1. Introduction

The legalization of euthanasia and assisted suicide remains one of the most complex and debated issues in contemporary European law. After the Netherlands adopted the world’s first law permitting active euthanasia in 2002, various regulatory models have emerged. The European Court of Human Rights acts as a key arbiter in defining the limits of national discretion [6]. Judicial practice plays an important role in the development of this area of law. Through the resolution of specific cases, the scope of the law is clarified, adapted, and expanded.

The object of this study is the legal regulation of euthanasia and assisted suicide in European countries. The subject of the study is specific judicial precedents that have significantly influenced the formation and development of judicial practice. The aim of this work is to identify the legal consequences of significant judicial precedents in selected European countries. To achieve this aim, the following tasks were set: to select the most significant court cases in the Netherlands, Belgium, Switzerland, and France; for each case, to describe the content, legal issue, and court decision; and to formulate the specific legal consequences of each precedent for the national legal system.

2. Material and methods

The empirical basis of the study comprises decisions of national courts: the Supreme Court of the Netherlands, the Court of Assizes of Ghent, the Federal Supreme Court of Switzerland, the Council of State of France, and judgments of the European Court of Human Rights. The theoretical framework of the work is formed by scientific articles and monographs devoted to the legal and ethical consequences of euthanasia.

The main method of research is comparative legal analysis, which allows comparing the approaches of different countries to similar legal issues. The formal legal method was used in the interpretation of specific legal norms. The analysis of judicial practice was applied to identify the essence of each precedent.

The Netherlands

Case on dementia (Supreme Court of the Netherlands, 21 April 2020). A doctor performed euthanasia on a 74-year-old patient suffering from Alzheimer’s disease. Several years before the event, the woman signed a declaration expressing her wish to end her life if the disease progressed. When the time for the procedure came, the patient could no longer consciously confirm her decision due to severe dementia. The prosecutor’s office charged the doctor with murder, alleging a violation of the legal requirement for conscious and personal consent to the procedure (Termination of Life on Request and Assisted Suicide Act, 2002). The District Court of The Hague recognized the written declaration as sufficient grounds for euthanasia. The Supreme Court upheld the acquittal and ruled that doctors may perform euthanasia on the basis of a prior written declaration, even if the patient is no longer able to express consent independently. In such cases, the opinion of at least two independent doctors is required. Buijsen analyzes this decision in detail, showing that the court legalized euthanasia for patients with progressive dementia based on previously expressed will, while simultaneously making the procedure more stringent [1].

Zoraya ter Beek case (2024). Electroconvulsive therapy and other treatments failed to help a woman who suffered from chronic depression, borderline personality disorder, and autism. In August 2020, a psychiatrist officially confirmed that there was no prospect of improvement. A euthanasia request was submitted in December 2020 and was reviewed by medical committees for three years. Permission for the procedure was obtained only in May 2024. Formally, this case is not a court decision, but its public discussion and the multi‑year review confirmed the legitimacy of euthanasia for incurable mental disorders. Cases of psychiatric euthanasia demonstrate the strictness of procedural safeguards that preclude hasty decisions [5].

Belgium

Tine Nys case (Court of Assizes of Ghent, 31 January 2020). After years of unsuccessful treatment, Tine Nys, who suffered from severe mental disorders, underwent euthanasia in 2010. Her family, believing that her condition was not hopeless, charged three doctors with negligent homicide. After eight hours of deliberation, the jury acquitted the doctors and recognized the hopelessness of the patient’s psychological condition. In 2023, the Court of Cassation repeatedly confirmed this decision. The legal consequence is that it has become more difficult to prosecute doctors who conscientiously comply with euthanasia procedures. The experience of Belgian doctors and nurses facing such situations is described in detail in the collective monograph edited by Devos [3]. Belgian practice of euthanasia for mental disorders is characterized by a high degree of control and the involvement of several independent experts [5].

Geneviève Lermitte case (2023). In 2008, a woman was convicted of murdering her five children. She was serving a life sentence but in 2022 requested euthanasia, citing unbearable mental suffering. The supervisory commission confirmed that the suffering was constant and the woman’s decision was voluntary and informed. The procedure was carried out exactly 16 years after the crime. This case showed that the right to euthanasia for mental suffering does not depend on the status of the person. Belgian law contains no exceptions for those convicted of particularly serious crimes if they are competent.

Switzerland

Peter Baumann case (Criminal Court of Basel, July 2007). A psychiatrist, also the founder of an assisted suicide association, helped three patients with mental disorders to commit suicide. The prosecution accused Baumann and insisted that these people were not capable of making an informed decision. The court found Peter Baumann guilty of manslaughter and sentenced him to three years in prison. In its judgment, the court emphasized that a doctor must conduct a thorough capacity assessment and not rely solely on formal consent. The judicial precedent showed that assisted suicide requires the doctor to be absolutely certain of the patient’s informed decision. After the Baumann case, requirements for psychiatric assessment were tightened. The general context of the Swiss liberal model of assisted suicide is presented in the review by Stoppe [9].

Pierre Beck case (Federal Supreme Court of Switzerland, 13 March 2024). A doctor prescribed a lethal dose of pentobarbital to an elderly woman who had no incurable physical illness. She decided to die together with her seriously ill husband because she did not want to live without him. The prosecutor charged the doctor with violating narcotics law. The Cantonal Court dismissed the appeal and confirmed that “existential suffering” (fear of loneliness, loss of meaning in life) is a sufficient ground provided the decision is voluntary and informed. Thus, assisted suicide was legalized for “healthy” elderly people who are “tired of life”. This legal consequence expanded the Swiss model beyond medical indications. Sperling’s study shows that the practice of assisted suicide in Switzerland, including assistance to foreigners, evokes an ambivalent reaction in society [8].

France

Vincent Lambert case (European Court of Human Rights, 5 June 2015). After an accident, a man fell into a vegetative state with irreversible brain damage. His wife insisted on stopping life‑sustaining treatment based on Vincent’s oral wishes. His parents demanded the opposite. The Council of State authorized the cessation of treatment. Lambert’s parents appealed to the ECtHR. The European Court ruled that the withdrawal of life‑sustaining treatment does not violate Article 2 of the European Convention (right to life) if the decision is made in accordance with national law and proper procedure. The right of doctors to discontinue treatment in cases of “unreasonable obstinacy” was established, even in the absence of written advance directives and in the presence of a conflict between relatives. The European Court of Human Rights left states a wide margin of appreciation but required clear procedural safeguards [10].

Alain Cocq case (2021). A man suffered for a long time from an incurable disease-causing unbearable pain. French law allowed deep sedation only for patients with a short‑term prognosis (a few hours to days). Cocq did not fall into this category. He failed to obtain permission for euthanasia and went to Switzerland, where on 15 June 2021 he committed assisted suicide with the help of Dignitas. Thus, a gap in French legislation was identified concerning patients with prolonged but non‑terminal suffering. The case sparked public debate and a bill on “assistance in dying”. It also demonstrated the phenomenon of “suicide tourism”. The French end‑of‑life law has both strengths (the right to palliative sedation) and weaknesses, especially in disputes between doctors and families [7].

3. Results and Discussion

During the study:

1) eight significant court cases have been analyzed that influenced the legal regulation of euthanasia and assisted suicide in European countries such as the Netherlands, Belgium, Switzerland and France;

2) the legal consequences of each precedent have been identified: legalization of euthanasia for dementia without final consent; protecting doctors from criminal prosecution; recognition of existential suffering as grounds for assisted suicide; securing the right of doctors to stop treatment with «unreasonable persistence».

The comparative analysis has revealed three common trends. First, courts are gradually expanding the circle of persons eligible for euthanasia: legalization of euthanasia for patients with dementia (Netherlands) [1]; patients suffering from mental disorders (Netherlands, Belgium) [5]; convicted persons (Belgium); “healthy” elderly people with existential suffering (Switzerland) [8].

Second, the expansion of the circle of persons is accompanied by stricter procedural safeguards: the requirement of medical opinions from two doctors for patients with progressive dementia (Netherlands); lengthy reviews for euthanasia related to mental disorders (Netherlands); tightening of requirements for assessing patient capacity (Switzerland).

Third, the European Court of Human Rights, while not recognizing a right to death, requires states to provide legal certainty (Gross v. Switzerland) and to observe proper procedures (Lambert and Others v. France) [10].

France demonstrates a transitional model: judicial practice developed around passive euthanasia while active euthanasia remained prohibited, leading to “suicide tourism” and pressure on the legislator [7].

4. Conclusion

The conducted research shows that the judicial practice of European countries on euthanasia serves to adapt legislation to complex ethical and clinical cases. Access to the procedure is expanding, which gives rise to stronger procedural guarantees. The European Court of Human Rights acts as a “procedural arbiter”: the court does not impose a specific solution on states but requires legal certainty in legislation.