Why Young Women in the Netherlands Are Choosing Assisted Dying for Psychiatric Suffering
In the Netherlands, a quiet but growing number of young women in their twenties are requesting and, in some cases, receiving medical assistance to end their lives. Unlike the majority of euthanasia cases, which involve older patients with terminal physical illnesses such as cancer, these requests stem from severe and persistent mental health conditions. The trend has sparked intense debate both within the country and internationally about the boundaries of assisted dying laws, the nature of psychiatric suffering, and the capacity of young adults to make irreversible decisions about their futures.
Euthanasia and physician-assisted suicide have been legal in the Netherlands since 2002 under the Termination of Life on Request and Assisted Suicide Act. The law requires that a patient make a voluntary and well-considered request, that their suffering be unbearable with no prospect of improvement, and that no reasonable alternatives remain. Two doctors must agree, and every case is reviewed by regional committees. While the legal text has remained largely unchanged, its application has expanded over time to include purely psychiatric grounds. In 2010, only two people received euthanasia primarily for mental suffering. By 2023 that figure had risen to 138. In 2024 it climbed sharply to 219 before declining to 174 in 2025. Overall euthanasia deaths reached 10,341 in 2025, accounting for roughly 6 percent of all deaths in the country.
Young people form a small but increasingly visible share of the psychiatric cases. In 2024, 30 people aged 15 to 29 died by euthanasia for psychological conditions; 25 of them were female. In 2025 the number under 30 dropped to 19. Studies of applications submitted to the Expertisecentrum Euthanasie, which handles many complex psychiatric requests, consistently show that the large majority of young applicants are women. One analysis of nearly 400 requests from people under 24 between 2012 and 2021 found that 73 percent came from females. These young women typically present with complex, overlapping diagnoses that began in childhood or early adolescence. Common conditions include chronic depression, anxiety disorders, post-traumatic stress disorder linked to abuse or bullying, autism spectrum conditions, borderline personality disorder, and eating disorders. Many have histories of repeated hospitalizations, including compulsory admissions, extensive medication trials, multiple forms of psychotherapy, and sometimes dozens of sessions of electroconvulsive therapy.
Researchers and clinicians note that these patients often enter the mental health system at a very young age—around 11 on average in one study—and accumulate long treatment records. By their early twenties, some have been told by clinicians that further treatment is unlikely to produce meaningful improvement. In interviews, women who pursued this path have described a sense of having exhausted every option, of living with constant internal distress that no therapy or medication could lift, and of viewing continued existence as an indefinite sentence of suffering. High-profile cases have brought the issue into public view. Zoraya ter Beek, who died at 29 in 2024 after a multi-year process, spoke openly about chronic depression, anxiety, trauma, autism, and personality difficulties. She had undergone years of treatment, including more than 30 sessions of electroconvulsive therapy, before concluding that recovery was no longer realistic. Similar stories involving young women with borderline personality disorder, anorexia, and trauma histories have appeared in Dutch and international media.
Several factors help explain why young women predominate in these requests. Women generally seek mental health care earlier and more frequently than men. This leads to longer documented treatment histories and a greater likelihood of eventually being assessed as having limited remaining therapeutic options. Certain conditions that feature heavily in these cases—depression, trauma-related disorders, eating disorders, and some personality disorders—also show higher rates or different presentation patterns among young women. Broader societal pressures, including rising rates of mental distress among adolescents and young adults, strained youth mental health services, and lengthening wait times for specialized care, have been cited by some experts as contributing factors. Cultural openness about death and dying in the Netherlands, combined with the existence of specialized centers willing to assess difficult psychiatric cases, has made the option more visible and accessible than in countries that restrict assisted dying to terminal physical illness.
It is important to note that the vast majority of requests from young people do not result in death. Studies consistently show that roughly 90 percent of applications by those under 24 are either withdrawn by the patient or rejected by assessors because the legal criteria are not met. Many applicants are encouraged or required to try additional treatments during the evaluation process, which can take months or years. Some later report that the process itself—being taken seriously and given space to explore their wishes—helped them re-engage with life. Others, however, continue to experience profound hopelessness.
The practice remains controversial even inside the Netherlands. Supporters argue that psychiatric suffering can be every bit as unbearable as physical pain and that competent adults, including those in their twenties, should retain the right to decide when their lives have become intolerable. They point out that the process involves rigorous safeguards, multiple independent assessments, and retrospective review. Critics, including a number of Dutch psychiatrists, raise concerns about the inherent uncertainty of psychiatric diagnosis and prognosis compared with physical disease. They question whether young adults whose brains are still developing can fully weigh the long-term consequences of ending their lives, and whether social isolation, inadequate treatment access, or temporary crises are sometimes being medicalized into irreversible decisions. Some note that women attempt suicide more often than men but complete it less often because they tend to use less lethal methods; the availability of a guaranteed medical method may therefore alter outcomes in this group. Debates continue about whether additional age-related safeguards or stricter criteria for psychiatric cases under 30 are warranted.
The Netherlands remains one of only a handful of countries that permit assisted dying solely on psychiatric grounds. As other nations consider expanding their own laws, the Dutch experience with young women serves as both an example and a cautionary tale. It highlights the depth of suffering some patients endure despite years of treatment, the difficulties of determining when mental illness has become truly refractory, and the profound ethical questions that arise when a society offers death as a medical option for conditions that primarily affect the mind. For the young women at the center of this trend, the decision is rarely framed as a simple preference for death over life. More often it is described as a last resort after every other path has been tried and found wanting—a choice between continued torment and a controlled exit. Whether that framing reflects medical reality, systemic failure, or something more complex remains the subject of ongoing and necessary scrutiny.
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