The frame analysis led to the reconstruction of seven problematising frames and seven associated deproblematising counter-frames (see Table 1). In the following section, all frames (indicated by an A) are described first. The opposing counter-frames (indicated by a B) are presented in the second part.
Seven problematising frames
With regard to palliative care, there are two frames that lead to a problematising definition in the debate. On the one hand, palliative care is perceived as ‘terminal’ care in the frame Fear of death (1A). Palliative care, “the road to the final destination” , generates thoughts such as “there is no more hope” and emotions such as uncertainty and loneliness. The parties involved seem to evade or delay talking about either death or palliative care. Additionally, palliative care takes a position outside regular medicine. On the other hand, according to the frame Heavy burden (2A), palliative care is too big a responsibility for the relatives of the patient. Due to social pressure, they feel accountable and they dedicate themselves to remain close to the patient. The extra effort this requires causes stress, indicated in the analysis material by words such as “emotionally a burden”. Sometimes, reference is made to the ‘liberation’ of the heavy palliative caregiving, as can be recognised in this phrasing:
When my mother was still alive, I didn’t dare to fantasise. She lost control of life and, out of love, I didn’t want to confront her with change. But now that barrier is gone and I feel like I can start over again .
With regard to euthanasia, five frames were identified that lead to a problematising definition: Thou shalt not kill (3A), Slippery slope (4A), Lack of willpower (5A), I am not God (6A), and Medical progress (7A).
The basic idea of the frame Thou shalt not kill is that life, in whatever phase or capacity, is valuable. As a result, “committing” euthanasia is presented as committing a crime against life. The word use consists of variants and associations of a criminal act. By comparison with murder, this frame also makes it obvious that euthanasia should be punishable. The frame Slippery slope postulates that euthanasia is increasingly becoming a light-minded solution in a liberal society; whoever ‘is a little bit tired of life’ can receive euthanasia. In the analysis material, use was made of metaphors such as “supermarket euthanasia”  and “freely available: humane death” . In Lack of willpower, euthanasia is seen as a sign of weakness, because someone refuses to accept or bear suffering as part of life. The frame can be recognised by formulations that indicate the choice for euthanasia as a simplicity solution. The starting point of the frame I am not God is that euthanasia involves a difficult moral decision about someone else's end of life that is passed on to another. This is done primarily to doctors, but indirectly also to relatives or to society, as the responsibility for the judgment and the act that requires euthanasia does not belong to human beings. Seen from this frame, also a medical doctor does not necessarily feel competent about these “very complicated dilemmas”: “We are not there to kill, we are there to cure them” . The final frame, Medical progress (7A) is built around the hope that medicine offers, and ultimately the hope for an eternal life. Seen from that perspective, euthanasia ‘deprives’ people of the opportunities offered by medicine.
Seven deproblematising counter-frames
Two counter-frames offer a non-problematising definition of palliative care in the debate: Quality of life (1B) and Completion (2B). The first, Quality of life, departs from the assumption that there are unspoken wishes and expectations among patients and relatives about illness, care and the end of life. Reasoning from this counter-frame, the confrontation with death is entered into, not avoided, as it is in the frame Fear of death. Furthermore, in palliative care, issues such as “excessive continuation of medical treatment” are made negotiable. (Early) palliative care is referred to in the data as “an added value”, and it “offers more control”. Also, one “can finish life better” and even “live longer”. Palliative care increases people’s resilience, as demonstrated by this excerpt:
From that moment on, I found that I had to stay positive. […] At first, these steps were big: seeing my children getting married, becoming a grandmother. Now they have become small steps. Going on holiday with the whole family, my eldest daughter leaving home, becoming fifty. 
Typical of this counter-frame is that defining ‘quality’ of life is open to subjective interpretation. In practice, it could be interpreted very restrictively (e.g. drinking a glass of champagne), whereas physical, psycho-social and spiritual aspects of life, suffering and dying, possibly remain undiscussed. In the second counter-frame, Completion, palliative care is seen as a very meaningful and valuable period for both the (informal) caregivers, who can say goodbye in a satisfactory way, and the patients who have the opportunity to look for an acceptable end for their life stories. The idea is that palliative care usually involves “direct contact and exchange between people” , allowing them to deepen their relationships. Like the frame Heavy burden, the counter-frame Completion places the (informal) caregivers in a central position. In the counterframe, however, they are also grateful for the significant role they can play. Palliative care contributes to their self-development. In the data, palliative care is referred to as “a pure gift”.
Five counter-frames are identified to deproblematise euthanasia: Mercy (3B), Prevention (4B), Triumph of reason (5B), Absolute autonomy (6B), and Economic utility thinking (7B). The counter-frame Mercy is based on the assumption that life is valuable, but if it becomes an unbearable agony without the prospect of significant improvement, it is a moral duty to release people from their suffering at their request. From the underlying moral foundation mercifulness, also defined by lexical choices as “compassion” and “caring”, the emphasis lies on the responsibility of society to intervene when people can hardly bear their suffering. The analysis material often emphasises the ‘goodness’ of euthanasia, for example: “He drinks it laughing, as if it is Pernod [aniseed]” . In the counter-frame Prevention, both palliative care and euthanasia function as an avoidance of something that is considered less desirable: unnecessary suffering, deterioration, old age, meaninglessness of life, and suicide. As such, euthanasia is perceived as a well-considered and responsible way to guide people with “a death wish”: “Better the End-of-Life Clinic than that people throw themselves in front of the train” . Whereas the frame Lack of willpower defines euthanasia as a sign of weakness, the counter-frame Triumph of reason presents the intervention as a sign of strength, as the data set refers to euthanasia as a “courageous” choice. Those directly involved, their environment and the facilitating society all gain a victory over death as they can plan and organise the moment of death. At the frame’s base lies the prospect of a deterioration process. This can imply an agony from which one wants to protect not only herself or himself, but also the relatives.
In the counter-frame Absolute autonomy, euthanasia is a decision about one's own moment of death, which must be respected and granted by others, regardless of a person’s situation. In contrast to Triumph of reason, in which caution and regulation from the outside are central reasoning devices, in this frame it is the directly involved person who decides. The right to choose the time of death belongs only to the individual. In the data set, this is expressed through terms such as “taking ownership”. Based on the moral value of self-determination, individuals can lead their own life at their own discretion. This should be distinguished from the idea of ‘relational autonomy’ because, in this frame, everyone can determine their own end, without having to consider the impact on others. According to this counter-frame, different routes are possible, such as “assisted suicide” in unbearable and hopeless suffering, and the termination of a “completed life” with the help of an expert, also known as a “death counsellor”. Furthermore, there is the “autonomous route” without guidance, for example via “powder euthanasia” or a “last-will pill”.
A fifth and last counter-frame that deproblematised euthanasia was less prominent in the data, namely Economic utility thinking (7B). This counter-frame is based on a rational cost-benefit analysis, so that in our “performance-oriented culture”  something is of use only if the yield is greater than the cost involved. Investing in the ever-increasing group of ‘unusable’ people is costly and unprofitable. Granting euthanasia in a flexible way would be a solution in that respect.
The relationship between the framing of euthanasia and of palliative care
The framing of euthanasia on the one hand and palliative care on the other are related, although the relationship is not always straightforward. With regard to the frames that are connected with palliative care, two patterns can be distinguished. The frame Heavy burden does comprise a more logical step towards euthanasia, whereas the opposite is true for Fear of dying. The counter-frame Quality of life primarily means that palliative care guarantees more quality at the final stage of life, and as such euthanasia might not be a logical step to take. Also with Completion, there is a deproblematisation of palliative care, which makes euthanasia a less obvious choice, although an argument in the opposite direction is also conceivable.
When it comes to the frames that give meaning to euthanasia, three patterns can be distinguished. First, there are the frames that result in a problematising definition of euthanasia. The fact that good palliative care can offer an alternative applies to all of them. For instance, in the frame Thou shalt not kill, society must focus on good palliative care to prevent people from suffering and longing for death; in the frame Lack of willpower, palliative care providers can make human suffering more bearable; and in the frame I am not God it offers help by being involved in the decision making of euthanasia.
Second, with regard to the identified counter-frames, euthanasia is not a problem and, as such, it can be inherently part of palliative care. For example, within Mercy, euthanasia can be included in palliative care, as the first is defined as the humane way of ending suffering at the request of the person by “providing” euthanasia. Alternatively, palliative care can opt for ‘palliative sedation’, which means that there is no interference in the natural course of dying. “Unnecessary” suffering is “softened” and “made tolerable”, through the attention, warmth and proximity that palliative care offers. According to the counter-frame Prevention, policy must follow this societal trend by regulating and facilitating euthanasia. On the other hand, palliative care can be seen as a prevention of euthanasia. Palliative care offers the opportunity for seriously ill people to end their lives in a dignified way. Euthanasia may be labelled as a merciful death, but it also involves intervention in the natural course of the end of the life process. The reasoning in Triumph of reason is that euthanasia can allow one to die in a dignified way, offering peace and strength to sustain life, possibly even longer. Palliative care providers can supply support through the proactive organisation, preparation and management of death.
A third possibility is that euthanasia is not problematised, as is the case with Economic utility thinking, and that the emphasis on palliative care is used as a counter-frame, in order to contradict it. In extremis, however, euthanasia can be seen as a way out for the (palliative) healthcare costs. This idea can be found in statements such as “‘Voluntary’ euthanasia is a ‘tidy–up-neatly’ action by the cabinet” . This deproblematising perspective can be perceived as highly problematic at the moral level because it places older and sick people in a rational economical context, which suggests that they are useless and costly. As a result, they can feel pressure to request euthanasia. The framing of palliative care in terms of Quality of life or Completion can offer full alternatives, in such a way that they act as counter-frames in the debate. Palliative care, combined with pain-relief medications, can help to overcome the choice dilemmas as included in problematising framing.
Combination of frames and counter-frames
In order that a text would contain only one frame, none of the identified frames or counter-frames were applied in isolation. For instance, Thou shalt not kill, Slippery slope, Lack of willpower, and I am not God are used in combination. As such, they confirm and reinforce each other. In the debate in the Netherlands, they are also combined with arguments involving a denial of the deproblematising counter-frames. The frame Slippery slope, for example, appears in texts in which societal challenges, such as aging, savings and the impoverishment of care are addressed and Economic utility thinking is questioned. In this example, reference is made to the Slippery slope and Economic utility thinking raises objections:
We have placed strict restrictions on the provision of medicines in our country because we find them scary. Would we then let go of that when deciding on life and death? [...] I share the fear of the elderly that eventually euthanasia can be forced upon them if they ‘no longer matter’. 
Furthermore, the counter-frames Absolute autonomy and Triumph of reason are applied together as euthanasia is presented as one's free choice to die in dignity with complete personal control. Finally, the frame Medical progress and the frame Fear of death manifest jointly, as palliative care is highlighted as the termination of life and the deprivation of hope, making it a topic to be postponed or avoided as long as possible.
None of the described frames belong exclusively to a particular actor. However, there seems to be a pattern in the analysed texts, in that sense that opponents of euthanasia, mainly the Christian Dutch Physicians’ Alliance (NAV), and the Dutch political party Christen Union (CU), most commonly used the problematising frames, while proponents, such as the Dutch political party Democrats 66 (D66), the Cooperative Last Will (CLW), mainly cited the alternative counter-frames. On the side of the opponents, the frame Thou shalt not kill is strongly, but not exclusively, expressed from a religious angle and from pro-life organisations such as Scream for Life (Schreeuw om Leven). The frame Slippery slope was explicitly used by some actors, for example by psychiatrists, who were concerned about the expansion of euthanasia to specific groups of vulnerable people, such as people with dementia. On the other hand, in communications coming from organisations that advocate for euthanasia, such as the Dutch Association for a Voluntary End of Life (NVVE), the counter-frames Absolute autonomy and Mercy were especially present.
The use of counter-frames was not reserved for stakeholder organisations, given that they were also noticeable in the accounts of persons requesting euthanasia and their families, although in these cases Triumph of reason and Prevention seemed to be more present. Finally, Quality of life was prominent in communication coming from stakeholders in palliative care. These stakeholders emphasised the attention that palliative care gives to the medical, psycho-social and spiritual changes of patients and their relatives, aimed at improving the quality of life, although there is a chance that ‘quality’ is interpreted too restrictively (see also ).