Noelia Castillo, a 25-year-old Spanish woman left paraplegic after a 2022 suicide attempt following sexual assault, died by legal euthanasia on March 26 near Barcelona. Her case-upheld by Spain’s Supreme Court, Constitutional Court, and the European Court of Human Rights-sparked national controversy, particularly from conservative groups questioning her mental capacity.
Spain legalized euthanasia in 2021 for those with serious, incurable or chronic debilitating conditions. Patients must submit two voluntary requests at least 15 days apart.
Only four European countries permit physician-administered euthanasia: the Netherlands, Belgium, Luxembourg, and Spain.
The Netherlands pioneered legalization in 2002, requiring unbearable suffering with no prospect of improvement-covering both physical and psychiatric conditions-and mandates independent physician consultation.
Belgium also decriminalized euthanasia in 2002 under similar criteria: terminal illness, unbearable suffering, and full mental capacity.
Luxembourg followed in 2009, allowing euthanasia for adults with incurable conditions causing unbearable suffering, provided the request is voluntary and pressure-free.
Austria permits only voluntary assisted dying since 2022, requiring patients to self-administer medication after rigorous review.
Elsewhere, France’s assisted-dying bill remains stalled between parliamentary chambers. Portugal passed a law in 2023, but it’s inactive due to presidential vetoes and court challenges. Malta launched a public consultation in 2025, while Slovenia’s euthanasia law was rejected by voters in a 2024 referendum.