A central issue in medical ethics today concerns medical end-of-life decisions with a possible or certain life shortening effect in dying patients, in particular euthanasia and legalisation. These issues increasingly pervade the societal, ethical and political arena worldwide. The legalisation of euthanasia in Belgium creates the opportunity to study the alleged effects on end-of-life practices. A well-known argument against legalised euthanasia is that it leads to a 'slippery slope' i.e. an increase in occurrence and/or kinds of ethically unacceptable practices. Examples are life-ending without explicit request, especially in vulnerable patients, disregard of legal conditions, growing carelessness in end-of-life care, etc. In this project proposal we wish to define and study change over time of ethically questionable medical end-of-life practices in Flanders, Belgium, before and after legalisation of euthanasia. The project will incorporate a module of international comparison with other countries including the Netherlands. A supplementary study involving a large representative death certificate sample and a survey of treating physicians will be conducted and its results compared with those of previous studies with the same method. This will provide the opportunity to test allegations of slippery slope phenomena and to ethically evaluate legal policy concerning euthanasia and other end-of-life decisions.