Although controversial in many countries, in The Netherlands euthanasia or physician assisted death has increased in patients with early stages of dementia, psychiatric illness and in conditions described as ‘being tired of life’ in the oldest old. There is a strong debate about this practice in the community and among professionals often with exclamation marks ranging from medical murder to providing ultimate care.

To provide figures, describe current practice and debate in The Netherlands with regard to capacity evaluation in older psychiatric patients and end of life questions.

Review of literature, case reports and own experience in the past decade.

There are few studies on the important issue of capacity making in psychiatric patients. The research that was performed does not show that a high threshold of capacity is required for granting euthanasia. Research on physician-assisted death in early dementia is scarce. With regard to end of life questions the debate in The Netherlands is still ongoing.

The author has not supplied his declaration of competing interest.