Patients who receive palliative sedation are those expected to die within days. To mitigate distressing symptoms they are heavily sedated, life-prolonging treatment and hydration is withheld and they die without regaining consciousness.
A study in the British Medical Journal in March confirmed the trend towards sedation and away from euthanasia.
"It is more than a coincidence that euthanasia has gone down and palliative sedation has gone up," said Rob Jonquiere, director of the Dutch Right to Die society.
"We hear anecdotal evidence from families that patients actually wanted euthanasia but the doctor instead gave palliative sedation," he said, adding he had struggled with euthanasia requests when he practiced medicine.
"Patients say: 'I don't want to be cuddled to death. I'm going to die anyway. Let me die now'."
A survey published this year in the Journal of Medical Ethics showed almost half the Dutch doctors questioned tried to avoid euthanasia because it was against their own values or difficult to deal with.
"There was a concern that once doctors started using euthanasia they would do it more and more easily. What we see is the opposite because they need emotional rest," Jonquiere said.
"TIRED OF LIFE"
Activists are pushing for the euthanasia law to be relaxed further to allow those suffering from dementia and who are "tired of life" to die.
"Since it's been legal there is less fear for doctors of being prosecuted, but the rules about 'unbearable suffering' are very limiting," said Hanny van de Velde, a member of the Right to Die organisation and a helpline volunteer.
A poll by Dutch research bureau Intomart GfK published in March showed 63 per cent of the 1,000 people surveyed supported granting the right to die to the elderly, even if they were not ill, while 74 per cent supported the controlled distribution of "suicide" pills to those who felt their lives were done.
But changes to Dutch law look unlikely as the religious Christian Union is a junior partner in the ruling coalition.
The CU opposes euthanasia and says more attention must be paid to the reasons people ask for mercy killing. The cabinet has approved an extra 10 million euros in annual spending on care for the terminally ill for the next three years.
"Good care and the reassuring certainty that effective pain relief is possible can solve the demand for euthanasia," said CU member of parliament Esme Wiegman-Van Meppelen Schepping.
Dutch writer JJ Voskuil died on May 1 in what his widow said was a case of euthanasia. He was 81.
"My beloved husband chose a dignified end," Lousje Voskuil-Haspers wrote in an obituary.
Stans Verhagen, a cancer specialist who deals with about 800 dying patients a year, said there should be less focus on euthanasia and more on other ways of helping the terminally ill.
"We started with euthanasia in Holland because people were suffering from so much pain - it's what makes us afraid of dying," he said. He likened the end of life to landing a plane.
"We should give less attention to the emergency exit and more to how not to crash. It is possible to have a good death."
