© 2010 Canadian Medical Association or its licensors

Euthanasia and physician-assisted suicide are heavilydebated issues in medical practice. In recent years,three European countries (Belgium and the Nether-lands in 2002, and Luxemburg in 2009) and two US states (Oregon in 1997 and Washington State in 2009) decriminal-ized euthanasia and physician-assisted suicide under formal conditions.1–5 Canada is among a number of countries where the debate over legalization has flared up, with a proposed bill reaching Parliament and a pro-euthanasia proposal by the Quebec College of Physicians.6 Understandably, the issue of euthanasia triggers much emotion and can be fraught with speculative arguments. Opponents of euthanasia often argue that legalizing the proce-dure will lead to a rise in the use of life-ending drugs without a patient’s explicit request, especially in vulnerable patient groups.7–10 Thus far, however, no indications of this have been found in studies of physician-assisted deaths before and after legalization in Belgium and the Netherlands.9,11,12 In Belgium, the percentage of deaths in which life-ending drugs were used remained stable, and the proportion without an explicit request from the patient decreased.12 Other studies have shown that euthanasia, physician-assisted suicide and the use of life- ending drugs without explicit patient request are not confined to countries where physician-assisted death is legal.13–16 In addition to knowing the overall occurrence of physi-cian-assisted death, it is equally important for an adequately informed, empirically based debate to know its performance in vulnerable patient groups and the care put into the decision and performance. In light of legalization and its alleged effects on the use of life-ending drugs without patient request, it is also important to map similarities and differences be-tween euthanasia and the use of life-ending drugs without explicit patient request. In this article, we report our investiga-tion of demographic and clinical characteristics associated with physician-assisted deaths in Flanders, Belgium; the involvement of the patient, relatives and other caregivers i