In the Netherlands, psychiatric euthanasia cases rose from effectively zero in 2002 to 138 in 2023 — representing just 1.5% of all cases after 24 years. In Belgium, psychiatric and cognitive disorder cases stand at 1.4% each of all cases as of 2024. The overwhelming majority — over 75% — involve cancer or polypathologies in elderly patients over 70. Canada has seen faster expansion of eligibility criteria (Track 2 non-terminal, Mental Health expansion planned for 2027), which has generated genuine policy debate. But critics who predicted the laws would quickly expand to cover any preference without safeguards have not been vindicated by the data from the pioneer jurisdictions. Academic analysis published in JAMA Network Open (2025) found that demographic changes explain a significant part of rising case numbers, not criteria expansion.

Belgium's data shows 84.74% of cases involve patients aged 60 or older — reflecting the demographics of serious incurable illness, not vulnerability exploitation. Oregon's data consistently shows MAID patients are predominantly white (92%), educated (45%+ with degrees), and insured (100%) — suggesting access skews toward the privileged, not the disadvantaged. Canada's 2024 report found that MAID recipients "do not disproportionately come from lower-income or disadvantaged communities." However, Canada's Track 2 data (non-terminal) shows 61.5% of recipients self-reported a disability — raising ongoing concerns that inadequate disability support may be driving some requests. The UN Committee on the Rights of Persons with Disabilities has expressed concern about Canada's Track 2 expansion.

The evidence is mixed. In Oregon, 92% of DWDA patients in 2024 were enrolled in hospice care — suggesting palliative and assisted-dying access are not mutually exclusive. In Canada, Health Canada reports that approximately 74% of MAID recipients in 2024 had received palliative care. However, critics note that a third of those received palliative care for less than one month, raising questions about quality. In Belgium and Netherlands, both palliative care infrastructure and assisted dying access have expanded simultaneously over 24 years — no evidence of displacement. The concern is most acute in lower-income countries where palliative care is already absent, making it structurally easier to offer death than care.

Both Belgium and the Netherlands allow euthanasia for psychiatric conditions where suffering is deemed constant, unbearable, and with no prospect of improvement. In the Netherlands, 138 psychiatric-only cases were approved in 2023 — up 20% from 2022's 115, but still representing only 1.5% of all cases. Belgium's FCCEE reports psychiatric and cognitive disorder cases at 1.4% each in 2024. These cases undergo the most rigorous scrutiny, typically requiring additional independent physician consultations including a specialist psychiatrist. Academic research confirms these remain a small and carefully screened cohort. Canada has explicitly delayed mental illness as a sole condition to March 2027 amid ongoing debate.

Oregon's 27-year dataset is the most detailed. In 2024, the three most cited concerns were: loss of autonomy (88.6%), decreasing ability to engage in enjoyable activities (87.8%), and loss of dignity (63.6%). Inadequate pain control was cited by only about 29% of patients. This pattern has been consistent for over two decades. It reveals that the primary driver is not uncontrolled physical pain — which palliative medicine can largely address — but the loss of self-determination and dignity. This directly supports the constitutional autonomy arguments at the core of Kahu Advocacy Foundation's PIL, which argues that the right to dignity under Article 21 cannot be reduced to merely ensuring freedom from pain.

The pandemic accelerated several trends. Canada saw a 36.8% single-year increase from 2019 to 2020 — its highest ever — partly driven by pandemic-related isolation and fear of dying in hospital without family. The Netherlands and Belgium implemented telehealth consultations for initial assessments during lockdowns, reducing access barriers. In Australia, Victoria's newly launched scheme navigated early implementation during the pandemic. Globally, the pandemic intensified public debate about death, dignity, and the right to control one's end-of-life circumstances — shifting public opinion polls toward greater support in every major survey conducted 2020–2022. Several countries that were debating legislation accelerated their timelines post-pandemic.