Summary Background In 2002, the euthanasia act came into effect in the Netherlands, which was followed by a slight decrease in the euthanasia frequency. We assessed frequency and characteristics of euthanasia, physician-assisted suicide, and other end-of-life practices in 2010, and assessed trends since 1990. Methods In 1990, 1995, 2001, 2005, and 2010 we did nationwide studies of a stratified sample from the death registry of Statistics Netherlands, to which all deaths and causes were reported. We mailed questionnaires to physicians attending these deaths (2010: n=8496 deaths). All cases were weighted to adjust for the stratification procedure and for differences in response rates in relation to the age, sex, marital status, region of residence, and cause and place of death. Findings In 2010, of all deaths in the Netherlands, 2·8% (95% CI 2·5–3·2; 475 of 6861) were the result of euthanasia. This rate is higher than the 1·7% (1·5–1·8; 294 of 9965) in 2005, but comparable with those in 2001 and 1995. Distribution of sex, age, and diagnosis was stable between 1990 and 2010. In 2010, 77% (3136 of 4050) of all cases of euthanasia or physician-assisted suicide were reported to a review committee (80% [1933 of 2425] in 2005). Ending of life without an explicit patient request in 2010 occurred less often (0·2%; 95% CI 0·1–0·3; 13 of 6861) than in 2005, 2001, 1995, and 1990 (0·8%; 0·6–1·1; 45 of 5197). Continuous deep sedation until death occurred more frequently in 2010 (12·3% [11·6–13·1; 789 of 6861]) than in 2005 (8·2% [7·8–8·6; 521 of 9965]). Of all deaths in 2010, 0·4% (0·3–0·6; 18 of 6861) were the result of the patient's decision to stop eating and drinking to end life; in half of these cases the patient had made a euthanasia request that was not granted. Interpretation Our study provides insight in consequences of regulating euthanasia and physician-assisted suicide within the broader context of end-of-life practices. In the Netherlands the euthanasia law resulted in a relatively transparent practice. Although translating these results to other countries is not straightforward, they can inform the debate on legalisation of assisted dying in other countries. Funding The Netherlands Organization for Research and Development (ZonMw).