Europe’s quiet revolution: when ‘dying with dignity’ replaces living with care

On 26 March 2026, Noelia Castillo Ramos died in a healthcare centre near Barcelona. She was 25. She was not terminally ill. Diagnosed with borderline personality disorder and left paraplegic after a suicide attempt following a sexual assault, she had requested euthanasia under Spain’s 2021 law. Her father challenged the procedure through the Spanish courts and at the European Court of Human Rights, but the challenges failed. Every court upheld her ‘right to die’. None paused to ask whether Spain had done enough to help her live.

Her case is not an aberration. It is the logic of a legal revolution playing out across Europe, one that replaces the ancient duty to care for the suffering with a new, sanitised permission to end their lives.

The continental drift

The picture across Europe divides sharply. In the West, euthanasia or assisted suicide is now legal in the Netherlands, Belgium, Luxembourg, Spain and, under specific conditions, in Austria, Germany, Switzerland and Italy. Portugal has legislated for euthanasia, but the law’s final form and entry into force have remained contested through constitutional review. France, the United Kingdom and Cyprus are currently processing their own bills. In Ireland, a parliamentary committee recommended assisted-dying legislation in 2024.

By contrast, in the East, the practice remains widely prohibited – in Poland, the Czech Republic, Slovakia, Hungary, Romania, Greece, Bulgaria, Croatia and beyond. The European Court of Human Rights, in the landmark Karsai v. Hungary judgment of June 2024, confirmed that signatory states are not obliged to legalise assisted dying and should instead establish quality palliative care. A welcome reminder: international law knows no ‘right to die’ – but it does guarantee a right to life.

Yet constitutional courts in Germany (2020), Austria (2020) and Spain (2023) have been driving the agenda from the bench, discovering new constitutional rights to ‘self-determined death’ where none existed before. In Germany, the Federal Constitutional Court struck down a ban on commercial assisted suicide organisations, creating a legal vacuum that has allowed such groups to proliferate across the country.

In Austria, the Constitutional Court effectively forced parliament to adopt an assisted suicide law. The Spanish Constitutional Court not only upheld the 2021 euthanasia law but went further, enshrining what it called a ‘right to self-determined death’ in euthanasia contexts. The case of Noelia Castillo showed what that right looks like in practice: a young woman with a treatable psychiatric condition, whose deepest need was sustained care and human connection, was instead offered a lethal injection.

The slope that was never hypothetical

Wherever euthanasia has been legalised, the numbers tell the same story. Belgium went from a few hundred reported euthanasia cases annually in the early years after legalisation to 2,658 in 2019 and 4,486 in 2025, another increase of 12.4% over 2024. Euthanasia now accounts for one in 25 deaths.

Similarly, the Netherlands saw cases more than triple in 15 years. The latest Dutch numbers speak for themselves: 9,958 euthanised persons in 2024, 5.8% of all reported deaths, and over 10,341 in 2025 (6% of all deaths). In the Netherlands, psychiatric euthanasia cases were up 60% in 2024, and 30 people under 30 were euthanised in 2024, compared with five in 2020.

In Canada, 7,595 people died by euthanasia in 2020 alone, a 34% increase in a single year. Health Canada’s Sixth Annual Report, published in November 2025, lists 16,499 ‘assisted deaths’ in 2024, another 6.9% increase over 2023. Over 76,000 people have been euthanised in Canada alone since legalisation in 2016. Today, one in 20 deaths in Canada is from euthanasia, or 5.1% of all deaths. In Canada’s 2024 official reporting, isolation or loneliness was recorded in 44.7% of Track 2 MAID cases (patients not nearing death) and 21.9% of Track 1 cases (those whose death is reasonably foreseeable).

These numbers speak but one language: what begins as an exception becomes routine. What is framed as compassion becomes infrastructure.

The categories of eligible persons expand relentlessly. Belgium extended euthanasia to children without any strict age limit in 2014, subject to their capacity to discern. The Netherlands introduced a ‘due-care procedure’ for terminally ill children aged 1–12 in certain cases; separate proposals for people who consider their life ‘completed’ remain politically contested. Even though that expansion is currently delayed until March 2027, Canada has legislated towards eligibility where mental illness is the sole underlying condition. In Belgium, the concept of ‘polypathology’ – meaning an accumulation of age-related conditions such as reduced sight, hearing loss or incontinence – has been accepted as sufficient grounds for euthanasia. In other words: growing old.

Meanwhile, the safeguards to prevent abuse have proven largely ineffective. In Belgium, only one case was referred to the prosecutor despite many tens of thousands of declared euthanasia cases since legalisation. A former member of the Belgian Control Commission resigned, writing that the body ‘deliberately violates the law and tries to hide it’. Research in Flanders suggested substantial underreporting, with only about half of euthanasia cases being officially reported.

A glimmer from the East

The counterpoint is instructive. In November 2025, Slovenia held a referendum on a euthanasia law that its parliament had passed earlier that year. Despite polls predicting comfortable support and a well-funded pro-euthanasia campaign, 53% of voters rejected the law. The human rights organisation ADF International supported the campaign in favour of life and quality palliative care, contributed a comparative study of European and Canadian legislation that enriched the national debate, and the Slovenian Supreme Court has since upheld the result. The people, when given the facts, chose care over killing.

The Scandinavian and Baltic countries have similarly resisted the trend. Norway’s Bioethics Committee took a strong stance against legalisation in 2023. The Portuguese Constitutional Court has repeatedly blocked euthanasia laws. These are not backward holdouts – they are societies that have looked at the evidence from Belgium, the Netherlands and Canada and concluded that something has gone profoundly wrong.

The question we refuse to ask

At the heart of all this lies a question that modern societies seem determined to avoid: what do we owe one another when life becomes difficult? The euthanasia movement offers an answer that is seductively simple: autonomy, choice, control. But the concept of a fully autonomous individual, freely choosing death without any external pressure, is a fiction. The German Constitutional Court itself acknowledged that 80–90% of people who survive a suicide attempt later regard their decision as a mistake and that psychological disorders are present in 90% of suicide cases. Yet the same court struck down the law designed to protect those very people.

The deeper problem is not legal but cultural. An ageing society confronted with loneliness, dementia, chronic illness and increasingly inadequate care systems finds it easier to offer a quick exit than to invest in the slow, costly, unglamorous work of accompaniment. It is no coincidence that the World Medical Association consistently and categorically rejects euthanasia as unethical, or that the Council of Europe resolved in 2012 that euthanasia ‘must always be prohibited’. Modern palliative care can address the vast majority of physical pain. What it cannot replace – but what euthanasia certainly extinguishes – is the human presence that gives suffering its meaning.

The civilisations that built Europe’s hospitals, hospices and care institutions understood something that our constitutional courts seem to have forgotten: that the measure of a society is not how efficiently it dispatches those who suffer, but how faithfully it stays by their side.

Noelia Castillo needed that faithfulness. She received a lethal dose instead. That is not dignity. It is abandonment dressed in the language of rights.

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What can be done

Where euthanasia or assisted suicide is already legal, the priority must be damage limitation and democratic accountability. Legislatures should commission honest and independent reviews of how safeguards actually function – not rely on control commissions whose members are often sympathetic to or even personally involved in the practice. Conscientious objection for healthcare professionals and institutions must be robustly protected, not eroded through referral obligations that make objectors complicit. Reporting requirements need tightening and enforcement strengthened. And parliaments should invest seriously in palliative care. A 2025 global palliative-care ranking developed by University of Navarra researchers using the new WHO framework shows how far most countries still have to go.

For states with no legalisation, Slovenia’s lesson is clear: informed public debate works. When citizens are given the facts, they tend to choose life. Governments should strengthen constitutional protections for the right to life, invest in palliative care and ensure that international pressure does not override domestic democratic decisions. The European Court of Human Rights is clear that the Convention does not oblige states to legalise assisted dying and stressed the importance of high-quality palliative care. That margin of appreciation should be used, not surrendered.

In both contexts, civil society is indispensable. Pro-life organisations, disability rights groups, medical associations and faith communities must work together to ensure the voices of the most vulnerable are heard, not silenced by a lethal injection. The question before Europe is not whether we can afford to care for the suffering. It is whether we can afford not to.

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