Van den Block and colleagues’ paper about end of life decision making and end of life care provides important data to support the debate about physicians’ role in death and dying. Their finding that end-of-life decision making seems to be associated with a high use of palliative care is not surprising, because a protracted dying process with much suffering may be expected to result in both a high use of palliative care and a high frequency of end-of-life decisions, especially for assertive patients with clear preferences concerning the end stage of their lives. More importantly, the study’s results suggest that palliative care is not able to prevent physicians and patients from making medical decisions that hasten death. This may be due to insufficient quality, that should be further improved, but it may also be indicative of principal limitations of palliative care, that apparently cannot address all suffering at the end of life.