Interestingly, the committee itself is also unhappy with its work. Each year, they find a couple cases where a doctor acted negligently. Under Dutch law, these doctors should be prosecuted but this has never happened. Starting in the 1970s, a series of court cases paved the way for the legalization of euthanasia in 2002. But since then, the courts have been completely absent. Doctors themselves are determining the boundaries.

In 2002, the Netherlands was the first country in the world to legalize euthanasia. Today, Dutch euthanasia is moving away from “straightforward” cases where a patient has a terminal illness like cancer—and into more oblique territory.

Since 2009, there has been a significant increase in euthanasia for patients with dementia and psychiatric illness. Doctors are also more open to euthanizing elderly patients who have an “accumulation of old-age complaints” rather than an actual terminal illness.

At the forefront of these developments is the Life End’s Clinic, based in The Hague. The clinic employs 40 doctors who provide euthanasia to patients whose own GPs refuse to assist. In 2016, there were 60 reported instances of euthanasia for patients with psychiatric illness. Of those, 46 were administered by Life’s End Clinic doctors. They were responsible for 40 percent of all instances of euthanasia for dementia patients. For patients with an accumulation of old-age complaints, nearly 50 percent of instances of euthanasia were administered by Life’s End Clinic doctors.

The clinic describes itself as an “expertise center for complex euthanasia requests.” Their doctors admit their decision to grant a request, when a patient’s own doctor has refused, can be subjective at times.

This was illustrated in the controversial 2016 documentary Life’s End Clinic(Levenseindekliniek) which aired on Dutch public television. The filmmakers interviewed Ans Dijkstra, who was 100 years old and requested euthanasia even though she does not have a terminal illness. She described her suffering thus: “It’s the one-dimensionality and the pain. All my fingers are stiff. I drop everything. I do nothing right. I think, ‘What am I still living for?’ My arm hurts in the night. I have trouble getting up in the morning.”

She was ultimately euthanized by a Life’s End Clinic doctor. He said, “I have the feeling that Mrs. Dijkstra’s case completely fits within the law. But also within my own boundaries. Given Mrs. Dijkstra’s situation, I understand her request very well. It’s relatable. So my feelings tell me to say not no, but yes. And perhaps the feelings of her GP told him the exact opposite.”

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