The number of official cases of euthanasia in the Netherlands rose 10% last year to 6091 and euthanasia now accounts for 4% of total deaths, the regional monitoring boards said on Wednesday.

In 10 cases, the rules for euthanasia were not followed correctly, most of which involved a failure to properly consult a second doctor, the RTE annual report said. In one case, a doctor was reprimanded for ‘crossing the line’ with a patient suffering from severe dementia.

Of the total, 87% of assisted deaths involved people with cancer, serious heart or lung problems or diseases of the nervous system such as ALS.

There were 32 more cases of assisted suicide involving people with dementia, most of whom were in the early stages of the disease. In addition, there were 60 cases involving people with severe psychiatric problems, a rise of four on 2015.

Demographics

Monitoring committee chairman Jacob Kohnstamm said it is not easy to determine why there has been a rise in overall cases. The demographic make-up of the Netherlands could be one reason for the increase, as could a change of opinion among doctors, he said.

Some 85% of euthanasia requests are carried out by the patient’s own doctor, usually at home.

Euthanasia is legal in the Netherlands under strict conditions. For example, the patient must be suffering unbearable pain and the doctor must be convinced the patient is making an informed choice. The opinion of a second doctor is also required.

Since the legislation was introduced in 2002, there have been a number of controversial cases, including a woman suffering severe tinnitus and a serious alcoholic.