Dutch people killed
© AlamyThe number of Dutch people killed by medical euthanasia in Holland has more than doubled since it was legalised 10 years ago
The number of Dutch people killed by medical euthanasia has more than doubled in the 10 years since legislation was changed to permit it, rising 13 per cent last year to 4,188.

Voluntary euthanasia or physician assisted suicide, where a doctor is present while a patient kills themselves, usually by drinking a strong barbiturate potion, has been legal in the Netherlands since 2002.

Requests have risen steadily since 2003 when 1,626 people applied for medically administered euthanasia, in most cases by a lethal injection, or assisted suicide.

As previously controversial "mercy killings" have become socially and medically acceptable, the number of cases, the vast majority of medical euthanasia, have more than doubled over the decade to 2012.

One explanation for the steep rise of Dutch cases is the introduction last year of mobile euthanasia units allowing patients to be killed by volunatry lethal injection when family doctors refused.

Around 80 per cent of people who request euthanasia die at home and are killed by doctors on the grounds that they are suffering unbearable pain and are making an informed choice. The opinion of a second doctor is also required.

Euthanasia carried out by doctors is only legal in three European countries, the Netherlands, Belgium and Luxembourg.

Both Holland and Belgium changed the law to permit it 10 years ago. Using figures for 2012 and based on per capita rates, the Netherlands kills twice as many people by euthanasia as Belgium.

Euthanasia is lowest in Luxembourg, where it has been legal since 2009, between 2011 and end 2012, 14 people were killed, a per capita rate a tenth of that in the Netherlands.

Most, 78 per cent or 3,251, of the euthanasia requests last year came from people with cancer, new statistics showed on Tuesday.

Those suffering from nervous system disorders were in second place, 257, followed by the euthanasia of 156 people suffering from cardiovascular disease.

Forty two people with dementia and 13 patients suffering severe psychiatric problems were medically killed in cases that are rarer and still generate concern over the competence of individuals to request death.

Medical review committees, that oversee euthanasia after the event, ruled that doctors had failed to meet legal requirements in 10 cases, with two incidents involving the difficulty of informed consent by people suffering from severe dementia.

It is not known whether or how often a decision to prosecute doctors was taken.

In one case, approved by the review committee, euthanasia was carried out on an unnamed woman aged between 80 and 90 who was in an advanced stage of dementia.

The elderly woman was suffering from back pain after a fall and was plagued by delusions caused by her dementia.

Medication for pain helped, but made her confused and, clinching the case, she had an advance directive requesting euthanasia in the event of her unbearable suffering. During a lucid moment, she was able to tell her doctor, "Yes, I want euthanasia".

Highlighting the role of doctors in euthanasia or assisted suicide, Dutch prosecutors demanded a suspended sentence for Albert Heringa, 71, who helped his 99-year kill herself in 2008.

Prosecutors, while accepting that he acted out of compassion, have pressed for a conviction because Mr Heringa did not look for the legal alternative of seeking medical assistance to kill his mother.