Euthanasia and dementia: reflection on the KNMG’s opinion on ‘End-of-life decisions’ Euthanasia in persons with dementia is a complex issue. After 4 years of study, in 2021 the Dutch Medical Association KNMG issued an opinion on how to deal with this as a physician. In this paper, the authors check their reflections on this topic, published in 2009, against this document. Euthanasia in persons with advanced dementia must remain an exceptional procedure in which the assessment of legal capacity and unbearable suffering are important elements. A lot of preconditions must be met and the process requires extensive preparation with (preferably multidisciplinary) concertation, with attention for the family and the representative. Even more than now, joint decision-making, early/previous care planning, information and education are key. This preparatory process requires energy and time, but may also be used for good quality care, taking into account the wishes and treatment goals of the person concerned. The process of ethical consultation can have an important input into all this. After critical reflection and testing of the recent advice of the KNMG, their position from 2009 remains valid.