare but monitored.

• Public Debate & Legislative Reassessment
  The rising numbers—especially in mental health related cases—have sparked debate. Some argue for tightening criteria, increased scrutiny, or higher age thresholds.

• Comparative Perspective
  The Netherlands’ high proportion raises questions about cultural, legal, medical, and social differences. Why is such a system more accepted there than in many other places?

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Conclusion

• In 2023, about 5.4 % of all deaths in the Netherlands were by euthanasia or assisted suicide under legal protocols.
• Compared to other countries, this is extraordinarily high. Very few — if any — jurisdictions approach this share under legalized active euthanasia.
• The Netherlands is also unusual in permitting euthanasia in certain cases of psychiatric suffering, dementia, and advance directives.
• That said, the number should be viewed with nuance: it refers to reported, legally sanctioned cases (not all end-of-life choices) and rests on strong regulatory safeguards.