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This contribution deals with the role of the principle of self-determination in the current Dutch euthanasia practice. The focus lies on the concrete elaborations of the principle of self-determination in law and practice. I distinguish between self-determination as a dynamic, diffuse and risky principle. I analyze these three characteristics in the light of the current developments in the Dutch euthanasia practice. My conclusion is that the attempts to broaden the influence of the principle of self-determination within the law is – to a certain extent – rather successful and can be justified by the societal developments and the nature of the Dutch Euthanasia Act. The principle of self-determination is reflected in almost all elements of the law and it is in the spirit of the law to allow more room for self-determination if societal developments give rise to this and if this is possible in a safe way. Attempts to allow more room for self-determination outside the law have not been successful and involve too many risks for society.