As of 2025, active euthanasia is legal in four European countries: the Netherlands, Belgium, Luxembourg, and Spain. Several other European countries permit assisted suicide but not euthanasia, and a few more are actively debating new legislation. The distinction matters: euthanasia means a physician administers a lethal substance, while assisted suicide means the patient self-administers medication provided by a doctor or, in Switzerland’s unique case, a non-physician.
Countries Where Active Euthanasia Is Legal
The Netherlands was the first country in the world to legalize euthanasia, doing so in 2002. Belgium followed the same year, Luxembourg in 2009, and Spain in 2021. Portugal legalized the practice in 2023 after years of parliamentary debate and multiple presidential vetoes, though its regulatory framework is still being established. In all of these countries, both euthanasia and physician-assisted suicide are permitted under strict conditions.
Each country requires that the patient be experiencing unbearable suffering with no prospect of improvement, that the request be voluntary and well-considered, and that at least one additional physician confirm the diagnosis. Beyond those shared principles, the specific rules vary considerably.
The Netherlands
Dutch law requires the physician to be convinced that the patient’s suffering is unbearable and without prospect of improvement. There is no requirement that the condition be terminal. The Netherlands has five regional euthanasia review committees that assess every case after it occurs, checking whether the physician met all the legal “due care” criteria. Euthanasia and assisted suicide remain criminal offenses on paper, but a physician who follows the statutory requirements and reports the case to the municipal pathologist is exempt from prosecution.
Children aged 12 to 15 can request euthanasia with parental consent. If the parents disagree, the request will not be granted. From age 16, parental consent is no longer required, though parents must still be involved in the decision-making process. Below age 12, euthanasia is not available.
Belgium
Belgium’s euthanasia law is notable for two reasons. First, it has no minimum age requirement. A 2014 amendment extended eligibility to minors, provided the child demonstrates the capacity to understand the decision and both parents give written consent. In practice, euthanasia for minors remains extremely rare and is limited to cases of terminal physical illness. Second, Belgium permits euthanasia for unbearable psychological suffering, including certain psychiatric conditions, though these cases undergo heightened scrutiny.
In 2023, Belgium registered 3,423 euthanasia cases, a 15% increase over 2022. Of those, 110 were people who traveled to Belgium from abroad, including from Germany, the Netherlands, Spain, the UK, Italy, and South Korea.
Luxembourg
Luxembourg legalized euthanasia and assisted suicide in 2009, largely following the Belgian model but with a key difference: only adults aged 18 and over may request it. The country’s small population means case numbers are far lower than in Belgium or the Netherlands.
Spain
Spain’s Organic Law on the Regulation of Euthanasia took effect in June 2021, making it the first Southern European country to legalize the practice. The law requires Spanish nationality or legal residence for at least 12 months. Patients must submit two voluntary written requests separated by at least 15 days, giving time to reconsider. The condition does not need to be terminal, but it must be serious, chronic, and cause intolerable physical or psychological suffering.
Portugal
After several failed attempts blocked by the Constitutional Court and presidential vetoes, Portugal amended its prohibition on euthanasia and assisted suicide in 2023. The law now permits both practices conditionally. People with a mental disorder or any medical condition that affects their decision-making capacity are excluded unless they are formally assessed and found competent to make the decision. The implementation of the law has been gradual, and regulatory details are still being finalized.
Switzerland: Assisted Suicide Only
Switzerland occupies a unique position. Active euthanasia is illegal, but assisted suicide has been permitted since 1942 under Article 115 of the Swiss penal code, which states that assisting someone’s suicide is a crime only if the motive is selfish. This means assisted suicide carried out for altruistic reasons is lawful.
Two features set Switzerland apart from every other country. First, a physician does not need to be involved. Organizations like Dignitas and Exit provide the service through trained staff. Second, the patient does not need to be terminally ill, and the law does not restrict access to Swiss residents. This is why Switzerland has become a destination for people from countries where assisted dying is illegal, a practice sometimes called “suicide tourism.” The person must be able to self-administer the lethal medication; no one else may perform the final act.
Germany and Austria: Legal but Unregulated
Germany’s Federal Constitutional Court struck down a ban on assisted suicide services in February 2020, ruling that the general right of personality under the German constitution “encompasses a right to a self-determined death.” The court held that this right includes the freedom to take one’s own life and to seek assistance from willing third parties. Crucially, the court stated that this right is not limited to people who are terminally ill, and that the individual’s decision “eludes any evaluation on the basis of general values, religious dogmas, societal norms for dealing with life and death, or considerations of objective rationality.”
However, Germany has not yet passed comprehensive legislation to regulate how assisted suicide services should operate in practice. This creates a legal gray zone where the act itself is permitted but the framework around it remains unclear. Active euthanasia is still illegal.
Austria followed a similar path. Its Constitutional Court ruled in 2020 that the ban on assisted suicide was unconstitutional, and a law permitting assisted suicide under specific conditions took effect in 2022. Like Germany, Austria does not permit active euthanasia.
Countries Actively Debating Legislation
The United Kingdom has no legal form of assisted dying, but a bill is working its way through Parliament. The Terminally Ill Adults (End of Life) Bill, introduced in October 2024, would allow assisted dying for terminally ill adults in England and Wales. The bill originally required High Court approval for each case, but a parliamentary committee replaced that with multidisciplinary review panels consisting of a senior legal figure, a psychiatrist, and a social worker. If the bill passes, most provisions would need to be implemented within four years. Report and third reading stages were scheduled for May 2025.
France has also been debating end-of-life legislation. President Macron’s government introduced a bill in 2024 that would permit assisted dying under limited circumstances, but political instability and a change of prime minister interrupted the legislative process. Italy’s Constitutional Court has similarly carved out limited exceptions for assisted suicide in specific circumstances, though the parliament has not passed a comprehensive law.
Where Euthanasia Remains Illegal
In most of Europe, both euthanasia and assisted suicide remain criminal offenses. This includes all of Scandinavia, Eastern Europe, and most of Southern Europe outside Spain and Portugal. Poland, Greece, Romania, Hungary, and the Baltic states have no legal provision for either practice. In many of these countries, cultural and religious factors make legislative change unlikely in the near term.
The patchwork of laws across Europe means that a person’s access to assisted dying depends heavily on where they live or whether they have the resources to travel. Belgium’s 2023 data showing 110 foreign residents who traveled there for euthanasia illustrates this reality. Switzerland remains the primary destination for cross-border assisted suicide, since it is the only European country that does not require residency or citizenship.