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[Euthanasia in Germany #1] Current Situation and Structure

[Euthanasia in Germany] - The unique balance between "individual freedom" and "state involvement"


1. Overview of the system and legal situation (Euthanasia in Germany)


In 2020, the German Federal Constitutional Court handed down a landmark ruling.


"A strict ban on assisted suicide would violate the Constitution."


That is our decision.

This ruling effectively made euthanasia (or more accurately, assisted suicide, or Sterbehilfe) legal in Germany .


However, unlike the Netherlands and Canada , the country does not have a system in place .

Currently, euthanasia services are provided primarily by private non-profit organizations , a system similar to the "Swiss model."


The three most prominent groups are:


  • German Society for Humane Death (DGHS)

  • Assisted suicide association (Verein Sterbehilfe)

  • Dignitas Germany


These organizations work in cooperation with doctors, lawyers, police, and others to provide counseling, screening, and assistance in carrying out euthanasia for those who wish to end their lives.


However, because it has not yet been legally established as a "system," it is not implemented within the framework of a national system or health insurance. In other words, it continues to be operated extremely independently, based on a judicial decision to "decriminalize" it .


*To be precise, private euthanasia has been taking place in Germany since the 1980s.

Then, in 2015, all euthanasia services were banned (strictly speaking, the ban was on "providing assisted suicide as a business," and personal assisted suicide was not completely banned even at the time ).

Dissatisfied with this, the three organizations filed a lawsuit in 2020 and won the decriminalization of the law.




2. History and timeline of the introduction of the system


The issue of "self-determined death" has long been debated in Germany. Below is a brief summary of the main trends surrounding euthanasia.


  • 2015 : A law banning assisted suicide in principle was enacted.

  • 2020 : The Federal Constitutional Court rules the above law to be unconstitutional. → Euthanasia is effectively legalized.

  • From 2021 onwards : Private organisations resume their activities, and support for euthanasia becomes more widespread again.

  • 2023 : A regulatory bill is submitted to the Diet but rejected. → The majority believes that new legislation is unnecessary .


A text describing the current state of euthanasia in Germany


There was a political movement to legalize private euthanasia services in 2023, but it was rejected by Parliament.




Behind this is Germany's historical memory - the Nazi era's " Operation T4 (the plan to eliminate disabled people) " - which casts a strong shadow. It is said that extreme wariness of the state being involved in "decisions between life and death" is still deeply rooted in society.


*Operation T4 was a policy of "forced euthanasia" implemented in Nazi Germany against the mentally and physically disabled.

It began in October 1939 and was discontinued in August 1941, but the euthanasia policy itself continued.

"T4" is the name of the organization, given after World War II, and is an abbreviation of Tiergartenstrasse 4 in Berlin, where the Euthanasia Administration is located .

Date of occurrence: September 1, 1939 Year of end: 1945




3. Latest trends and summary report


In 2024, the three organizations provided a total of 977 euthanasia cases .

The number of users is increasing year by year, and the activities of the long-established organization DGHS (German Society for Humane Death) are particularly notable.


Trends in the number of people using euthanasia in Germany

(Graph showing trends in number of users by group)



People who used euthanasia in Germany (breakdown by organization)

(Breakdown of each organization)





However, the total number of deaths in Germany is about 1 million per year, and of those, only 0.097% are due to euthanasia, which is extremely low compared to the Netherlands (about 5.4%) and Canada (about 4.7%).




4. Main Eligibility Criteria

In Germany, there are no national laws, so there are no "uniform standards." However, all three major organizations have strict screening procedures. A careful decision is made after a medical examination, multiple interviews, and document review.


According to data released by DGHS, the top reasons for application are as follows:


Reasons for requesting euthanasia in Germany

(DGHS publication: Graph of motivations for requesting euthanasia)


Diseases that qualify for euthanasia in Germany

(※Machine translation)


1st place Multi-morbidity/complex disease (27.8%)

2nd place: Fatigue and loss of will to live (22.2%)

3. Cancer (21.8%)

4. ALS and intractable neurological diseases (14.6%)


Age and sex of those euthanized in Germany

(Breakdown by age and gender in DGHS)


In addition, the average age of DGHS users is 79 years old , and the proportion of women is slightly higher at 62%.

Users under the age of 60 make up just under 5% of the total, with the majority of users being elderly .




5. Specific examples of implementation status


The "euthanasia proxy system" run by private organizations is similar to that in Switzerland.

Doctors, legal affairs, police, and local governments work together in a loose manner to provide support after confirming the individual's wishes.

Unlike the Netherlands, where euthanasia is provided within the medical system, Japan's structure is characterized by support for self-determination by civil organizations .


Among those who have undergone euthanasia, there have been reported cases where people have felt satisfied with their lives or where couples have chosen euthanasia at the same time. (The simultaneous euthanasia of the former Dutch Prime Minister and his wife in 2022 is cited as a symbolic example.)


On the other hand, because the screening process is complicated and the procedures are cumbersome, many people "travel to Switzerland to undergo the procedure even though euthanasia is permitted in Germany." In the future, it is hoped that the system will be improved to make it smoother while maintaining transparency.




6. Evaluation of the system and historical background

Discussions of euthanasia in German society are always inextricably linked to reflections on "state control of life."

"If the state were to legislate euthanasia, the power of life and death would once again be concentrated in the state."

This strong historical memory supports a cautious stance toward legislation.


In fact, the majority of people in the Diet are against the legislation, with the Green Party and the Free Democratic Party (FDP) in particular clearly taking an opposing stance.


German politicians' statements in support of euthanasia


And organizations like DGHS argue:


Statement from Germany's main euthanasia organisations


"There is no need to create a new legal system.

As it stands, it is already fully 'legalized'."



In other words, it aims for a social model that respects the free choice of citizens based on their own self-determination, rather than legal control .




This philosophy is deeply rooted in the ideas of "individual dignity" and "limitations on state power" that Germany established after the war. In modern Germany, euthanasia is handled calmly, and there is a gentle social acceptance of those who wish to end their lives with dignity .


Germany's euthanasia system is not a state-controlled system, but rather a free model led by civil society . Behind this is the two ideological pillars of "distrust of the state" and "respect for individual rights," based on reflection on the Nazi era.


This unique structure of "legalization without law" continues to raise universal questions about how to protect human dignity and freedom in German society, where ethics, law, and history intersect.




7. Note: Life-prolonging treatment in Japan


German citizens must not allow their "individual rights and will" to be placed under state control, much less taken away.

Based on such strong principles, I have stated that in Germany, freedom of self-determination regarding life and death is respected.


On the other hand, what about Japan?

In reality , a structure exists in which a group of doctors who hold medical licenses issued by the "state" hold the final decision regarding an individual's life or death under their powerful authority.


As a result, many elderly people are being kept alive despite their suffering in the name of "life-prolonging treatment," regardless of their own wishes.


If visiting nurses are included, the number of people in this situation is estimated to be around 3 to 4 million nationwide . It is no exaggeration to say that this is a systemic custom , and the amount of suffering suffered by the victims probably far exceeds that of the 1.1 million people massacred in concentration camps such as Auschwitz.



*A video created by a member of our association that provides a detailed explanation of life-prolonging treatment (slow explanation)



Some people who oppose euthanasia loudly express concerns such as, "Germany is a country that once experienced a horrible past under Hitler's regime, including Operation T4," and "If euthanasia is permitted, eugenics will once again be put into practice in the same way."


However, in modern Germany, it has become established as a system led by civil society rather than a state system, and functions as a system that protects the dignity and free will of individuals .

Rather, it is Japan's medical system, which ignores the wishes of patients and continues to prolong their suffering , that needs to be deeply questioned ethically.

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