Until death do us part. Duo euthanasia can become a worldwide trend


Western Europe

Joe-Lize Kruijsse-Brugge, CNE.news

Former Dutch Prime Minister Dries van Agt and his wife Eugenie decided to end their lives together. They had been together for over 70 years. Photo ANP, Marcel van Hoorn

They died hand in hand. Together, they ensured the other would never have to live in mourning. Sounds romantic, right? It might become a new trend in the world of euthanasia.

Duo euthanasia is a new word. Former Dutch Prime Minister Dries van Agt and his wife Eugenie decided to end their lives together on February 5, as was made known to the public on February 9. Both struggled with their health and did not want to live without one another, the Dutch broadcaster RTL Nieuws reported. The two had been married for more than seventy years.

Yet, the conversation about the death of Van Agt is not about his service as a colourful Prime Minister around 1980, or his long marriage. Instead, the most remarkable about it is that he did it by duo euthanasia, a new but growing phenomenon in the Netherlands.

Copying behaviour

Van Agt is not the first Christian Democrat who chose for couple euthanasia. In 2016, the former MP Frans Jozef van der Heijden ended his life together with his wife Gonnie. Both were terminally ill. In the political debates, the Christian Democrats have always spoken about euthanasia as a regulation to protect against worse evil but never as an ideal arrangement.

The publicity about Van Agt now and about Van der Heijden in 2016 gives this new phenomenon the flavour of something interesting. Dying together can become an act of bravado. In some media articles experts speak about copying behaviour.


"Interest in this is growing, but it is still rare", Elke Swart told The Guardian. The spokesperson for the Expertisecentrum Euthanasie, which assesses the death wish of Dutch people, said that both spouses met the strict requirements for euthanasia, as they need to apply for euthanasia separately. "It is pure chance that two people are suffering unbearably with no prospect of relief at the same time and that they both wish for euthanasia."

In 2019, 17 couples chose for duo euthanasia. However, in 2020, this number grew to 13, in 2021, it became 16 and in 2022, 29 couples died together.

Euthanasia is officially illegal in the Netherlands. But under strict conditions, it is allowed. The law speaks of unbearable suffering with no prospect of relief. Euthanasia is the last resort in case of emergency. The death wish must be confirmed by a second medical specialist.

Fransien van ter Beek from the Dutch pro-euthanasia organisation NVVE confirms this growth to The Guardian. She stresses that many people express this wish.


However, dying together is not as romantic as it seems, the Christian columnist Reina Wiskerke writes in Nederlands Dagblad. Besides the complicated process that both spouses need to go through to apply for a self-determined death, the death of two people is extra difficult for those who stay behind.

In addition, Wiskerke questions the carefulness with which duo euthanasia is assessed. Even though both spouses need to undergo a separate procedure for their request for euthanasia, the assessing experts must have contact together, she writes. "If only to find a moment together for the execution of the euthanasia." She also finds it remarkable that Van Agt allegedly mentioned the possibility of duo euthanasia for him and his wife years ago. In other words: it was not a case of emergency.


And how about the criteria of suffering unbearably without the prospect of relief? Wiskerke is sceptical. "Unbearable suffering is a relative term. And mutual dependability, in an emotional or practical sense, can apparently influence the decision, even though suffering an uncurable disease or handicap remains a condition."

Earlier, other healthcare professionals mentioned that the death of an informal caregiver that leads to admission into a care home could be a reason to approve euthanasia. Another mentioned specifically the death of a spouse as an understandable reason why people would want to end their lives. Wiskerke fears that euthanasia becomes the "emergency exit in a society where needy elderly people cannot receive enough care and attention."

Ethicist Stef Groenewoud says to Reformatorisch Dagblad that the current euthanasia practice can be classified as "careful". However, he worries about the loosening of these boundaries. "When more and more cases are deemed to fulfil the criteria, couples will receive permission more easily to end their lives together, as it is called."


Van Agt's duo euthanasia also received much attention in media outside of the Netherlands. In Italy, for example, the news was received with mixed feelings, the Dutch daily Reformatorisch Dagblad stated. In the Southern European country, all forms of self-determined death are currently forbidden. The leftist newspaper La Repubblica writes about a choice, while the rightist newspaper Il Giornale only states that the practice has been allowed in the Netherlands since 2002.

Euthanasia has been a sensitive issue in Italy. There have been several proposals for legalisation since 1984. However, until now, none have been accepted, even though the Constitutional Court ruled that the government should make a regulation to legalise the practice.

Currently, regions have the authority to decide whether they want to legalise the practice in their own territories. Emilia-Romagna was the first to implement a regional euthanasia regulation last week. However, it is uncertain whether this is the first step to a national regulation. The Catholic Church has declared that it opposes all forms of self-determined death. And in a country like Italy, that is important too.


Also, in Belgium, duo euthanasia is allowed under certain circumstances, Standaard writes. The practice does not happen regularly because, like in the Netherlands, it is complicated to fulfil all conditions together. Yet, there are a few cases where both husband and wife ended their lives at the same time.

In Switzerland, where assisted suicide regulations are quite liberal, people have ended their lives together since the early 2000s already.

Currently, the Netherlands, Belgium, Luxembourg, Spain, Portugal, and Switzerland have legalised self-determined death.

France and Germany are working on legislation on this issue.



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