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THE HAGUE, April 10 -- Despite protests outside parliament, the Netherlands today legalized mercy killings and assisted suicide, becoming the first nation to pass a law allowing doctors to end the life of patients with unbearable, terminal illnesses.

About 10,000 euthanasia opponents surrounded the building, praying, singing hymns and quoting from the Bible, while the upper house of parliament considered the legislation. It voted 46 to 28 in favor of the law, which is likely to take effect this summer.

Before the vote, Health Minister Els Borst reassured legislators that the law could not be abused by doctors because of careful supervisory provisions. "There are sufficient measures to eliminate those concerns," Borst told the senators.

Euthanasia, she said, will remain a last resort for those who have no other choice but endless suffering.

The law presupposes a long doctor-patient relationship and requires that patients be legal residents of the Netherlands. It formalizes a practice discreetly used in Dutch hospitals and homes for decades, turning guidelines adopted by parliament in 1993 into law. Doctors will face punishment if they fail to meet the law's strict codes.

Outside parliament, some protesters wore black masks and carried oversize syringes dripping with simulated blood. Others gathered signatures for a petition against the measure, adding to the 25,000 names collected before the debate opened Monday evening. Several Christian schools canceled classes to allow students to participate in the demonstrations.

"We don't have the right to decide about matters of life and death, but God does," said Henrico van der Hoek, 19, as he walked passed parliament. "As Christians, we simply cannot support this law."

After the vote, protesters said they were disappointed but not surprised. Political analysts had considered the upper house vote a formality because the bill had already passed the lower house. "The tide will turn back someday," said 69-year-old Piet Huurman of the group Cry for Life. "They will realize they have made a terrible mistake."

In the debate, Borst said a broad consensus had coalesced after 30 years of discussion, with 90 percent of the population backing the changes.

Under the law, a patient would have to be experiencing irremediable and unbearable suffering, be aware of all other medical options and have sought a second professional opinion. The request would have to be made voluntarily, persistently and independently while the patient is of sound mind. Doctors are not supposed to suggest it as an option.

The new law also allows patients to leave a written request for euthanasia, giving doctors the right to use their discretion when patients become too physically or mentally ill to decide for themselves. An independent commission would review cases to ensure the guidelines were followed.
If a doctor is suspected of wrongdoing, the case will be referred to public prosecutors for review and possible punishment.

Several countries -- Switzerland, Colombia and Belgium -- tolerate euthanasia. In the United States, Oregon has allowed doctor-assisted suicide for the terminally ill since 1996, but its law is more restrictive than the Dutch law.