Photographs by Jagoda Lasota
Dr. Menno Oosterhoff leaned forward in his living-room chair, took a sip from his coffee mug, and told me about the first time he ended a patient’s life.
She was 18 years old and had been diagnosed with obsessive-compulsive disorder, an eating disorder, and autism. Despite years of treatment, she was still bedeviled by negative thoughts, and she told Oosterhoff, a specialist in child and adolescent psychiatry in the Netherlands, that she couldn’t stand any more suffering. He suggested deep brain stimulation, an invasive procedure sometimes used to treat severe OCD. She insisted that she wanted help dying instead.
Dutch law gave Oosterhoff the power to grant her request. In 2002, the Netherlands began allowing doctors to administer death to patients who make “voluntary and well considered” pleas to end “unbearable” suffering from any medical condition—provided there is no “prospect of improvement” and no “reasonable alternative” to dying. Eighteen-year-olds are adults and can request euthanasia even over family objections. Children as young as 12 are also eligible, with parental consent; for 16- and 17-year-olds, only parental consultation is required.
Oosterhoff’s patient had no physical illness, fatal or otherwise; he concluded, rather, that she was “mentally terminal.” An administered death would be preferable, he thought, to prolonged suffering or the possibility of unassisted suicide. To comply with the law’s requirement of “due care,” he consulted another psychiatrist and convened a “moral case deliberation session.”
Telling me about his internal conflict at that moment, Oosterhoff’s previously casual tone became more intense. At the age of 70, he is no longer an adherent of the strict Dutch Calvinism he’d learned as a child, but he said he felt haunted by the idea of “final judgment” in the afterlife; his patient’s request for euthanasia made him think, God is testing me.
So Oosterhoff imagined a dialogue with God. If he didn’t help the girl die, God would ask him why he had allowed her suffering to continue. “I was anxious,” he would reply, but God would say, “I told you: You should do what your conscience tells you.” If Oosterhoff did end his patient’s life, however, God might reproach him for having acted without knowing all of the consequences. In that case, he imagined telling God: “You didn’t make it clear enough. I did what I could.”
On the appointed day in October 2022, Oosterhoff went to the girl’s home and asked one last time whether she wanted to die. When she said yes, he injected her with a series of chemicals: first lidocaine to numb the area where the needle entered, then a coma-inducing drug, and finally rocuronium, a muscle relaxer, to stop her breathing.
Afterward, a colleague asked Oosterhoff whether he still felt anxious about the final judgment. “No,” he replied. “If this is not good, then God should make a better user manual for our life.”
The right to die by euthanasia is popular in the Netherlands. It is even a point of national pride. The country has a tradition of decriminalizing once-taboo behaviors, such as prostitution and marijuana use, which allows them to be managed under the law. It’s a reflection of the high value that Dutch culture places on individual autonomy—the notion that “our thoughts and beliefs are holy and should not be interfered with,” says Rosanne Hertzberger, a former member of Parliament from New Social Contract, a center-right party. “People say, ‘Who are you to tell me what to do, what to think?’”
But while absolute prohibitions might feel oppressive, they can also be useful, because they spare us the costs of making difficult moral choices—and the potentially catastrophic risks of getting them wrong. Seeking euthanasia for psychiatric reasons is the grayest of gray areas. It’s very hard to know whether a suffering person could get better, and the desire for death can be a symptom of the illness itself. The decision to die is drastic and irreversible; should it really be left up to a young person whose brain is still developing, and who is susceptible to influence by peers and authority figures?
Now Dutch physicians, politicians, and journalists are beginning to sound alarms. The overwhelming majority of physician-assisted deaths in the country of 18 million still involve terminal physical illness—about 86 percent of the 9,958 cases in 2024. But the number of people who received euthanasia solely on the grounds of mental suffering spiked from 88 in 2020 to 219 in 2024. In that five-year period, doctors ended 675 lives for psychiatric reasons, more than in the previous 18 years put together.
Especially troubling is the number of very young people requesting euthanasia because of their mental suffering. In 2024 alone, 30 people ages 15 to 29 were killed because of psychological conditions. This represents 3.1 percent of all deaths in that age bracket in the Netherlands.
Oosterhoff played a prominent role in these developments. With his inhibitions vanquished after his dialogue with God in October 2022, he personally administered lethal injections to 12 psychiatric patients in a 13-month stretch from 2023 to 2024. The oldest was in his 50s. The youngest were 16 and 17—the first minors in any country ever lawfully euthanized for mental illness. These represented only a small fraction of the hundreds of people who reached out to him in response to an aggressive advocacy campaign he launched through social media, TV interviews, and a book, Let Me Go.
[From the September 2025 issue: Elaina Plott-Calabro on euthanasia in Canada]
The termination of lives that could be expected to go on for decades, based on psychiatric diagnoses and prognoses that are inherently far less certain than those for physical illnesses, has spawned a wrenching debate—one that is tame by U.S. standards but vicious for the Dutch.
“Most psychiatrists intuit that it’s not a logical thing to equate somebody with a death wish at 25 and somebody with two weeks to live at age 80 wanting to die in a dignified fashion,” Jim van Os, a psychiatrist and the chair of neuroscience at the Utrecht University Medical Center, told me. Doctors are generally reluctant to speak publicly about the issue, he said, because they fear being branded as opponents of euthanasia generally. But in September, van Os was one of 87 Dutch psychiatrists and health-care professionals, along with 46 colleagues from other countries, who signed an open letter to the Dutch Psychiatric Association, warning that current practice “inevitably carries the risk that psychiatric patients will die unnecessarily by euthanasia.”
The potential repercussions extend beyond the Netherlands. As populations age and traditional religion loses influence, the demand for a right to die is rising globally. Some form of doctor-assisted death is now allowed in 12 countries, and more are likely to legalize it soon. So far only the Netherlands and Belgium regularly see cases of euthanasia for psychiatric reasons, but the law in some other countries doesn’t rule it out. Canada, where 16,499 people were medically euthanized in 2024, is likely to start permitting psychiatric euthanasia in 2027.
With 12 U.S. states and the District of Columbia allowing doctors to prescribe lethal drugs to terminal patients, and New York set to join them in June, Americans also have something to learn from the Dutch experience. It suggests that the right metaphor for the risks of euthanasia is not a slippery slope but a runaway train.
Supporters call Oosterhoff a savior; detractors consider him a fanatic. Either way, he looks the part. His face—framed by white hair, crisscrossed by age lines, and rendered strangely magnetic by unusually small, ice-blue eyes—has become the face of psychiatric euthanasia in the Netherlands.
That role was confirmed last fall when Dutch public television broadcast Milou’s Battle Continues, the most-watched TV documentary of the year. It tells the story of Milou Verhoof, a 17-year-old girl who received euthanasia from Oosterhoff to end her psychological suffering.
Once the cheerful daughter of a well-to-do family, Milou was deeply shaken at age 11 by the near-fatal illness of her beloved brother. At 13, she was raped and spiraled into post-traumatic stress, depression, and violent self-harm. At a secure in-patient facility, she was reportedly sexually abused again, by a fellow patient. She made several suicide attempts and requested euthanasia, but psychiatrists demurred—until, in late 2022, her family contacted Oosterhoff after learning about him through the media.
Milou’s story could be told as an indictment of the Netherlands’ mental-health system, which failed a troubled, victimized teenager and then had nothing left to offer but medicalized death. But the documentary—which was chosen as Dutch public television’s entry for this year’s International Emmy Awards—adopts the viewpoint of Oosterhoff and of the girl’s parents, who praise Oosterhoff for understanding their daughter’s suffering, respecting her autonomy, and sparing both her and them a lonely, undignified suicide. As Milou’s mother, Mireille Verhoof, put it in an email to me: “Because of Dr. Oosterhoff’s extremely careful and cautious approach, we as parents trusted that his conclusion—that Milou truly could not go on and that the days were unlivable for her—was the only correct one and confirmed what we as parents had long seen in our child.”
Before dying, Milou got her nails done and picked out an evening gown and high heels to wear in her coffin. On October 2, 2023, Oosterhoff gave her a lethal injection in her childhood bedroom. “Girl, have a good trip,” he told her, as her mother and father looked on. “You’ve been through so much.” Oosterhoff spoke at her funeral.
In April 2024, 14 psychiatrists and doctors wrote to the Dutch public prosecutor to raise concerns about Milou’s case, including the way Oosterhoff publicized it. Two months before he euthanized her, Oosterhoff recorded a video conversation with Milou about her wish to die. After her death, he posted it on the website of the KEA Foundation, which he established to support psychiatric euthanasia and to encourage more psychiatrists to perform it.
The doctors’ letter suggested that Oosterhoff’s video exploited Milou, who, they wrote, “may not have been fully decision-competent to assess her own right to life or adequately safeguard her care needs in a situation of acute distress.” The Dutch newspaper NRC published a transcript of part of the video, in which a despondent Milou says, “I would have liked to have had another life, but that was not granted to me.” Oosterhoff then asks how she would respond to those who might say, “Yes, but you’re still so young.” Milou answers, “It’s not about age; it’s about the suffering.” Oosterhoff replies with an approving murmur. Milou continues, “I tried everything I could to make it better,” as Oosterhoff nods.
The doctors sent their letter privately and didn’t explicitly request a criminal investigation, but when Oosterhoff found out about it he fired back in the media, demanding that the letter’s authors apologize. They refused. To this day, he is furious, insisting that everything he did was consistent with the law and that, as he puts it, “Milou wanted attention for her situation.” Oosterhoff’s foundation has since removed the video from its website but he insists that it “contains nothing controversial that I would need to hide.” (He declined my request to see the video, telling me it has since been destroyed.)
[From the June 2023 issue: David Brooks on euthanasia and the limits of liberalism]
Oosterhoff has a point. All of the euthanasias he performed were reviewed after the fact, as a matter of standard procedure, by the Netherlands’ Regional Euthanasia Review Committees (known by the Dutch initials RTE), and his conduct passed muster. Without a finding of fault from the RTE, prosecutors would have been very unlikely to start a criminal investigation into Milou’s case.
The RTE, however, was designed on the assumption that it would need to review a moderate number of relatively clear cases—not the thousands of euthanasias, including psychiatric ones, now flooding the system. RTE panelists do not conduct independent investigations but rely on physicians’ written reports, augmented in a few cases by additional questioning. Oosterhoff says the RTE called him in to discuss Milou’s case because of her young age.
As a practical matter, doctors have little to fear from the RTE. From 2002 to 2024, it found that physicians failed to meet all of the “due care criteria” in just 144 out of 110,591 euthanasia cases, including 14 of the 1,123 psychiatric-euthanasia cases. Of these, prosecutors took exactly one case to court. Marinou Arends faced murder charges for allegedly euthanizing an unconsenting elderly patient in 2016. She was acquitted and later made a knight in the Order of Orange-Nassau, in recognition of her career as a geriatric physician.
Whatever procedural checks and balances surround euthanasia in the Netherlands, the system necessarily relies on an individual physician’s judgment as the ultimate safeguard. And to spend time with Menno Oosterhoff is to understand vividly that there is no such thing as a purely professional judgment on euthanasia. His approach seems to reflect his idiosyncratic, still-unfinished spiritual journey as much as his medical training or expertise.
Born in 1955 into a household where God was a looming presence and the afterlife an everyday concern, Oosterhoff was a teenager when he watched his beloved father waste away from cancer. In his book, Oosterhoff recounts feeling guilty for hoping his father would die, and relieved when death ended his suffering. Six years later, his older brother also died after a painful illness.
Around the time of his father’s death, Oosterhoff was diagnosed with obsessive-compulsive disorder, which he now controls with the help of medication. At his home—a cozy hobbit hole of a place in the northern Dutch village of Thesinge, well stocked with artwork, houseplants, and dog beds—he told me how the condition influences him. “OCD,” he said, “means you are hyperaware of the existential problems of life: death, responsibility, loneliness, the purpose of it all.” This led to his interest in medicine, because it gave him “a very strong conscience.” He became a specialist in treating patients with OCD.
While he was in medical school in the 1980s, Oosterhoff left Christianity for anthroposophy, the “spiritual science” founded by the 20th-century Austrian philosopher Rudolf Steiner, which teaches that the collective human spirit evolves through the reincarnation of individual souls. Unable to conquer his doubts about that idea, Oosterhoff eventually soured on anthroposophy too. But he retained his own version of another anthroposophical doctrine: that morality consists in finding a balance between equally damaging extremes, not obeying absolute imperatives.
He views euthanasia as a middle path between two evils: on the one hand, allowing a patient’s suffering to continue, and on the other, causing an unnecessary death. “Not giving euthanasia has consequences too,” Oosterhoff told me repeatedly, almost like a mantra. One consequence, he says, is that “mentally terminal” people might end their lives on their own, impulsively or violently.
For Oosterhoff, the idea that psychiatric euthanasia reduces the risk of suicide is one of the strongest rationales for making it available. Yet scientific evidence for this theory is scant. From 2020 to 2024, as psychiatric euthanasia reached new heights among Dutch young people, the suicide rate for those ages 10 to 30 also hit 21st century highs of 8.8 per 100,000 men and 4.7 per 100,000 for women. Suicide is the leading cause of death for this age group.
Gender is another worrisome issue. In the Netherlands, twice as many women as men attempt suicide, but only half as many complete the act, because women tend to use less violent and less reliably deadly methods. The availability of euthanasia, a guaranteed method, thus makes it more likely that suicidal women and girls will die. Of the 30 people under age 30 who received psychiatric euthanasia in 2024, 25 were female.
Oosterhoff concedes that psychiatric diagnoses and prognoses are inherently less certain than those of physical illnesses. “The scientific basis of psychiatry is still very, very unclear,” he said. “A lot of things people say are just based on nothing.” But to him, this doesn’t mean that psychiatrists should refrain from making life-or-death judgments. Rather, they should forge ahead, guided by their good intentions and by a patient’s autonomous will. Psychiatrists, he said, are trained “to help people to not lose hope and to find sparks of light and so on. But is that honest ad infinitum? Or is there a moment that you say, ‘That is the opinion of this person themselves. My opinion is no better’?”
His euthanasia patients’ reactions, as Oosterhoff remembers them, vindicate his approach. “The gratitude for what I did is so immense sometimes,” he told me, emotion thickening his voice. Two days after ending Milou Verhoof’s life, Oosterhoff euthanized David Mulder, a 31-year-old man with chronic depression. As he prepared the lethal injection, Oosterhoff recalled, Mulder told him, “You’re my hero.”
What defenders of psychiatric euthanasia fail to acknowledge is that “people are always ambivalent about the death wish,” Koos Neuvel, the editor in chief of the Netherlands Journal of Literature and Medicine, told me. This was the conclusion he drew from interviewing numerous patients with mental illness who had considered euthanasia, for his new book on the subject, Finally at Peace.
Neuvel became a critic of the Dutch mental-health system after witnessing the experiences of his teenage daughter, Nora, who suffered from severe anorexia. Despite years of psychiatric treatment, she finally died of starvation after refusing to eat or drink. Today Neuvel is one of a small but growing number of Dutch journalists challenging the media’s portrayal of psychiatric euthanasia. “It’s always presented in the same way: that it’s an important thing to do and it’s necessary for the doctor to cooperate with this and that the death wish can’t be changed,” he said.
In 2024, the psychiatrist Mascha Mos posted one such story on a medical blog, about administering euthanasia to “a 34-year-old man with OCD, depression, later-diagnosed autism, tinnitus, and personality disorders.” For a distraction while she inserted the needle, he watched a video game in demo mode. “I picture him lying on his couch, with Grand Theft Auto playing in the background, in his neat, tidy, darkened home,” Mos wrote. “What a brave and heartbreaking decision he made to request euthanasia. And how courageously he followed the process, considering his problems.”
To Neuvel and other critics, such portrayals romanticize euthanasia for mental illness, creating a risk of social contagion. That concern is shared by the Euthanasia Expertise Center, an organization in the Hague that specializes in facilitating doctor-assisted death for patients whose regular physicians cannot or will not perform it. In December, the center issued a statement noting that it “saw a spike in registrations” after every positive media story about euthanasia. It warned that public perceptions “did not match reality: for only a very small number of young people with psychological suffering is euthanasia possibly the best outcome.”
What young patients really need from psychiatrists, Neuvel believes, isn’t help with dying but reasons to keep living. “Even if the patient has lost all hope, the doctors shouldn’t give up hope,” he said. “There’s always something people want to live for, that they find interesting.”
Lisa Tiersma, a 27-year-old graduate student in Utrecht, was treated for 10 different psychiatric diagnoses as an adolescent, including a two-year hospitalization. She attempted suicide, feeling her treatments were going nowhere. What kept her going through her worst times, Tiersma told me, was her dream of studying music. Today she teaches piano and performs original compositions. Her song “Help Me,” an exploration of her struggles with mental illness written under the stage name Left Lynx, earned a prize in the 2022 European Songwriting Awards.
“I wouldn’t say I’m fully recovered,” she said, “but I do have a purpose, a will to live. And I think that’s what matters in the end.” Last year, Tiersma’s psychiatrist, possibly probing for suicidal tendencies, asked her what she thought about euthanasia. She told me the question struck her as “planting a seed, but it’s not the right kind of seed.” Her own experience had taught her that staying hopeful can be hard. “But that is still not a reason to give up,” she said.
The ultimate concern for Dutch critics of psychiatric euthanasia is that death will become just another treatment option in a mental-health system plagued by long waits for sometimes inadequate care. In 2025, the Euthanasia Expertise Center and Foundation 113, a suicide-prevention group, surveyed nearly 400 young people who had sought euthanasia. Nearly all reported negative experiences with Dutch youth care or mental-health services.
Yet Oosterhoff and like-minded colleagues have campaigned for even lighter regulation of doctor-assisted dying. Ideally, they say, a patient would have the same psychiatrist through an entire “euthanasia trajectory,” from clinical treatment to deciding to die to the lethal injection. As matters now stand, many psychiatrists balk at administering death to patients with whom they have established treatment relationships. Thus those intent on being euthanized “doctor-shop” for someone who will do the job.
Few critics of psychiatric euthanasia propose that the Netherlands ban it completely. Instead they advocate for reforms, such as a higher minimum age and more robust oversight by the RTE. For now, such changes seem unlikely. In 2025, the New Social Contract party proposed a three-year moratorium on euthanasia for mental illness of people under 30; the Dutch Parliament voted it down.
D66, the socially liberal party that spearheaded the euthanasia law a quarter century ago, opposed the resolution. “By proposing a moratorium you chop away at the foundation” of legal euthanasia, D66 Parliamentarian Wieke Paulusma said. She faulted moratorium advocates for second-guessing “well-educated professionals who are continuously deliberating.” The Dutch legislature did vote for more research into the issue, though D66, now the Netherlands’ ruling party, opposed that as well.
There’s a better chance that the Dutch Psychiatric Association will toughen its guidelines on euthanasia, which it is currently reviewing, including a minimum-age requirement. That would lack the force of law but could shape standards of professional responsibility. In December, Accare, a Dutch mental-health center for people younger than 23, announced that “as a rule we do not provide euthanasia to minors and young adults.”
But “a legal age limit, such as the one Belgium applies at eighteen, is a sensitive subject in the Netherlands,” a recent NRC article explained. After all, saying psychiatric euthanasia for young people should be avoided in the future implies that it should have been avoided in the past. That would reflect badly on a lot more people than just Menno Oosterhoff. Defenders of the right to die, van Os said, “can’t be nuanced about it, because they feel the whole euthanasia house will crumble.”
Oosterhoff’s own career as a euthanasia provider is probably over. In March 2025, he let his medical license expire, so he can no longer treat patients or end their lives. After two years of text messages and phone calls from euthanasia seekers, he was burned out; he told one TV interviewer that he felt like a doctor working in Gaza.
Oosterhoff told me he has no regrets. When it comes to the deaths he has administered, he seems to inhabit a separate, self-contained ethical universe in which he has used all of his experience, intellect, and erudition to rationalize—successfully, in his view—the taking of youthful life. “Morality,” he told me repeatedly, “is not anxiety for punishment but enthusiasm for the good.”
During our conversation, he seemed to waver only once, when I asked about the risk to society if psychiatry endorses the notion that psychological suffering can be as hopeless as end-stage lung cancer. Wouldn’t that be destructive in a world where people with mental illness already struggle to find purpose? “What is good for one patient can be bad for the whole community—that’s a very difficult thing,” Oosterhoff acknowledged. In performing euthanasia, he said, he looked “to the individual patient,” adding that public policy is “not my work.”
Musing about unintended consequences, Oosterhoff mentioned the myth of Pandora’s box and Goethe’s tale of the sorcerer’s apprentice. And he brought up Aktion T4, the Nazi program in which German psychiatrists euthanized children and adults with mental illness and other disabilities. That surprised me: The victims of Aktion T4 were completely uninformed and unconsenting, a crucial distinction with psychiatric euthanasia in the Netherlands, as Oosterhoff noted.
Listening to Oosterhoff, however, I realized that the difference between the two programs is not absolute. Euthanasia patients in the Netherlands make the choice to die—but when a teenager is suffering from psychiatric illness, can that choice really be considered an expression of autonomous will? The rationale for euthanasia in Nazi Germany was racial hygiene; in the Netherlands today, it’s autonomy and compassion. But Dutch physicians who perform euthanasia also accept the principle that some lives are better not lived. “I’m shocked that so many psychiatrists and nurses worked with Aktion T4,” Oosterhoff said. “Then, of course, I think, What am I doing? How will the future judge about me? I don’t know. I only can say I did what I thought I should do.”
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