Suicide and Physician-Assisted Death for Persons With Psychiatric Disorders: How Much Overlap?
Open accessAI snapshot
Written from the paper’s full text.
TL;DR
This commentary argues that the American Association of Suicidology’s position that physician-assisted death is not suicide is not supported when applied to psychiatric PAD, because recipients share many features and motivations with people who die by suicide. It calls for a more evidence-based debate and notes that even some supporters of legal psychiatric PAD urge stricter safeguards or oppose legalization.
Key findings
Psychiatric PAD remains rare but rising in Belgium and the Netherlands, where it accounts for roughly 1% to 2% of PAD; the Netherlands had 83 cases in 2017, equivalent per capita to about 1,580 US cases. The AAS statement distinguishes PAD from conventional suicide and extends support to all legal PAD, including for non-terminally ill psychiatric patients, without addressing whether psychiatric PAD can be distinguished. Evidence cited indicates psychiatric PAD recipients commonly have mental illness, personality disorders, prior suicide attempts, and social isolation or loneliness; some receive PAD soon after a suicide attempt. Features the AAS associates with suicide—persistent psychological pain, despair, a sense that life lacks meaning, and perceived lack of future—are also present in psychiatric PAD and are used to justify unbearable suffering; most patients receiving psychiatric PAD refused available treatments yet were deemed to meet the futility criterion, and capacity evaluations often were not rigorous.
Methods
Design: viewpoint/commentary, not an original empirical study. Data: the AAS statement, Dutch Regional Euthanasia Review Committees data, a Dutch government evaluation, and prior studies on psychiatric PAD and capacity evaluations. Analysis: conceptual and evidence-based comparison of AAS claims about suicide with characteristics of psychiatric PAD cases.
Limitations
The paper states no formal limitations. Evident from the text: it is a commentary relying on selected existing evidence and illustrative cases rather than systematic data collection, with no new empirical analysis. Evident: its focus is mainly the Netherlands, Belgium, and the US policy context, so generalizability to other jurisdictions is not established.
Model-written summary. Check it against the paper before relying on it.
Integrity signals
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Cites
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Claims the paper makes
0 of 15 cited sources checked · 0 supported · 0 flagged
- Premisecitation§ Suicide and Physician-Assisted Death for Persons With Psychiatric Disorders How Much Overlap?
Contrary to the expectation that physicians evaluating psychiatric PAD requests would apply a high degree of scrutiny and a high threshold for decisional capacity, this is not the standard practice in most cases.
“The evidence shows that, contrary to the expectation that physicians evaluating psychiatric PAD requests would apply a high degree of scrutiny and a high threshold for decisional capacity, this is not the standard practice for most cases.7”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [7] Doernberg SN, Peteet JR, Kim SY. Capacity evaluations of psychiatric patients requesting assisted death in the Netherlands. Psychosomatics. 2016; 57(6): 556– 565. doi: 10.1016/j.psym.2016.06.005 27590345 PMC5097685
Not checked in the free run.
- Premisecitation§ Suicide and Physician-Assisted Death for Persons With Psychiatric Disorders How Much Overlap?
Some persons receive psychiatric PAD shortly after a suicide attempt, as in the case of a man who survived a jump from a building with broken thighs and then received PAD during the resulting hospitalization.
“Indeed, some receive PAD shortly after a suicide attempt, like a man who jumped off a building, survived the fall with broken thighs, and then received PAD during the ensuing hospitalization.5”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [5] Kim SY, De Vries RG, Peteet JR. Euthanasia and assisted suicide of patients with psychiatric disorders in the Netherlands 2011 to 2014. JAMA Psychiatry. 2016; 73(4): 362– 368. doi: 10.1001/jamapsychiatry.2015.2887 26864709 PMC5530592 source
Not checked in the free run.
- Premisecitation§ Suicide and Physician-Assisted Death for Persons With Psychiatric Disorders How Much Overlap?
The evidence has led some supporters of legalized psychiatric PAD to call either for a much more rigorous method of evaluating psychiatric PAD requests or for rejecting its legalization altogether.
“Such evidence has led even some supporters of legalized psychiatric PAD to call for either a much more rigorous method of evaluating psychiatric PAD requests (eg, longer repeated evaluations by multiple evaluators with specialty expertise; prospective panel reviews; rigorous application of more objective medical criteria for futility) or rejecting its legalization altogether.8”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [8] Vandenberghe J Physician-assisted suicide and psychiatric illness. N Engl J Med. 2018; 378(10): 885– 887. doi: 10.1056/NEJMp1714496 29514019
Not checked in the free run.
- Interpretationcitation§ Suicide and Physician-Assisted Death for Persons With Psychiatric Disorders How Much Overlap?
The features of people who die by suicide that are said to distinguish them from people seeking PAD for terminal illness are in fact shared by people who receive psychiatric PAD.
“However, juxtaposing the AAS statement’s descriptions of “suicide in the ordinary, traditional sense”2 with the existing evidence on psychiatric PAD reveals that the features of persons who die by suicide that are said to distinguish them from persons who seek PAD for terminal illness are, in fact, features shared by those who receive psychiatric PAD.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [2] American Association of Suicidology. “Suicide” is not the same as “physician aid in dying.” http://www.suicidology.org/Portals/14/docs/Press%20Release/AAS%20PAD%20Statement%20Approved%2010.30.17%20ed%2010-30-17.pdf. 10 30, 2017 Accessed February 12, 2018.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Premisecitation§ Suicide and Physician-Assisted Death for Persons With Psychiatric Disorders How Much Overlap?
A person with persistent psychosis and an anxiety-provoking delusion who requests PAD can in practice be declared competent to receive it with no specific justification from the evaluators.
“So a person with persistent psychosis and anxiety-provoking delusion and requesting PAD can in practice be pronounced competent to receive PAD with no specific justifications from the evaluators.7”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [7] Doernberg SN, Peteet JR, Kim SY. Capacity evaluations of psychiatric patients requesting assisted death in the Netherlands. Psychosomatics. 2016; 57(6): 556– 565. doi: 10.1016/j.psym.2016.06.005 27590345 PMC5097685
Not checked in the free run.
- Interpretationreasoning§ Suicide and Physician-Assisted Death for Persons With Psychiatric Disorders How Much Overlap?
Psychiatric PAD is difficult to distinguish from suicide.
“It should give us pause when a leading suicide prevention organization minimizes this problem while ignoring the evidence that psychiatric PAD is difficult to distinguish from suicide.”
Quote in the paperNot a substantial claim
- May combine two claims. 9
- Classified as probably not a substantial claim. 4
May combine two claims.
Premisecitation§ Suicide and Physician-Assisted Death for Persons With Psychiatric Disorders How Much Overlap?Features commonly associated with suicide, such as unrelenting psychological pain and despair, inability to enjoy life or foresee change, and loss of meaning, are present in psychiatric PAD and are cited as justifications for it under Dutch law and the Code of Practice.
“However, research shows that these common features of suicide are not only present in psychiatric PAD but are cited as justifications for PAD (to show that a person is suffering intolerably, as defined in and required by the Dutch law and Code of Practice1).”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [1] Regional Euthanasia Review Committees website. https://www.euthanasiecommissie.nl. Accessed March 1, 2018.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites [2] American Association of Suicidology. “Suicide” is not the same as “physician aid in dying.” http://www.suicidology.org/Portals/14/docs/Press%20Release/AAS%20PAD%20Statement%20Approved%2010.30.17%20ed%2010-30-17.pdf. 10 30, 2017 Accessed February 12, 2018.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
May combine two claims.
Premisecitation§ Suicide and Physician-Assisted Death for Persons With Psychiatric Disorders How Much Overlap?Most patients receiving psychiatric PAD refuse available treatments, such as electroconvulsive therapy or monoamine oxidase inhibitors for depression, yet are still judged to meet the futility criterion.
“This view is consistent with evidence showing that most patients receiving psychiatric PAD refuse available treatments (such as electroconvulsive therapy or monoamine oxidase inhibitors for depression) but are still deemed to meet the futility criterion.5”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [5] Kim SY, De Vries RG, Peteet JR. Euthanasia and assisted suicide of patients with psychiatric disorders in the Netherlands 2011 to 2014. JAMA Psychiatry. 2016; 73(4): 362– 368. doi: 10.1001/jamapsychiatry.2015.2887 26864709 PMC5530592 source
Not checked in the free run.
Probably not a substantial claim: may not pass S4 (based). May combine two claims.
Interpretationnone given§ Suicide and Physician-Assisted Death for Persons With Psychiatric Disorders How Much Overlap?Physician-assisted death at the end of life concerns the desire to control how one dies rather than whether one lives or dies, whereas psychiatric PAD concerns whether one lives or dies, as suicide does.
“Physician-assisted death at the end of life is about the desire to control how one dies, not whether one lives or dies. In contrast, psychiatric PAD is about whether one lives or dies—as it is in suicide.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim. May combine two claims.
Premisecitation§ Suicide and Physician-Assisted Death for Persons With Psychiatric Disorders How Much Overlap?The AAS statement extends support to psychiatric PAD without addressing whether psychiatric PAD can be distinguished from suicide in the conventional sense, despite the recognized societal duty to prevent suicide among people with mental illness.
“It does so without discussing whether psychiatric PAD can be distinguished from “suicide in the conventional sense”2—a key issue given “the established societal responsibility to prevent suicides by people with mental illness.”4”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [2] American Association of Suicidology. “Suicide” is not the same as “physician aid in dying.” http://www.suicidology.org/Portals/14/docs/Press%20Release/AAS%20PAD%20Statement%20Approved%2010.30.17%20ed%2010-30-17.pdf. 10 30, 2017 Accessed February 12, 2018.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites [4] Miller FG, Appelbaum PS. Physician-assisted death for psychiatric patients: misguided public policy. N Engl J Med. 2018; 378(10): 883– 885. doi: 10.1056/NEJMp1709024 29514026 source
Not checked in the free run.
May combine two claims.
Interpretationreasoning§ Suicide and Physician-Assisted Death for Persons With Psychiatric Disorders How Much Overlap?The emerging evidence does not support the AAS position on psychiatric PAD and in fact points in the opposite direction.
“In fact, the emerging evidence does not support their position, and actually goes in the opposite direction.”
Quote in the paperNot a substantial claimMay combine two claims.
Premisecitation§ Suicide and Physician-Assisted Death for Persons With Psychiatric Disorders How Much Overlap?The American Association of Suicidology's statement endorses legalized physician-assisted death of all types, explicitly including PAD for persons who are not terminally ill but have psychiatric disorders.
“Yet the AAS statement’s support for PAD explicitly includes legalized PAD of all types, including PAD for non–terminally ill persons with psychiatric disorders.2”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [2] American Association of Suicidology. “Suicide” is not the same as “physician aid in dying.” http://www.suicidology.org/Portals/14/docs/Press%20Release/AAS%20PAD%20Statement%20Approved%2010.30.17%20ed%2010-30-17.pdf. 10 30, 2017 Accessed February 12, 2018.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Probably not a substantial claim: may not pass S4 (based).
Interpretationnone given§ Suicide and Physician-Assisted Death for Persons With Psychiatric Disorders How Much Overlap?The AAS statement ignores the evidence that psychiatric PAD is difficult to distinguish from suicide.
“It should give us pause when a leading suicide prevention organization minimizes this problem while ignoring the evidence that psychiatric PAD is difficult to distinguish from suicide.”
Quote in the paperNot a substantial claimMay combine two claims.
Premisecitation§ Suicide and Physician-Assisted Death for Persons With Psychiatric Disorders How Much Overlap?All persons who receive psychiatric PAD have some form of mental illness, and most also have personality disorders, have attempted suicide, and are socially isolated or lonely.
“they all have some form of mental illness; most also have personality disorders, have attempted suicide, and are socially isolated or lonely.5”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [5] Kim SY, De Vries RG, Peteet JR. Euthanasia and assisted suicide of patients with psychiatric disorders in the Netherlands 2011 to 2014. JAMA Psychiatry. 2016; 73(4): 362– 368. doi: 10.1001/jamapsychiatry.2015.2887 26864709 PMC5530592 source
Not checked in the free run.
Classified as probably not a substantial claim. May combine two claims.
Premisecitation§ Suicide and Physician-Assisted Death for Persons With Psychiatric Disorders How Much Overlap?The AAS statement assumes that a suicidal person's perspective is distorted and that treatment can make the person's experience tolerable and restore the will to live.
“The statement’s assumption is that the perspective of a person with suicidal thoughts is distorted, that the person’s experiences can be made tolerable and the will to live restored with treatment.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [2] American Association of Suicidology. “Suicide” is not the same as “physician aid in dying.” http://www.suicidology.org/Portals/14/docs/Press%20Release/AAS%20PAD%20Statement%20Approved%2010.30.17%20ed%2010-30-17.pdf. 10 30, 2017 Accessed February 12, 2018.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
May combine two claims.
Premisecitation§ Suicide and Physician-Assisted Death for Persons With Psychiatric Disorders How Much Overlap?Although in theory patient and physician must agree that there is no prospect of improvement, the criterion is now overstretched toward its subjective component, according to psychiatrists interviewed in a Dutch government study.
“While in theory a patient and the physician together must agree that there is “no prospect of improvement,”5 the criterion is now overstretched to emphasize the subjective component, according to psychiatrists interviewed in a Dutch government study.6”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [5] Kim SY, De Vries RG, Peteet JR. Euthanasia and assisted suicide of patients with psychiatric disorders in the Netherlands 2011 to 2014. JAMA Psychiatry. 2016; 73(4): 362– 368. doi: 10.1001/jamapsychiatry.2015.2887 26864709 PMC5530592 source
Not checked in the free run.
- cites [6] Onwuteaka-Philipsen BD, Legemaate J, van der Heide A, Derde Evaluatie Wet Toetsing Levensbeëindiging op Verzoek en Hulp bij Zelfdoding. The Hague, the Netherlands: ZonMw; 2017.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
The paper relies on this without support.
In the United States, in those states where physician-assisted death is legal, it is limited to terminally ill patients.
“In those states within the United States where PAD is legal, the procedure is limited to the terminally ill but we believe there will be efforts to expand the laws to include psychiatric PAD.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
About half of Belgian patients had made suicide attempts before, including while waiting for approval.
“about half of patients had made suicide attempts before [62, 63], including while waiting for approval [61].”
From Debating Euthanasia and Physician-Assisted Death in People with Psychiatric Disorders (2022) · cites this paper as [63]
In the main text (page unavailable), the paper says that most people receiving psychiatric physician-assisted death had attempted suicide and gives an example of someone who received it shortly after an attempt. Its cited evidence concerns the Netherlands, not Belgian patients, and it gives no ‘about half’ figure. The sentence assigns the waiting-for-approval detail to a different citation [61]. (LLM, conf=0.86)
Experimental — accuracy not yet measuredIn the Netherlands, MAiD-NT cases were for patients with mood or personality disorders, mainly women aged between 50 and 70 years.
“for patients with mood or personality disorders, mainly women and aged between 50 and 70 years [62, 65].”
From Debating Euthanasia and Physician-Assisted Death in People with Psychiatric Disorders (2022) · cites this paper as [65]
In “How Much Overlap?” (page unavailable), the paper says that most people receiving psychiatric physician-assisted death also have personality disorders, and it discusses treatment for depression. It does not report that recipients were mainly women aged 50–70 or establish the claimed prevalence of mood disorders. (LLM, conf=0.84)
Experimental — accuracy not yet measuredIdeation-to-action theories of suicide focus on the process from suicidal ideation to suicidal behavior.
“For this purpose, we will consider the usefulness of ideation-to-action theories, which focus on the suicidal process from suicidal ideation to behavior.(14–16)”
From Psychiatric euthanasia, suicide and the role of gender (2022) · cites this paper as [14]
The section on overlap between suicide and psychiatric physician-assisted death discusses suicidal thoughts, motivations, and suicide attempts, but does not describe ideation-to-action theories or their focus. Searches for those theories and for the transition from suicidal thoughts to behavior found no passage addressing the claim. (LLM, conf=0.78)
Experimental — accuracy not yet measuredThe role of impulsive action in suicide has been overstated, and only a very small amount of suicidal behavior occurs without planning.
“Their key reliance on impulsivity can be challenged, as the role of impulsive action in suicide has been overstated and only very little suicidal behavior (lethal or non-lethal) occurs without planning.(13–15)”
From Psychiatric euthanasia, suicide and the role of gender (2022) · cites this paper as [14]
The section “Suicide and Physician-Assisted Death for Persons With Psychiatric Disorders: How Much Overlap?” (page not provided) discusses similarities between suicide and psychiatric physician-assisted death, but does not address how often suicidal behavior is impulsive or unplanned. Searches for impulsive action and for suicidal behavior without planning found no passage supporting either part of the claim. (LLM, conf=0.70)
Experimental — accuracy not yet measuredSuicide capability includes practical factors such as knowledge of and access to highly lethal means and psychological factors such as fearlessness of death and pain tolerance, all of which can be acquired over time.
“Within this framework, “capability” includes practical factors (knowledge of and access to highly lethal means) and psychological factors (fearlessness of death, pain tolerance), both of which can be acquired over time.(14–19)”
From Psychiatric euthanasia, suicide and the role of gender (2022) · cites this paper as [14]
The section “Suicide and Physician-Assisted Death for Persons With Psychiatric Disorders: How Much Overlap?” (page not provided) discusses characteristics and motivations of people who die by suicide, but does not describe suicide capability in terms of access to lethal means, fearlessness of death, or pain tolerance. Searches for those terms and for acquired capability found no supporting passage in our copy. (LLM, conf=0.77)
Experimental — accuracy not yet measured
Ideation-to-action theories focus on suicide capability, which determines the transition from suicidal ideation to suicidal behavior.
“Rather than emphasizing the role of suicide risk factors, it focuses on the concept of suicide “capability”, which determines the transition from suicidal ideation to (lethal and non-lethal) suicidal behavior.”
From Psychiatric euthanasia, suicide and the role of gender (2022) · cites this paper as [14]
The section “Suicide and Physician-Assisted Death for Persons With Psychiatric Disorders: How Much Overlap?” discusses similarities between psychiatric physician-assisted death and suicide, but does not address ideation-to-action theories or suicide capability. Searches for the transition from suicidal ideation to behavior and for acquired capability found no relevant passage in our copy; no page number was available. (LLM, conf=0.74)
Experimental — accuracy not yet measuredWhen combined with the gender gap in psychiatric EAS, ideation-to-action theories of suicide support the hypothesis that differences between psychiatric EAS and suicide are based not on impulsivity but on suicide capability.
“Next, we turn to ideation-to-action theories of suicide, arguing that, when combined with the gender gap in psychiatric EAS, such theories support the hypothesis that differences between psychiatric EAS and suicide are not based on impulsivity, but rather on the notion of suicide “capability”.”
From Psychiatric euthanasia, suicide and the role of gender (2022) · cites this paper as [14]
The section “Suicide and Physician-Assisted Death for Persons With Psychiatric Disorders: How Much Overlap?” discusses shared characteristics of psychiatric physician-assisted death and suicide, but does not address the proposed explanation for their differences. Searches for the gender gap, ideation-to-action theories, impulsivity, and suicide capability found no passage evaluating that hypothesis. The citing sentence also frames the hypothesis as the citing authors’ own argument. (LLM, conf=0.76)
Experimental — accuracy not yet measuredMore women than men attempt suicide.
“more women than men attempt suicide”
From Patients <i>requesting</i> and <i>receiving</i> euthanasia for psychiatric disorders in the Netherlands (2023) · cites this paper as [14]
The main text (page unavailable) discusses suicide attempts among people receiving psychiatric physician-assisted death, but gives no comparison of attempt rates between women and men. Searches for the quoted claim and for sex- and gender-related terms found no passage addressing that comparison. (LLM, conf=0.72)
Experimental — accuracy not yet measured
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"The Case Against Legalizing Assisted Death for Psychiatric Disorders"Preprint
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Legal Issues in Psychiatric Practice
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Legal Issues in Psychiatric Practice
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- Authors
- Kim, S. Y. H., Conwell, Y., & Caine, E. D.
- Affiliations
- National Institutes of Health (US)
- University of Rochester Medicine (US)
- Venue
- JAMA Psychiatry
- Publisher
- American Medical Association (AMA)
- Published
- 2018-11-01
- Volume
- 75
- Issue
- 11
- Pages
- 1099
- ISSN
- 2168-622X (ISSN-L)
- PMC
- PMC6394825
- OpenAlex
- W2887654587
- Cited by
- 25
- References
- 5
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 3 · 2023: 4 · 2022: 2 · 2021: 4 · 2020: 5 · 2019: 2
- FWCI
- 3.23
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- JAMA Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (Z99CL999999)
- Centers for Disease Control and Prevention (R49CE002093)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Health Sciences › Health Professions › General Health Professions › Health, Medicine and Society
- Keywords
- suicide, physician-assisted death, mental illness, end-of-life decisions, assisted suicide
- MeSH terms
- Mental Disorders, Humans, Societies, Medical, Suicide, Assisted
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-04.
Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-04.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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