This paper aims to reflect on whether substantive limits should be implemented and what procedural rules should be introduced by legislators wishing to legalize euthanasia or assisted suicide (EAS) to guarantee health and autonomy of both the mentally ill and other patients.

We analyzed and compared the rules of the nine European States (the Netherlands, Belgium, Luxembourg, Austria, Portugal, Spain, Italy, Switzerland and Germany) where EAS is lawful.

The increase of countries that in the last years have implemented or introduced regulations on EAS leads us to think that: (a) substantive requirements should not be reduced, for example, allowing healthy people to access EAS; (b) substantive requirements must be ascertained through procedures that offer all of the guarantees of protection of the rights to life and self-determination provided for by the different regulations of the aforementioned countries, including, for example, clinical-psychological counselling to ensure autonomy of choice as well as preventive and ex-post control commission on compliance with substantive and procedural requirements. No law or ruling provided for the introduction of policies aimed at eliminating, before executing EAS, the socio-economic causes that led to the request to die.

The framework regulating EAS should be integrated with policies and measures to guarantee favorable family and socio-economic conditions, offer full access to palliative care, and allow free and equal decision-making.