In 2002 the Netherlands became the first country to legalize euthanasia and physician-assisted suicide for those suffering deadly diseases or in the last stages of life. Not long after the legislation was enacted, eligibility was expanded to include those experiencing psychological suffering or dementia. Today pressure is mounting for the Dutch government to legalize a “euthanasia pill” for those who are not ill, but simply consider their lives to be “full.”

Proponents of assisted suicide continue to claim that safeguards already built into Dutch law are sufficient to reduce the risk of abuse. They point out that medical professionals are required to assess whether a person’s suffering is indeed unbearable and hopeless.

These safeguards do exist. In practice, however, they are hard to enforce. A poignant illustration was recently aired on Dutch television. An older woman stricken with semantic dementia had lost her ability to use words to convey meaning. “Upsy-daisy, let’s go,” she said. Both her husband and her physician at the end-of-life clinic interpreted her words to mean, “I want to die.” A review committee judged her euthanasia was in accordance both with the law and her earlier written instructions, an outcome very few would have imagined possible as recently as 10 years ago.

Such episodes have many Dutch people worried about the erosion of protections for the socially vulnerable and medically fragile. A broad and heated public debate recently flared about whether doctors may administer fatal drugs to those with severe dementia based on a previously signed “advance directive.” In several controversial cases, assisted suicide was not directly discussed with patients who were incapable of reaffirming earlier written death wishes. In one case, a doctor slipped a dementia patient a sleeping pill in some apple sauce so that he could be easily taken home and given a deadly injection.

Hundreds of Dutch physicians signed a declaration outlining their moral objection to these increasingly common practices. Nonetheless, the Dutch government stands by its claim that the law permits doctors to end such patients’ lives. Meanwhile, the Dutch Right to Die Society, a national euthanasia lobby, keeps pressing to take further steps, arguing that individuals should have the option to “step out of life.”