30-07-2025
Final journey: The divide within Europe over euthanasia and assisted dying
Every year, dozens of terminally ill patients from across Europe travel to Belgium and Switzerland, not in search of hope, but of a dignified death.
With euthanasia and assisted dying still illegal in most EU countries, many have no choice but to cross borders to end their suffering. Such a discrepancy in how the issue is handled across Europe makes it difficult for those experiencing chronic illness to plan a dignified end to the lives close to home.
In 2024, 120 patients travelled to Belgium for euthanasia, of which 102 were French nationals. Belgium remains the only EU country where euthanasia is legal for foreigners. The practice – defined as a doctor directly administering a lethal substance – is strictly regulated, yet accessible across borders. These cases have often cynically been described as 'death tourism'. But as Anne Raynaud, head of youth at the French Association for the Right to Die with Dignity (ADMD), points out: "For most end-of-life patients, requesting euthanasia is far from 'tourism'."
The reason so many French patients cross the border is simple, she adds: 'Those who want to choose the terms of their end of life currently have no option in France.' A survey of European policies The French are not alone in their frustration. When it comes to terminally ill patients, only a few countries offer legal options for ending life.
Belgium, Luxembourg, the Netherlands, Portugal, and Spain have legalised euthanasia, but access is generally limited to their own citizens or residents.
Assisted dying – where patients administer life-ending medication themselves – is legal in Austria and Germany, following court rulings in 2019 and 2022.
Switzerland is the only European country that allows foreigners to access assisted dying, although it does not keep official statistics on this. Dignitas, the country's best-known provider, reported 280 assisted deaths last year – its highest on record. Most were foreign nationals, 57 from France, 37 from the UK, and 22 from Italy.
The UK has recently taken the first steps toward an assisted dying bill. Tuscany, a region of Italy, has also passed a law allowing assisted dying and carried out its first assisted death in June, a possible blueprint for other regions.
Meanwhile, France's National Assembly voted in May to permit assisted dying, but the bill must still pass the more conservative Senate in autumn, though there is no clear division along party lines.
Even a strictly Catholic country as Malta, where abortion is forbidden, is debating the topic now as the government has launched a public consultation to ask its citizens for their views on assisted voluntary euthanasia.
Also, in countries that have previously refused to legalise assisted dying or euthanasia, the topic continues to reappear on the agenda. For example, in Czechia, it is a key issue ahead of the upcoming parliamentary elections in October.
But not all national debates are moving forward. In Slovenia, a top state body vetoed a new assisted dying bill, warning that it raised unresolved ethical, legal and philosophical questions.
Nevertheless, according to ADMD's Anne Raynaud, many patients understand that even if laws are eventually passed, their implementation "will likely take many months". "Sadly, many of them do not have that kind of time and are forced to go abroad to end their suffering," she said. An EU blind spot Despite clear demand, the European Commission has explicitly said it won't act.
In response to MEP queries, the Commission said that "responsibility for healthcare, including care for terminally ill patients, as well as ethical questions, rests with the Member States."
The lack of legal options within the EU is particularly affecting Switzerland, where Dignitas would at least like to see international guidelines.
"An international approach is necessary because the hopes, wishes, and needs of people are quite similar in most places around the world," the organisation argues, but one that also respects "cultural and social context."
The Swiss association EXIT, which supports only Swiss nationals and residents with assisted dying, takes a more pragmatic stance: "A pan-European regulation is neither necessary nor realistic," the association said in response to a request from Euractiv .
In EXIT's view, it would be sufficient if every European country legalised euthanasia.
Germany's experience shows how national laws can make a difference. After the country legalised assisted dying, the number of German nationals travelling to Switzerland dropped sharply – from 85 a year to just five in 2023.
Raynaud of ADMD warns that assisted dying isn't an option for everyone. "Patients who are physically unable to self-administer the lethal substance cannot benefit from it."
There is also a stark economic divide. In Switzerland, assisted dying can cost over €10,000. In Belgium, the process is about one-tenth of that. And for many, it's not just about cost, but the emotional burden.
Whether in Belgium or Switzerland, as Raynaud noted, most people would still prefer to die at home or close to loved ones.
(bms, aw, cs)
