Ritualization of euthanasia in cases of unbearable psychiatric versus unbearable somatic suffering in the Netherlands: a comparison

Abstract

The Netherlands has an established euthanasia practice. The increase in euthanasia cases for psychiatric suffering over the past 10 years is subject to ongoing public and political debate. During the fieldwork of the research project “ritualisation of euthanasia”, remarkable differences between euthanasia cases for somatic suffering and psychiatric suffering were observed, which sparked a closer investigation. This article analyses how euthanasia is ritualised differently in cases of those two groups and tentatively explained using theories from ritual studies, sociology and anthropology. Between November 2023 and November 2025, 52 euthanasia cases were explored using a multi-sited focused ethnography approach. Through observations and prospective and retrospective interviews, data was collected and analysed using constant comparative methods. This paper reveals that psychiatric cases, often younger people and more socially stigmatised, engage in more expressive, symbolic, and creative rituals, such as curated funerals, memory boxes, and tattoos. In contrast, somatic cases tend to focus on relational closure through familiar and everyday rituals. The paper highlights how ritual behaviour reflects age, stigma, and social positioning, with rituals in psychiatric cases serving the creation of a post-self, recognition, agency, and active narrative shaping at the end of life. The findings suggest that ritualisation is not only personal but also deeply socio-cultural and moral, offering insight into how different forms of suffering shape the meaning of a “good death”.