How a doctor, sailor and lecturer changed Europe’s assisted dying debate

Moves to legalise euthanasia are gathering pace and public opinion in many countries is now in favour of reform

The case of Zoraya ter Beek comes at a time when moves to legalise assisted dying are picking up pace across Europe. Seven European countries have already legalised euthanasia and courts in Italy and Germany have ruled in its favour. A bill to allow people to request assistance in dying will go before the French parliament on May 27. Ireland is also considering legislation, and a bill has been tabled in the Scottish parliament.

The issue triggers passionate arguments on both sides, but there is little doubt that public opinion in many European countries now supports people with terminal illnesses having some control over the timing and manner of their death.

Here, Guardian correspondents look at the changing picture of assisted dying in Europe.

The Netherlands

In 1973, the prosecution of a rural doctor, Truus Postma, for injecting her terminally ill mother with 200mg of morphine challenged the Netherlands to rethink death options. It became the first country to legalise euthanasia in 2002, and now has one of the world’s most open laws.

Truus Postma getting out of a car
Truus Postma. Photograph: Bert Verhoeff/Anefo/Nationaal Archief

As well as physical diseases, such as terminal cancer, it recognises suffering in dementia, psychiatric causes and “multiple geriatric symptoms” such as immobility, deafness and blindness. Euthanasia can only be carried out by a doctor.

People requesting euthanasia must be of sound mind and make a voluntary request. They must be experiencing “unbearable suffering with no prospect of improvement”, be properly informed about their situation and choices, and have no other reasonable solution. An independent doctor must agree (and, by convention, also a second psychiatrist in cases of non-physical suffering).

Every case is examined by regional committees, and doctors risk prosecution if a committee concludes that the conditions were not met – which has happened in one case of a dementia patient and another involving psychiatric suffering.

Some have raised concerns about an increasing number of cases in recent years in areas such as advanced dementia, “duo” euthanasia of couples, and psychiatric suffering.

But Menno Oosterhoff, a psychiatrist who has given euthanasia for psychiatric suffering, said there was “greater acceptance” of such cases. “You are talking about unbearable and hopeless suffering, and we know this because a lot of people commit suicide.

“If you had said 50 years ago that within 50 years one in 20 people will die from euthanasia, we would have screamed bloody murder. Most people now think it is humane that you should no longer make people suffer to the bitter end. There has been a huge change in the Netherlands.”

Senay Boztas in Amsterdam


In Spain, it was a charismatic sailor who cast a spotlight on the issue, setting in motion a movement that led to physician-assisted dying and euthanasia being legalised in 2021.

Nearly 20 years earlier, Ramón Sampedro, who was paralysed from the neck down after a diving accident at the age of 25, had asked the country’s courts to allow him to die.

Ramón Sampedro lying in a bed
Ramón Sampedro described himself as ‘being a living head glued to a dead body’. Photograph: Lavandeira Jr/AP

When his appeals were rejected, he turned to his friends for help in ingesting a potassium-cyanide concoction. At the time, the identity of those who had helped him to kill himself – a crime punishable by up to 10 years in prison – remained a mystery.

“When I have drunk this I will have renounced one of the worst types of slavery, that of being a living head glued to a dead body,” said Sampedro, whose story was told in the 2004 Academy award-winning film The Sea Inside.

His case is often credited with why, in the lead-up to Spain’s 2021 legalisation, polls suggested that as many as 87% of the country agreed with the statement that “people with incurable diseases should have the right to access medically assisted dying”.

What sets Spain apart is that assisted dying is recognised as a constitutional right, said Loren Arseguet of the campaign group Right to Die with Dignity. “The Dutch law, for example, is made to protect doctors who practise euthanasia,” she said. “While in Spain, it is a patient’s right if they meet the conditions of the law.”

The law also provides a special dispensation for medical workers who refuse to participate on grounds of belief.

In the first 18 months, 383 people with serious and incurable or debilitating diseases opted for an assisted death, according to the country’s health ministry. During this time frame, about 0.07% of all deaths in Spain were by euthanasia, compared with 5.1% in the Netherlands or 2.5% in Belgium, said Arseguet.

The Spanish law does not distinguish between physical or mental illnesses when it comes to requesting assisted dying, said Arseguet. Instead the law is quite broad, allowing anyone to make a request if they have a “severe, chronic and debilitating condition or illness” with no possibility of improvement.

People wearing caricature masks of Salvador Dalí carry skull and crossbones flags through a street
People protesting against a law to legalise assisted dying, in Madrid in 2020. Photograph: Manu Fernández/AP

The process of seeking approval took an average of 55 days in 2022. Candidates must submit two requests in writing and undergo consultations with medical professionals not previously involved in the case before being signed off by a regional committee of experts.

The issue remains polarising, with conservative and far-right lawmakers staunchly opposed. This division is reflected across Spain’s 17 autonomous regions. “In regions where the conservative People’s party are in power, they’ve done the minimum of what’s legally necessary, but they haven’t made much effort in terms of training professionals or educating the public,” said Arseguet.

Ashifa Kassam in Madrid


In 2013, Marie Fleming, a university lecturer with multiple sclerosis, went to the supreme court to demand the right to an assisted death. She lost the case, but won widespread public attention. A high court judge said she was “the most remarkable witness which any member of this court has ever been privileged to encounter”. Fleming died in December 2013.

Just over 10 years later, in March this year, an Irish parliamentary committee recommended legislation to permit assisted dying for those with a terminal illness or only a short time to live.

Right-to-die campaigner Marie Fleming
Right-to-die campaigner Marie Fleming. Photograph: Niall Carson/PA

The legislation would apply to people diagnosed with an illness or a medical condition that is “incurable, irreversible, progressive” and at an advanced stage that will cause death within six months. The time limit for those with a neurodegenerative condition would be extended to 12 months.

The all-party committee submitted its landmark report after 14 months of testimony from experts in law, ethics, medicine, disability, palliative care and psychiatry, as well as from people who shared personal accounts of end-of-life care. “These heartfelt stories were difficult to tell and difficult to hear but they helped to inform the committee members and deepened our understanding of this sensitive topic,” the report said.

The report’s conclusions appeared to be in tune with public sentiment, which has become increasingly secular in a country once dominated by the Catholic church. A 2020 opinion poll found that 52% of voters favoured allowing people to be given medical assistance to end their lives, with 17% opposed and about a quarter undecided.

Representatives of Christian churches and a Muslim cleric opposed the recommendation, saying it was morally wrong to kill. Some psychiatrists argued it could lead to “a slippery slope” with increasing numbers seeking to end their lives.

Three members of the 14-member committee, including the chair, Michael Healy-Rae, dissented and said the existing ban should be retained. Assisting a death carries a potential 14-year jail sentence in Ireland.

Constitutional law experts said the recommendation would require a simple law change, not a referendum. It is unclear if the recommendation will be enacted.

Rory Carroll in Dublin


Dame Esther Rantzen’s disclosure in December that she would like the option of an assisted death in the face of her diagnosis of terminal lung cancer galvanised the debate over end-of-life care in the UK.

The 83-year-old television personality said she had joined Dignitas, the Swiss centre that offers assisted dying to non-Swiss nationals for about £15,000. “If the next scan says nothing’s working I might buzz off to Zurich – but it puts my family and friends in a difficult position because they would want to go with me. And that means that the police might prosecute them. So we’ve got to do something,” she told the BBC. The law needs to “catch up with what the country wants”.

Campaigners for assisted dying gathered outside parliament in April.
Campaigners for assisted dying gathered outside parliament in April. Photograph: Tolga Akmen/EPA

Within days, Keir Starmer, the leader of the opposition, announced he was backing calls for a change in the law, and later the prime minister, Rishi Sunak, said he would facilitate a change in the law if MPs wanted it.

Westminster MPs last voted on a proposal to legalise assisted dying in 2015, when they overwhelmingly rejected it by 330 to 118.

But since then there has been a significant shift in opinion in favour of assisted dying among lawmakers, members of the public and medical organisations. A change in the law to allow assisted dying for terminally ill adults is backed by 75% of the British public.

In February, a parliamentary inquiry into assisted dying warned of a looming divergence between different parts of the UK and British Isles.

At the moment, assisting a suicide in England and Wales is a crime with a maximum sentence of 14 years. A similar law is in place in Northern Ireland. In Scotland, there is no specific crime but helping a person to die could lead to prosecution for culpable homicide.

But Scotland and the crown dependencies of Jersey and the Isle of Man are all taking active steps towards legalising assisted dying. In each place, it would be restricted to residents in order to avoid “death tourism”.

Guardian 17th May 2024