From Euthanasia and Sex Change for Minors to Elective Abortion: Europe’s Most Liberal States
Since World War II, Europeans have consistently turned away from the Church, and public policy has become more secular and more liberal, with same-sex marriage, gender identity policies, and abortion becoming widespread.
Euthanasia and assisted suicide have become legal in several European countries. The Netherlands became the first country to legalize euthanasia in 2002, followed by Belgium the same year, Luxembourg in 2009, and Spain in 2021. Portugal passed a euthanasia law in May 2023, though it remains unimplemented pending government regulation.
In November 2024, the United Kingdom voted to advance assisted dying legislation for England and Wales that would allow terminally ill adults expected to die within six months to request assistance to end their lives. France’s parliament is debating assisted dying legislation as of 2025. Switzerland has permitted assisted suicide since 1942, though active euthanasia remains illegal. Germany, Austria, and Italy allow assisted suicide under certain conditions based on constitutional court rulings, though comprehensive legislation is still being developed in these countries.
Belgium is the most permissive country, having removed all age restrictions on euthanasia in 2014. Children of any age can request euthanasia if they are terminally ill, demonstrate understanding of their choice, and have parental consent.
The Netherlands allows euthanasia for minors aged 12-15 with parental consent, and ages 16-17 with parental consultation. Netherlands also permits euthanasia for infants under one year through the Groningen Protocol, and in 2024 extended this to children aged 1-12 who cannot consent themselves but are suffering from incurable terminal illnesses.
Twelve European countries allow legal gender recognition based on self-determination, permitting individuals to change their official gender marker on identity documents without medical requirements. In some countries, this extends to children and adolescents under 18. Policies vary, with requirements ranging from parental consent or court approval to minimum age thresholds, while some allow self-declaration and others require medical diagnosis.
All EU member states except Hungary, Latvia, and Romania provide access to hormone therapy (testosterone and estrogen) for gender transition purposes. Public health funding for gender transition varies across countries.
The Netherlands, Belgium, Spain, and Denmark provide full coverage through national health insurance for gender transition hormone therapy and surgeries, though Denmark has some limitations on estrogen coverage.
Most other EU countries provide some level of public health coverage for gender transition procedures. Estonia, Lithuania, Croatia, Poland, Czech Republic, and Romania provide limited or no coverage for various gender transition procedures.
Croatia does not cover gender-affirming surgeries through national insurance at all. The Netherlands, Belgium, Spain, and Malta have the most comprehensive coverage for gender transition healthcare.
Eighteen EU member states permit puberty blockers for minors. Fourteen member states provide over 70 percent public health funding for puberty blockers. Almost all member states that allow puberty blockers also permit hormone therapy for minors, except Estonia and Slovenia. Two-thirds of EU countries still allow transgender youth at least some access to puberty blockers as of 2025.
Several European countries have recently restricted access to puberty blockers for minors. The United Kingdom banned puberty blockers for under-18s in December 2024, though patients already receiving them can continue and clinical trials are exempted. Sweden allows treatments for minors only within a research context and for exceptional cases since 2022.
Finland recommended in 2020 that minors first receive psychological support, with medical treatment only after being made aware of risks. France’s National Academy of Medicine recommended in 2022 the greatest reserve regarding puberty blockers for minors.
Norway’s Healthcare Investigation Board recommended in 2023 that puberty blockers be defined as experimental treatment. Germany’s 2025 guidelines discourage puberty blockers and reject surgeries for nonbinary adolescents, though the position on hormones is less clear.
Most European countries allow abortion on request, typically between 10 and 14 weeks. Fifteen countries have expanded abortion access since 2021. Sweden ranks highest for abortion access, scoring 94.6 percent on the European Abortion Policies Atlas, followed by France at 85.2 percent and the Netherlands at 80.3 percent. Public support for legal abortion reaches 95 percent in Sweden and at least 75 percent in nearly every European country, with Poland as an exception at 56 percent support.
France enshrined abortion as a right in its Constitution in 2024. Ireland, which until the 1970s was one of the most Catholic countries in the world, voted to repeal its abortion ban in a 2018 referendum.
At the opposite end of the spectrum, Andorra maintains a total ban with only one exception for life-saving necessity under general criminal law. Criminal penalties can reach up to 10 years imprisonment. Malta has nearly completely banned abortion with a 3.7 percent score, permitting the procedure only when a woman’s life is in grave jeopardy from medical complication or immediate risk of death.
Malta imposes criminal penalties of 18 months to three years for women and 18 months to four years for providers who perform abortions, including lifetime medical license bans.
Poland maintains highly restrictive laws with an 18.6 percent score. Abortion is legal only for rape, incest, or threat to the mother’s life or health. A 2020 Constitutional Tribunal ruling eliminated the fetal abnormality exception, creating a de facto ban. The ruling sparked the largest protests in Poland since the fall of communism.
Liechtenstein permits abortion only when there is a life or health risk or in cases of rape. Monaco allows abortion for life or health risk, rape, or severe fetal impairment. Monaco recently liberalized from a total ban, with around 5 to 10 cases per year expected.
The Faroe Islands currently restrict abortion to cases involving life risk, health risk, fetal defect, or rape. However, legislation passed in December 2025 will allow abortion on request up to 12 weeks beginning July 1, 2026.
Slovakia faces new constitutional amendments from September 2025 that will restrict abortion. Croatia has ongoing attempts to impose barriers on abortion access.
Hungary presents a complex situation. Abortion remains technically legal until 12 weeks of pregnancy for socioeconomic reasons, but the Orbán government has erected barriers. Hungary’s 2012 constitution states that fetal life must be protected from conception. A 2022 law requires women to listen to fetal vital signs or heartbeat before abortion.
The law mandates counseling sessions at least twice with the Family Protection Service and a 72-hour waiting period. Hungary banned medical abortion in 2012, allowing only surgical abortions. Mandatory documentation and referrals create administrative obstacles. High rates of conscientious objection among doctors and public hospitals increasingly refusing to provide abortions create long waiting lists, often over a month.
Italy passed a new law allowing anti-abortion groups into counseling centers, creating additional barriers to access.
Across Europe and across the world, while there are exceptions, Slovakia and Croatia are the only notable cases moving in a more restrictive direction. France constitutionalized abortion in 2024, Ireland shifted from deeply Catholic to repealing its abortion ban, and the Faroe Islands will liberalize abortion in 2026. Overall, the trend moves in one direction: greater liberalization and normalization of abortion and transgender ideology.
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