In 2022, the most recent year for which there is data, Dutch officials recorded 8,720 cases of euthanasia, a 13.7 percent increase from 2021, when there were 7,666 cases. To put this in perspective, there were a total of 170,100 deaths in the Netherlands in 2022—meaning euthanasia cases comprised more than 5 percent.
“This upward trend, in both the absolute and relative numbers, has been visible for a number of years,” the country’s Regional Euthanasia Review Committee’s 2022 Annual Report states. What’s more, the number of euthanized people between the ages of 18 and 40 jumped from 77 in 2021 to 86 in 2022. And the number of people with psychiatric disorders who choose euthanasia is rising: In 2011, there were just 13 cases; in 2013, there were 42; and by 2021, there were 115.
This trend is not limited to the Netherlands. From 2018 to 2021, countries where euthanasia or assisted suicide is most popular saw sizable increases in the number of people signing up to die: In the United States, where ten states and the District of Columbia have physician-assisted suicide, there was a 53 percent jump; in Canada, 125 percent.
Meanwhile, studies show that the rise of legal suicide coincides with a rise in suicide in general. A 2015 study conducted in Britain by bioethicist David Jones and economist David Paton found that the eight U.S. states where euthanasia was then legal have seen an increased rate of total suicides—including those that were state-sanctioned and those that were not—relative to other states.
For example, in Oregon, which in 1997 became the first state to legalize assisted suicide, the total suicide rate rose from 15.9 per 100,000 people, pre-legalization, to 16.9, post-legalization—while the suicide rate in all other states dipped from 11.8 to 11.3. In Washington, the second state to legalize, in 2008, the pre-legalization total suicide rate was 13.3, and the post-legalization rate was 15.3, a 15 percent increase.
All this pointed to a “dystopian view of the future,” said Theo Boer, the healthcare ethics professor.
“Whether or not you’re religious, killing yourself, taking your own life, saying that I’m done with life before life is done with me, I think that reflects a poverty of spirit,” Boer told me.
None of this seems to trouble the right-to-die movement—quite the opposite. Ever since Oregon adopted the first physician-assisted suicide law, in 1997, and then the Netherlands became the first country to legalize euthanasia four years later, the movement has pushed its way across Europe, North America, Australia, and New Zealand, and later, Colombia, Ecuador, and Cuba.
“The movement has reached a threshold where it is unstoppable,” Barbara Coombs Lee, the president of the right-to-die group Compassion & Choices, said back in 2015.
The Dutch group Coöperatie Laatste Wil or Last Wish Cooperative (CLW) is at the cutting edge of the movement. It is pushing for even cheaper, easier to access assisted suicide. One day, if CLW has its way, everyone will have suicide kits—including sodium azide pills, painkillers, anti-nausea tablets, and sleep aids—in their medicine cabinets. The kits will be readily available at the local pharmacy, grocery store, or on Amazon. (To ensure toddlers can’t pop sodium azide, each kit will come with a fingerprint-identification lock.)
But for now, CLW is fighting to de-medicalize assisted suicide—allowing anyone to end their life without the help of a doctor. In late 2022, CLW filed a lawsuit against the Dutch government arguing that its regulation of assisted suicide violates the European Convention of Human Rights. The suit is ongoing, with 80 percent of Dutch people voicing support for the bill in a poll last October.
“We don’t want the medical profession to interfere with your wish to be dead,” Jos van Wijk, the head of CLW, told me.
Dutch law requires those seeking assisted suicide to show they are in great pain, have no alternative, and are acting of their own volition. They also must get sign-off from at least two doctors, including a psychiatrist. The process can take a few years, culminating with a doctor giving the patient a fatal medication or, if done by oneself, a cup filled with poison to drink. When it’s over, a government panel reviews the case to ensure everything was above board.
Martje van der Brug, 65, a Dutch novelist and CLW member pushing for the bill, said the current red tape around legal suicide leads desperate people to kill themselves in a more dramatic and bloody fashion.
“We, as adults, should have an option to get out of life without jumping in front of a train or from a building or doing something horrible, but through humane means,” she told me. “There’s no government, no doctor, no religion, no nothing who should decide this for us.
“Everyone is afraid that people will start pouring poison in their mother-in-law’s coffee or kill the neighbor,” van der Brug added. But everyone, she said, has things upside down. In the future, she hopes, people will view CLW and the larger completed lives movement “from the vantage point of mercy” rather than as an “accomplice to suicide.”
When it was her time, van der Brug said, she wanted to go quickly—with the aid of sodium azide—and she envisioned leaving this world surrounded by friends and family, with lit candles and a glass of wine.
“Much better than a lonely suicide,” she said.
Canada offers some insight into what happens to a culture when euthanasia becomes normalized.
In 2016, the country implemented the “medical assistance in dying” program, or MAiD, which legalized assisted suicide for those whose deaths were “reasonably foreseeable.”
When Prime Minister Justin Trudeau introduced the MAiD legislation that year, he said his government was “focused very much on respecting Canadians’ rights” and “defending their choices.” In 2017, the first full year in which MAiD was in effect, 2,838 people chose to die by assisted suicide. By 2021, that figure had jumped to 10,064, accounting for more than 3 percent of all deaths in Canada. In 2022, it was 13,241.
By early 2023, 61 percent of Canadians supported MAiD but opposed expanding it, as planned, to include the mentally ill. Fueling that opposition was news that poor people had been nudged into assisted suicide. In late January, Canada’s government announced that it was postponing the MAiD expansion until 2027—after the next federal elections take place in 2025.
All this has raised questions about whether the right-to-die movement—which has gripped much of the West—is really about self-empowerment, as its supporters insist, or whether it points to something darker eating away at our civilizational fabric.
“Look at the countries that have legalized it,” bioethicist David Jones told The Free Press. “It’s not Somalia, it’s California. It’s not Bangladesh, it’s Canada or Luxembourg. It’s places where people are used to having more and more control, where people have more difficulty with accepting that there are some things that they simply will never be able to control.”
Trudo Lemmens, a Belgian bioethicist at the University of Toronto’s law school, suggested that expanding the parameters of assisted suicide would encourage those who are already unstable to view suicide as a cure to what ails them, stating that “this may undermine the resilience of people faced with complex conditions.”
He had in mind people like Zoraya ter Beek.
Or Lauren Hoeve.
On November 30, 2022, Hoeve, a Dutch YouTube creator who was then 27, took to her newly created blog, Brain Fog, to announce that she wanted to die.
She explained that she had autism, ADHD, ARFID (a.k.a. avoidant/restrictive food intake disorder), depression, anxiety, a “history of complex trauma,” and, since 2019, myalgic encephalomyelitis, or chronic fatigue syndrome.
She added that she had registered with the Euthanasia Expertise Center, in The Hague, to get the ball rolling.
In December 2023, a little more than a year later, Lauren’s mother, Leonie, wrote in her daughter’s blog that “the end point is getting closer.”
“I understand very well why Lauren chose this path and I am also happy about it, because there is no alternative at all,” Leonie wrote. “And plenty of time to say goodbye, say everything that can still be said. This is the best humane way to say goodbye to life, falling asleep peacefully. How beautiful is that?”
On January 27, Lauren—who had no terminal illnesses—tweeted that, at long last, her wish to be euthanized was coming true.
“This will be my last tweet,” Lauren wrote. “Thanks for the love, everyone. I’m going to rest a bit more and be with my loved ones. Enjoy a last morbid meme from me.”
The photo next to her post was labeled “Me getting euthanized.” It featured a child wearing sunglasses and lying on a gurney, while giving a thumbs-up.
Soon after, a doctor started an IV on Lauren and administered a drug that plunged her into a coma, followed by another that stopped her breathing.
She was at home, surrounded by her parents and a close friend.
At 1:55 p.m. that day, Lauren, 28, was pronounced dead.
Lemmens suggested that people like Lauren Hoeve may have been influenced by stories of other people’s premature deaths—and that Zoraya’s premature death would cause other young people to take the same way out.
“I am inclined to think that suicide contagion plays a role in some of these cases,” he said. (When I asked Zoraya ter Beek about this, she dismissed it as “media hype.”)
Along those lines, Frank Miller, a bioethicist at Weill Cornell Medical College and the National Institutes of Health, worries that the new, more expansive assisted-dying ethos means that many people will die who shouldn’t.
“Many suicides are driven by depression that may be effectively relieved by drugs and/or talk therapy,” Miller said in an email. “Also, they can be impulsive, and it becomes all too easy for people to kill themselves with easy access to lethal agents.”
Theo Boer added: “Death is gradually moving into the very center of our discussions and also the very center of where we see the solution to our problems. Supply has created demand.”
Proponents of the completed lives movement agree with Jones that the right to die is very much about control—taking control of our death and overcoming our squeamishness, our fear.
That was certainly how Daan Bakker,* a retired 72-year-old Dutch radiologist, saw it.
On August 9, 2023, Daan told his wife, Sophie, that he wanted to die. The next day, ideally.
He had suffered a stroke, which was followed by a debilitating heart attack, and then another, and now it was getting impossible to walk or eat or live.
The next evening, Sophie made a bowl of soup for her husband, and he took two capsules of sodium azide, which he had obtained from “someone who knew someone” and had no idea he wanted to die, she said. (Sodium azide can be used to make sponge rubber, among other things.)
As he lay in bed, Daan and Sophie held hands and listened to Vivaldi. They had met in school more than a half-century before; they had four children and three grandchildren; and now their life together was ending.
Daan’s last words to Sophie were: “I cannot leave you behind. But I am relaxed, and if this is the way I am going to die, it is excellent.”
Sophie replied, “I love you.”
In the early morning hours of August 11, Daan slipped away.
It was, as far as right-to-die activists were concerned, a perfect death. (There is, in fact, a great deal of debate about how painless death by sodium azide is. The drug starves red blood cells of oxygen, and it can take anywhere from 40 minutes to a few hours to pass away.)
Sophie felt lucky—for her husband and herself. There are a few leftover pills that she plans to take when it’s her time to bow out.
“It’s a very relaxing idea to have them at home,” Sophie said. “I don’t know if I’m going to take them, but to have them and to have the ability to take them if life is not good anymore is very, very relaxing.”
Philip Nitschke, in Melbourne, Australia, prefers to think of death not as an awful end but the start of a great journey.
With that in mind, in 2017, Nitschke, who is a physicist and doctor, created a suicide machine that doubles as a casket. (He has been called the “Elon Musk of assisted suicide.”)
“The Sarco is a 3D-printable machine that provides death by hypoxia, an environment with low levels of oxygen,” Nitschke wrote in a 2018 article. “It can be transported wherever one chooses. Facing the awe of the Rockies? Overlooking the crashing waves of the Pacific Ocean? Where you die is certainly an important factor.”
He views the Sarco as part of a reimagination of the inevitable—liberating “prisoners of medical treatment” from “Western technological medicine.”
It is no coincidence that the Sarco, which is short for sarcophagus, resembles a miniature spaceship ready to blast off into the great unknown. (The spaceship rests atop a canister of nitrogen that, when inhaled in the absence of oxygen, kills you. It should be noted that this is the same way that Alabama now executes its death row inmates, which UN officials have likened to “torture.”)
“This most important day in a person’s life should be marked with a sense of occasion, even celebration,” Nitschke told The Free Press.
The initial prototypes have been expensive, Nitschke said, but 3D printing costs are going down.
“Printing costs drop with each model,” he said in a message, adding that the most recent model cost less than “25K euro and we expect costs to fall further to around 10–15K.”
“Final instrument testing” on the Sarco is scheduled for early April—and then, Nitschke said, liftoff.
“We expect first use in Switzerland in the next few weeks,” he said.
All this talk about embarking on a great journey was typical of right-to-die activists “romanticizing” assisted suicide, David Jones, the bioethicist, said.
Jones said the recent trend of “duo euthanasia,” in which both spouses kill themselves at the same time Romeo and Juliet–style, has only exacerbated this romanticization—for example, the double suicide, in February, of former Dutch prime minister Dries van Agt and his wife, Eugenie. Both were 93 and said to be ill; the former prime minister had apparently never fully recovered from a 2019 brain hemorrhage. (Progressive group The Rights Forum issued a statement after his death, saying the prime minister and his wife died “together and hand in hand.”)
“There’s lots of ambiguity with these cases,” Jones said. “Like whose decision really was it? And was it an equal decision on both sides? And were they both equally ill?”
He added: “It tends to be that the man goes, and the lady follows.”
I asked Piet de Groot, a CLW member and a self-described pious Christian, whether he has any problem with euthanasia and assisted suicide and about the philosophical divide between the right-to-die camp, which views life as a commodity, and the faithful, who say it is not our place to end a life that God has created.
“We want to go when we are still happy and comfortable,” de Groot said simply. “It’s not that everyone should do it, but people should have the freedom to do it.”
He added that, in the Bible, there are seven suicides, and no one ever calls it a sin.
Theo Boer, the bioethicist, acknowledged that none of the suicides in the Bible is condemned, but he added that they are not lionized or commemorated either.
“Suicide in the Bible belongs in the realm of the tragic, and the tragic should not be condemned—nor should it be regulated or celebrated,” he said.
He feared that this was, ultimately, the price we will pay for low-cost, easy-access suicide: a loss of the sense of the tragic.
“When we’re talking about euthanasia and completed life and assisted suicide, the individual is saying, ‘I want to be killed,’ ” Boer said. He thinks that we need to keep that in mind always, that we shouldn’t let the new language camouflage what is happening. “Let us keep that vocabulary alive instead of concealing it with a sweet layer of ‘completed life.’ ”
Marion van Gerrevink is one of the 29 individuals who has signed onto CLW’s lawsuit against the Dutch government alleging that regulation of assisted suicide is a human rights violation. (A court ruled against CLW in late 2023, but members have vowed they will appeal.) She doesn’t believe the country’s elected leaders should tell people when they can die, or how, or who can help them, and she thinks they create real pain and suffering by making suicide harder to access.
When I asked where her convictions come from, she said it had everything to do with her son, Rob.
Rob had battled autism and ADHD since he’d been a kid, and he dressed like a goth and sported a mohawk.
His dream was to become a chef in Amsterdam, an hour away, and he had an infectious laugh, but he felt all alone, Marion told me.
“You have to keep going,” she recalled telling Rob. This was maybe 15 years ago. “You have to have faith. It’s going to get better. Keep fighting those bad thoughts.” She meant the depression, the not fitting in, the dropping out of culinary school, the inability to find friends or girlfriends.
Sometimes, when things got really bad, when she felt helpless, she’d tell him: “If you really can’t take it anymore, then just go, but don’t involve other people.” She advised him not to jump from a building, because “it would cause trauma to other people.” She didn’t have any ideas about how he should kill himself. She just knew that he shouldn’t make a mess.
After he was kicked out of an assisted living facility for smoking weed, he moved back home to his parents’ place, in Beekbergen.
And then, slowly, unexpectedly, things started to improve, his mother said. After all the ups and downs, he seemed to like the familiarity of home, his two Jack Russell terriers, his family.
The first weekend of May 2010, they watched movies and laughed a lot, and the family took a walk through Rob’s favorite forest, where he had spent so many happy times as a Boy Scout.
On Monday morning, Marion woke up in an especially good mood: she had recently found a psychiatrist who, she thought, could help Rob.
Rinke, Rob’s father, left early for work. Marion asked Rob to make them coffee, and she went upstairs to shower. She noticed that he had taken off a ring his grandmother had given him on his 18th birthday and left it on his desk.
When she came down, a half hour later, it was quiet. She didn’t see Rob anywhere.
Finally, she went to open the laundry room door, but it was blocked. She pushed harder. And then harder. And after a lot of pushing, she forced her way into the laundry room—where she discovered her son dangling from the ceiling. He had hanged himself. He was 22.
Marion recalled removing her son’s neck from the makeshift noose and laying him on the floor. “It’s okay, you can go now,” she told him.
In retrospect, she said, her son’s suicide was a foregone conclusion. What bothered her most was not that he had killed himself but how. That’s why, in 2013, she joined CLW.
“I am deeply resentful of why there wasn’t a means to let him gracefully transition out of life and why he couldn’t have support for that final step,” Marion said. “That is the greatest sorrow for me, that I was there at his birth but not at his death.”
*Sophie and Daan Bakker’s names have been changed.
