Nic and Trees Elderhorst knew exactly how they wanted to die.

They were both 91 years old and in declining health. Nic Elderhorst suffered a stroke in 2012 and more recently, his wife, Trees Elderhorst, was diagnosed with dementia, according to the Dutch newspaper, De Gelderlander.

Neither wanted to live without the other, or leave this world alone.

So the two, who lived in Didam, a town in the eastern part of the Netherlands, and had been together 65 years, shared a last word, and a kiss, then died last month hand-in-hand in a double euthanasia allowed under Dutch law, according to De Gelderlander.

Dying together was their deepest wish, their daughters told the newspaper, according to an English translation.

The Netherlands became the first country to legalize euthanasia in 2002, allowing physicians to assist ailing patients in ending their lives without facing criminal prosecution.

Euthanasia, in which a physician terminates a patients life at his or her request, is legal in a few countries, including Belgium, Colombia and Luxembourg. Physician-assisted suicide, in which a doctor prescribes lethal drugs that a patient may take to end his or her life, is permitted in a few others, including in certain states in the United States, according to ProCon.org, a nonprofit organization that researches countries legislation on the issue.

We are pleased that we have in the Netherlands this humane and carefully executed legislation that allows the honorable wishes of these two people whose fate was painful and hopeless, Dick Bosscher, of the Dutch Association for a Voluntary End of Life (NVVE), said in a statement to The Washington Post. He said the Elderhorsts belonged to NVVE, a 165,000-member organization for euthanasia and assisted suicide in the Netherlands.

In recent years, apparent double-suicides and murder-suicides have been capturing worldwide attention amid an emotional right-to-die debate couples from Florida to Paris reportedly ending their lives together.

Assisted suicide has summoned up deep religious and ethical concerns among critics.

In the United States, the subject was widely debated in 2014, when a 29-year-old woman who had a fatal brain tumor moved from California to Oregon, where she could legally seek medical aid to end her life. California has since enacted its End of Life Option Act, joining a small number of states where it is legal.

Even in the Netherlands, according to Bosscher with NVVE, the Elderhorsts case is rare in that both of them were able to meet the criteria for euthanasia under the Dutch Termination of Life on Request and Assisted Suicide (Review Procedures) Act. Euthanasia and physician-assisted suicide can be carried out only when the patients request is voluntary and well thought-out, the patient is in lasting and unbearable suffering and there are no other solutions, among other things.

Research published this month in the New England Journal of Medicine revealed that euthanasia and physician-assisted suicides accounted for 4.5 percent of deaths in the Netherlands in 2015, up from 1.7 percent in 1990, before it was legal. The 25-year review found that most patients who received assistance had serious illnesses.

It looks like patients are now more willing to ask for euthanasia and physicians are more willing to grant it, lead author Agnes Van der Heide, of Erasmus University Medical Center in Rotterdam, told the Associated Press.

However, Bosscher said that there are more than 15,000 requests for euthanasia each year in the Netherlands and that only about 6,000 of them are granted.

The Elderhorsts discussed their options and submitted requests for euthanasia, a year-long process their daughters called an intense time, according to De Gelderlander.

The couple, who had even planned their own funerals, died July 4.

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