The number of people helped to die under Dutch euthanasia legislation rose 8% last year to 6,585, the regional monitoring committee said on Wednesday. Of them, 99.8% were carried out carefully and in line with the guidelines, the committee says in its 2017 annual report.

In almost 90% of cases, the patient was suffering from cancer, heart and artery disease or diseases of the nervous system, such as Parkinson and MS. Three patients were in the advanced stage of dementia and 166 were in earlier stages.

In 83 cases, the patient was suffering from severe psychiatric issues, a trend which has raised questions among psychiatrists, RTL Nieuws reported earlier this year.

Twelve cases were labeled by the monitoring committee as not being carefully carried out – these were mainly problems with medical care or not having an independent second opinion.

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.

The 8% rise in cases is in line with previous years and most patients are over the age of 70. ‘People are becoming older,’ said Jacob Kohnstamm, who chairs the committee, in the NRC. ‘Doctors know more about euthanasia and people are more aware of the issues. Given the post war population increase, this trend will continue.’