In 1990 the Dutch government appointed a committee to investigate medical decisions concerning the end of life. The committee was chaired by Professor J. Remmelink, who was at that time the attorney general of the Dutch Supreme Court. Although the immediate motivation for this investigation was the ongoing discussion in Parliament about legalizing euthanasia, the committee was explicitly asked to do more than explore the incidence of euthanasia. In fact, it was asked by the government to investigate all kinds of medical decisions concerning the end of life. Consequently, euthanasia-related decisions such as assisted suicide and life-terminating acts without the explicit request of the patient were also studied, as were decisions not to treat and decisions to alleviate pain and other symptoms with possibly life-shortening effect. The Remmelink Committee did not perform this investigation itself but instead asked the Department of Public Health of the Erasmus University to form a fully independent research group to do the actual work. We were members of this research group. In this article, after a short description of the main results, we will discuss the impact of our report to the Remmelink Committee on the Dutch debate about end-of-life legislation and some of the implications of the data. Results We have previously described details of the study design elsewhere.[1] For this article it suffices to state that there were three different substudies: interviews with physicians, questionnaires mailed to the attending physicians of deceased persons, and a prospective survey. The response rates of the substudies were 91 percent, 76 percent, and 80 percent respectively. In total we obtained information about approximately 10,000 deaths. The total number of deaths in the Netherlands is 129,000 per year. Most of the doctors we interviewed found voluntary euthanasia or assisted suicide acceptable under special circumstances. Fifty-four percent of them had performed euthanasia or assisted suicide at some time or other, and a further 34 percent considered it conceivable that they would do so, although some of them could conceive of this only under extreme conditions. Although 12 percent of the physicians indicated that they would never perform euthanasia or assist in suicide, two-thirds of these (8 percent of the total) would refer patients requesting such help to a colleague. A final 4 percent refused to have anything to do with such requests. We found that 2,300 cases of euthanasia (1.8% of all annual deaths) and 400 cases of assisted suicide (0.3% of all deaths) occurred in 1990. Nineteen hundred of these 2,700 cases were performed by general practitioners at home, 750 by specialists in hospitals, and approximately 20 by nursing home physicians. In 22,500 cases (17.5%) a decision had been taken not to treat; the same number of decisions were made to alleviate pain and other symptoms even if doing so hastened the patient's death. Life-terminating acts undertaken without the patient's explicit request appeared to occur 1000 times (0.8%). As we return to it below, we will expand the description of the results for this type of act. First, however, we must explain the study design somewhat. As is commonly known, in the Netherlands euthanasia is defined as ending a patient's life at the patient's explicit request. Our category of life-terminating acts without explicit request, then, was derived by excluding euthanasia. The category included all those cases in which there was patient involvement but in which this had not reached the stage of an explicit request. In 59 percent (600) of cases in this category there was some such patient involvement. The whole category involving no explicit request can best be characterized as concerning patients who were near death and clearly suffering grievously. The decision to end their lives was most often made within hospitals (710 times yearly), less often in general practice (270) and nursing homes (50). …