No studies have explicitly addressed the attitudes and desires of terminally ill patients on euthanasia and physician-assisted suicide (PAS). In this prospective cohort study, 988 terminally ill patients and 893 caregivers were surveyed. A total of 60.2% patients supported euthanasia or PAS in a standard poll question, but only 10.6% seriously considered these interventions for themselves. Patients with depressive symptoms, moderate to severe pain, and significant care needs were more likely to consider euthanasia and PAS. Half of the patients who initially considered euthanasia or PAS changed their minds at the follow-up interview, and an almost equal number newly considered these interventions. Patients with depressive symptoms and dyspnea were more likely to change their minds over time. According to the caregivers of 256 deceased patients, 5.6% of patients discussed euthanasia or PAS in the last month of life, 2.5% hoarded drugs for suicide, and 0.4% died by PAS.