In Reply The letters from Bollen et al and Florijn and Kaptein point to the reality of suffering among people, in this case frail older adults who choose death over continued life burdened by the limitations of old age. The authors argue that the right to self-determination is in moral conflict with respect for the sanctity of life and that moral conflict is inevitable. Of course, moral principles come into conflict and, of course, there are individuals who would choose to control the timing and circumstances of their own death. I am not arguing that such a desire is immoral or unethical. I am arguing that public policy in support of such action is quite likely to have unintended consequences.1 The authors insist that all of these Dutch cases of physician-assisted suicide are characterized by a vital patient-physician relationship and that all these requests are voluntary and well considered. Although we hope that this is true, there is growing evidence to the contrary.2,3 The reports of these cases are all post mortem when there is strong incentive by the involved physicians to report their adherence to the rules. Similarly, the Dutch review committees that, it is claimed, despite opposing evidence,2,3 always perform a thorough post hoc assessment, are themselves without regulatory oversight. The assertion that these instances of physician-assisted suicide always follow the letter of the law and never involve family, financial, or other pressures is only that—an assertion based on hope, not on research. Given the enormous caregiving and financial burdens of caring for vulnerable people, it is naive to believe that these pressures play no role in these decisions. In fact, in 2016, 201 euthanasia deaths were reported among Dutch people with mental illness or dementia,2 leading one of its strongest initial proponents, a psychiatrist, to say, “…it really went off the tracks when the review committee concealed that incapacitated people were surreptitiously killed. I don’t see how we can get the genie back in the bottle. It would already mean a lot if we’d acknowledge he’s out.”3