The law also applies to minors: it provides that a doctor may accept a minor`s request if his or her parents are involved in the decision-making process (if the minor is between 16 and 18 years of age) or may give parental consent (if he or she is between 12 and 15 years of age). In addition, since 2005, a protocol known as the “Groningen Protocol” lists the conditions and necessary steps to be followed with regard to end-of-life decisions for young children, especially newborns. From 2014, the Ethics and Legal Commission of the NVK (Nederlandse Vereniging voor Kindergeneeskunde – Dutch Children`s Association) proposed to hold discussions on the approval of euthanasia for children under 12 years of age (the decision would be taken by both parents and the doctor without necessarily having the child`s consent) . Already in 2015, the NVK had ruled in favour of euthanasia of children aged 1 to 12 on the basis of an analysis of the capacity for judgment . In cases where children cannot understand or speak for themselves, the doctor could choose euthanasia with the consent of both parents, as is already the case for newborns. Under current Dutch law, euthanasia by doctors is only legal in cases of “desperate and unbearable” suffering. In practice, this means that it is limited to people who suffer from serious illnesses such as severe pain, exhaustion or asphyxiation. Sometimes psychiatric patients who have proven to be incurable may receive euthanasia. There is a lot of discussion about people with early-onset dementia who have already stated in a written will that if they ever have dementia, they want to get euthanasia.
 Beyond medical technology issues, there are many real ethical issues that need to be clarified. The clear aim is that, thanks to these new guidelines, organ harvesting from people who have died of euthanasia will be facilitated and that the number of autopsies available in the Netherlands will be doubled. Nevertheless, it is worrying that medical or societal pressures to preserve organs may lead individuals to “sacrifice” themselves through a misunderstood notion of charity between sick and healthy people. The issue of euthanasia is likely to remain at the top of the medico-legal or ethical agenda in many countries in the years to come. One reason, according to some experts, is the growing insistence that patients in many countries have the final say in the true sense of the word on their medical treatment. In the Netherlands, euthanasia can only be carried out under strict conditions laid down by Dutch law. Golden butterflies adorn the walls of the Netherlands` only euthanasia centre of excellence, built to commemorate thousands of patients who have chosen to die with dignity over the past two decades. In 2016, the number of official cases of euthanasia in the Netherlands was 6,091, or 4% of all deaths in the Netherlands.  NVVE data show 2,123 cases of euthanasia reported in the Netherlands in 2000, although the actual number is likely higher as it is believed that not all cases are reported to the coroner. The Euthanasia Centre of Excellence is located in a leafy suburb of The Hague and is the only one of its kind to provide information, support physicians and offer euthanasia as end-of-life care, which will take place on 1. It was first legalized in April 2002 in the Netherlands. According to the official report of the regional euthanasia review committees in 2016, physicians at the end-of-life clinic performed approximately 400 euthanasia cases, compared to 107 in 2013.
They gladly accept the most borderline and “complicated” cases that other doctors do not necessarily think are justified, and yet this clinic does not seem to notice being reprimanded by the supervisory board or the judiciary (see below). The decision follows a landmark case unrelated to the Center of Excellence in which a doctor was acquitted of euthanasia in 2016 on a woman with severe Alzheimer`s disease who had previously ordered the procedure. While some denounce violations of the law, others want to expand the conditions of access to euthanasia and practices. Parliament is under pressure to allow assisted suicide to people over 70 who request it, for no reason other than their age and “tired of life.” At the beginning of 2010, for example, the association “Aus freier Willen” (Uit vrije will) organised a citizens` initiative petition to force a parliamentary debate. A draft law presented by the government in October 2016 is currently under consideration. Australia`s Northern Territory was the first place in the world to legalize euthanasia in 1996, but the law was repealed after nine months. Prominent figures such as Professor Theo Boer have denounced the slippery slope towards trivialization and loss of control of euthanasia, which is becoming the standard method of dying cancer patients. In 2010, 3,136 cases were reported in which a physician assisted in the death of a patient.
In the categorization, there were 2,910 cases of “end of life on demand”, 182 cases of assisted suicide, and in 44 cases, it was a combination. The evaluation commissions decided that in 9 cases the procedure was not based on the protocol and referred the cases to the Public Prosecutor`s Office and the Health Inspectorate.  The number of reported cases has increased by 8% each year. By 2017, the number of reported euthanasia cases had increased to 6,585; 99.8% of them are carried out with care.  The reason for this increase is unclear.  French Health Minister Bernard Kouchner, a doctor by training, said last year that he would use the Dutch decision to push for the legalization of euthanasia in France and confessed to committing clemency killings himself in Vietnam and Lebanon. In its final recommendations, the 3rd five-year evaluation report (2012-2016) of the Dutch law nevertheless stresses that “the government should reaffirm the fact that doctors are not obliged to accede to requests for euthanasia. The report also included the following suggestion: “Waiver of the legal obligation to require referral to a colleague in cases where physicians deny a request for euthanasia or assisted suicide (conscience clause).” Around 3000 cases of voluntary euthanasia are carried out each year in the Netherlands. Rob Jonquierre, executive director of the Dutch Society for Voluntary Euthanasia, believes the new legislation will not lead to a massive increase in the number of cases. He told the bulletin: We might see more inquiries because patients might find it easier to talk to a doctor about euthanasia knowing that the doctor is not going to commit a crime now. In 2016, there were 16 cases of euthanasia per day in this country for a population of 16.8 million; This represents 4% of all deaths per year. Belgium could be the next country to change its mercy killing laws, as a bill to partially decriminalize euthanasia is currently before parliament.
In Belgium, it is estimated that 72% of the population supports some kind of death on demand. In 2009, the Regional Review Committee reported 12 cases of euthanasia for neurological conditions, including people in the early stages of Alzheimer`s disease. In 2016, 201 cases of euthanasia were reported for psychiatric illness (60 cases) and dementia (141 cases), according to the data. The capacity of a person with a mental disability to consent is difficult to determine and, as a result, many physicians reject euthanasia for these patients. The issue of “suffering with no prospect of improvement” could also be raised in some psychiatric cases. In the Netherlands, euthanasia is governed by the Act on End of Life on Request and Assisted Suicide (Review Procedure)”, adopted in 2001 and entered into force in 2002.