With permissive euthanasia laws looming in the United Kingdom, Dutch priests said their British counterparts can expect challenges to sacramental ministry, and the Church's public witness on the dignity of human life.
But one priest said that conversations with Catholics considering euthanasia can be an opportunity for serious and meaningful evangelization.
The Dutch euthanasia regime
“Euthanasia has become very normalized, it’s just part of Dutch society. Barely anyone hasn’t had a death by euthanasia in their family,” Elisa García, a medical ethicist and geneticist at Amsterdam’s Free University, told The Pillar this month.
However, the Church faces an increasing number of practicing Catholics, mostly elderly, who request euthanasia, and are open about it.
In February 2024, Dries van Agt, a former prime minister of the Netherlands and one of the best-known Catholic laypeople in the country, died by euthanasia at 93 years old along with his wife. Van Agst was a parishioner of the Cenakelkerk, near the city of Nijmegen.
“Ten years ago, you only knew someone underwent euthanasia after it happened. They didn’t mention it to the priest. Today, they speak openly to you about it,” explained Fr. Lambert Hendriks, rector of the Rolduc seminary in the diocese of Roermond and president of the Dutch Catholic Medical Ethics Association.
But Hendriks thinks that people’s openness in talking about their desires to be euthanized is also an opportunity for catechesis.
“Nowadays, the main issue is that people don’t realize it’s something problematic. They don’t even know the Church opposes this practice, which is why they openly talk about it with the priest. In a way, this is good, because if they talk to you about it you have the chance to catechize them about the value of life,” Fr. Hendriks added.
Fr. Hendriks said that he himself has had such experiences.
“Some time ago, I was called by the mother of a former schoolmate to do her brother-in-law’s funeral, because I was the only priest she knew. I then asked if I should make the funeral arrangements with her or another family member. But she told me that I could make an appointment with her brother-in-law the next week because he would then be euthanized,” he said.
“I said that I was very sorry, but I couldn’t do a funeral for someone who has chosen euthanasia, because it meant I consented to the practice, and I explained why I was against it. She told me that she would tell him it was not possible. But a day later, she called me again and said that she spoke with her brother-in-law about what I said, and he told her that he wanted me to celebrate his funeral, but [only] when he died in a few months — because he would cancel the euthanasia.”
Hendriks said that priests and pastoral workers should use similar situations to help address the reason people ask for euthanasia in the first place.
“In the six months between the call and this man’s death, we spoke many times, and it never seemed that [euthanasia] was something he was longing for, or that he really was under unbearable pain. It was probably something the doctor or some relatives mentioned as a way not to suffer anymore, and who says no to that?” he added.
The Netherlands has one of the most permissive euthanasia regimes in the world. Euthanasia can be requested by any person under “unbearable suffering with no prospect of improving,” a definition whose meaning has expanded over time. It can also be request by the parents of a person younger than 16.
“Everyone understood originally that the law referred to physical suffering, but the Catholic Church and many others said this was a slippery slope,” Fr. Hendriks told The Pillar.
“And the slippery slope quickly became true. After some years, doctors accepted the idea that elderly people could request euthanasia without having any specific health issues, just the accumulation of problems that come with age. And then they added psychological suffering as a type of ‘unbearable suffering with no prospect of improving,’” he added.
The Netherlands' euthanasia policy was criticized worldwide in April 2024 when The Free Press interviewed Zoraya ter Beek, a Dutch 28-year-old woman who requested euthanasia after being diagnosed with autism, ADHD, and depression.
Ter Beek mentioned in the interview that her psychiatrist suggested euthanasia when she was 23 years old because her depression would not improve.
Ter Beek was euthanized in late May 2024.
“I know of a case of someone who requested euthanasia because of tinnitus, so that’s how wide the definition of ‘unbearable suffering’ is,” Fr. Hendriks told The Pillar.
The age allowed to request euthanasia was also expanded in time.
The original law allowed patients as young as 12 years old to request euthanasia with parental consent until they became 16 years old.
Then, in 2004, Dr. Eduard Verhagen developed the “Groningen Protocol” to administer euthanasia to children under one year of age. The protocol was created in the University Medical Center of Groningen in collaboration with the Groningen district attorney.
While the protocol is not a law itself, it is widely understood in the Netherlands that medical professionals who follow it will not be prosecuted, and Dutch case law supports that practice.
“It’s nothing but postnatal abortion,” Fr. Hendriks told The Pillar.
In 2023, the Dutch parliament expanded euthanasia to children between one and 12 years old.
Hendriks told The Pillar that the expansion of euthanasia in the Netherlands is going in two directions.
“One is including euthanasia when you are no longer in a mental state of asking for euthanasia but you have a written declaration of euthanasia beforehand. And the other is a debate about getting euthanasia when you consider your life to be fulfilled. Namely, that you don’t have any kind of physical or psychological condition, but simply think you’ve done enough with your life.”
Even if it is legal, the practice of euthanasia with “anticipatory consent” is still contentious in the Netherlands — mostly because of an infamous case called the ‘coffee euthanasia.’
A woman signed an “anticipatory consent” form in which she asked to be euthanized if she suffered from dementia or Alzheimer's. However, when she was about to be euthanized, she refused the procedure.
According to media reports, a doctor gave the woman a coffee with sedatives to make her fall asleep, but she continued to stay awake, so she injected a second round of sedatives to finally put her to sleep.
After that, the woman woke up while the euthanasia drugs were being applied and had to be held down by her family while the injection was administered.
“So now it is perfectly legal to give sedatives to a patient with dementia that provided an ‘anticipatory consent,’” García said.
Euthanasia because of “fulfillment of life” is another contentious issue.
“Euthanasia under the excuse of ‘fulfillment of life’ is not yet legal, but the government tried to pass it both in 2016 and 2023. Some ethicists and supporters of the practice have said that the law doesn’t need to change, because it could be considered a type of ‘unbearable suffering,’” Fr. Hendriks told The Pillar.
The broadening of the scope of euthanasia has also broadened the number of people requesting it. In 2003, two years after the passage of the law, 1,626 people were euthanized, amounting to 1.2% of the deaths in the Netherlands.
By 2023, the number of cases had increased to 9,68 deaths, 5.4% of deaths in the country, more than 1 in 20.
Defenders of the practice in the UK say their bill is not modeled after the Netherlands but after the laws in U.S. states, such as Oregon.
The U.K. bill, which is expected to become law in the upcoming months, would allow terminally ill people in England and Wales to request an assisted suicide.
According to the bill, people requesting the procedure should be over 18 years old and living in England or Wales; have the mental capacity to make the decision free from coercion, and be expected to die within six months; make two statements about their desire to die, and get the approval by two doctors that they are eligible for the procedure.
Lastly, a High Court judge would have to rule each time a person makes a request, and the patient would have to wait for 14 days after the decision before they are allowed to undergo assisted suicide.
However, critics in the Netherlands believe that the Dutch law initially presented similar barriers to the practice, to no avail.
“The Dutch law is technically stricter than in other countries, because euthanasia and assisted suicide are still considered homicide under the criminal code, and they are not considered a ‘medical act’ in itself. The law does is to establish criteria under which physicians cannot be prosecuted if they perform an euthanasia,” said García.
“Of course, this is just on paper. The practice has been expanded constantly since it was legalized,” she added.
Other countries that have legalized euthanasia have quickly expanded the practice.
For example, Canada legalized euthanasia and assisted suicide in 2016 for terminally ill patients and in 2021 this was expanded to patients with a “grievous and irremediable condition whose death was not reasonably foreseeable.”
In 2023, 1 in 20 deaths in Canada were due to euthanasia or assisted suicide, about the same as in the Netherlands.
The voice of the Church
Since its inception, the Catholic Church has been the staunchest and, sometimes, the sole opponent of the Dutch euthanasia regime.
“Catholic doctors and some protestant doctors have always opposed the laws, although most protestants accept euthanasia in very extreme cases,” García told The Pillar.
Unlike the Netherlands, in the U.K. both the Catholic Church and representatives from other Christian communities and even other religions showed their opposition to the bill.
Cardinal Vincent Nichols, the president of the English and Welsh bishops’ Conference, set out three concerns about the bill.
The first was to “be careful what you wish for,” because every country that has legalized assisted suicide has seen the practice expand inexorably. The second was that the “right to die” can become “a duty to die.” The third was that no longer seeing life as a gift from God diminishes human dignity.
Leaders of other religious groups signed a joint letter expressing fears the bill would lead to “life-threatening abuse and coercion.”
Signatories included the Anglican Bishop Sarah Mullally, who previously served as the chief nursing officer for England, Chief Rabbi Ephraim Mirvis, and Muslim Council of Britain secretary general Zara Mohammed.
Despite its clear stance against euthanasia, local Catholics feel that the Church in the Netherlands sometimes has been too shy in showing it.
“The Catholic Church has always been very much against it, but I would say it doesn’t allow its voice to be heard enough sometimes,” García said. “The Church doesn’t get much in the public opinion these days.”
Local Catholics sometimes feel the public opinion on the subject is too far gone for the Church to have any kind of influence in the public discussion.
“The Church doesn’t speak much on the subject, but it’s not because there’s an uncertainty with the Church’s position. I think they’re not so sure about how to talk to society about this issue,” Hendriks told The Pillar.
“When the Association for Medical Ethics publishes an article or interview on the problem of euthanasia, you can’t begin to imagine how sour, how negative the reaction is. It’s almost like you can’t be taken seriously if you try to oppose these practices, so it’s a difficult balance. If you’re too harsh, you won’t be taken seriously [in other matters],” he added.
Both Hendriks and García agreed that this difficulty is due to the Netherlands' long-standing process of secularization.
“Protestants oppose the most extreme aspects of the law very publicly, but protestants have a privileged voice in this country that the Catholic Church doesn’t have. The Catholic Church has been historically discriminated against, so it’s always more careful when it partakes in the public debate,” García said.
García also believes that there has been some resistance from within the Catholic Church to the Church’s opposition to the practice.
“The first university clinic to introduce organ donation after euthanasia was the Radboud UMC, which is part of Radboud University, which back then was a Catholic university and medical center,” García told The Pillar.
The Dutch bishops’ ordered Radboud University to stop calling itself a Catholic university, although the Vatican later reversed that directive. Nonetheless, the Vatican agreed that the foundation that oversees the university and the medical center should not be considered a Catholic institution, meaning that the medical center itself is not Catholic anymore.
In 2004, the Dutch bishops’ conference issued pastoral guidelines for priests and pastoral workers concerning euthanasia.
“The guidelines indicate that it is not possible to give the last rites to a person who has already chosen euthanasia,” Bishop Jan Hendriks of Haarlem-Amsterdam told The Pillar.
“A church funeral after euthanasia is not completely excluded but it is not possible to have funeral arrangements done before an euthanasia is done. After a death by euthanasia, there needs to be a serious reason for a church funeral, but the seal of confession must always be respected. Therefore, the reason for admitting [the funeral] does not necessarily need to be revealed. We must consider that sometimes a person is not fully responsible and the euthanasia has been chosen out of fear or severe stress. Like in cases of suicide, a funeral may be allowed,” Bishop Hendriks added.
“In practice, not many church funerals are denied because of euthanasia,” Fr. Lambert Hendriks added.
“The guidelines also indicate a priest should never be present at the moment of euthanasia,” he added.
García added that Catholic medical professionals face difficulties.
“As euthanasia is not considered a medical act, doctors can exercise their right to conscientious objection. However, they’re legally required to refer their patients to another doctor that will do the procedure for them,” she added.
“Many Catholic doctors try to explain the possibilities, that in most cases it is not necessary to suffer because palliative care exists, and if people insist on euthanasia, they say that they can change doctors, without endorsing the practice personally,” García said.
However, an additional issue Catholic medical professionals face is the lack of palliative care centers in the Netherlands.
“Euthanasia started before palliative care in the Netherlands. Palliative care is growing, but slowly. Another issue is that there’s no clear distinction between palliative care and euthanasia because most hospices practice euthanasia and consider euthanasia as part of palliative care. I only know of maybe two hospices that do not practice or condone euthanasia,” García added.
Fr. Hendriks believes that the situation of the Catholic Church in the Netherlands makes it harder for it to provide palliative care.
“There’s a very simple reason why the Church doesn’t have many hospices or palliative care centers, which is a lack of resources,” he said.
“In Germany, there are many Catholic hospices and centers, which are funded by the church tax, and other countries have a longer Catholic tradition and more people in their pews, which puts them in the position to do these things. But here, parishes are barely able to stay alive, so it’s hard to see them running a hospice,” he added.
“So, it all depends on the will and energy of Dutch Catholics to tell everyone what they think of euthanasia, and spread the Catholic idea for the value of life.”
