Do Doctors Differentiate Between Suicide and Physician-Assisted Death? A Qualitative Study into the Views of Psychiatrists and General Practitioners
Open accessAbstract
Physician-assisted death for patients suffering from psychiatric disorders is allowed in the Netherlands under certain circumstances. One of the central problems that arise with regard to this practice is the question of whether it is possible to distinguish between suicidality and a request for physician-assisted death. We set up this study to gain insight into how psychiatrists and general practitioners distinguish between suicidality and physician-assisted death. The data for this study were collected through qualitative interviews with 20 general practitioners and 17 psychiatrists in the Netherlands. From the interviews, we conclude that physicians distinguish three types of death wishes among patients suffering from psychiatric disorders: 'impulsive suicidality,' 'chronic suicidality,' and 'rational death wishes.' To discern between them they evaluate whether the death wish is seen as part of the psychopathology, whether it is consistent over time, and whether they consider it treatable. Some considered physician-assisted death an alternative to a 'rational suicide,' as this was perceived to be a more humane manner of death for the patient and their relatives. We argue that physician-assisted death can be justified also in some cases in which the death wish is part of the psychopathology, as the patient's suffering can be unbearable and irremediable. Physician-assisted death in these cases may remain the only option left to relieve the suffering.
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Surveys of Swiss and Dutch psychiatrists reveal reluctance to support MAiD MD-SUMC, often citing limited familiarity with assessment procedures, uncertainty about patients' understanding and discomfort in predicting psychiatric prognoses.
“Surveys of Swiss and Dutch psychiatrists reveal reluctance to support MAiD MD-SUMC, often citing limited familiarity with assessment procedures, uncertainty about patients’ understanding and discomfort in predicting psychiatric prognoses.”
From Medical Assistance in Dying for the Sole Underlying Condition of Mental Disorder (MAiD MD-SUMC): an analysis and qualitative evidence synthesis (2026) · cites this paper as [58]
The Introduction (page unavailable) says Dutch psychiatrists are generally reluctant to perform assisted dying for psychiatric suffering, chiefly because they find it difficult to distinguish an assisted-dying request from suicidality. The Methods > Design section (page unavailable) describes interviews with Dutch psychiatrists and GPs, not surveys of Swiss and Dutch psychiatrists. The Results > Treatment for Suicidality section discusses difficulty assessing competence and prospects for improvement, but attributes that difficulty to GPs; the paper does not establish the stated reasons as psychiatrists’ reported reasons for reluctance. (LLM, conf=0.88)
Experimental — accuracy not yet measuredPhysicians differentiate three types of death wishes among patients with psychiatric disorders: death wish related to psychopathology or impulsive suicidality; death wish consistent over time, or chronic suicidality; and rational death wishes.
“Although physicians differentiate three types of death wishes among patients with psychiatric disorders (death wish related to psychopathology or impulsive suicidality; death wish consistent over time, or chronic suicidality, and rational death wishes) [74]”
From Debating Euthanasia and Physician-Assisted Death in People with Psychiatric Disorders (2022) · cites this paper as [74]
The fluctuating nature of suicidality may hamper assessment of the consistency of the death wish.
“Moreover, suicidality might complicate MAID assessment: the fluctuating nature of suicidality13 may hamper assessment of the consistency of the death wish,14 and acute suicidality might interfere with decision-making.15”
From Requests for Medical Assistance in Dying by Young Dutch People With Psychiatric Disorders (2025) · cites this paper as [14]
It may also be relevant for distinguishing MAID requests from impulsive suicidality.
“It may also be relevant for distinguishing MAID requests from impulsive suicidality.”
From Irremediable psychiatric suffering in the context of medical assistance in dying: A delphi-study (2022) · cites this paper as [21]
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Debating Euthanasia and Physician-Assisted Death in People with Psychiatric Disorders
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- Authors
- Pronk, R., Willems, D. L., & van de Vathorst, S.
- Affiliations
- Amsterdam UMC Location University of Amsterdam (NL)
- Corresponding author
- Pronk, Rosalie
- Venue
- Culture Medicine and Psychiatry
- Published
- 2020-08-24
- Volume
- 45
- Issue
- 2
- Pages
- 268-281
- ISSN
- 0165-005X (ISSN-L)
- 1573-076X
- PMC
- PMC8110501
- OpenAlex
- W3080870298
- Cited by
- 21
- References
- 10
- Citations by year
- 2026: 3 · 2025: 5 · 2023: 5 · 2022: 6 · 2021: 2
- FWCI
- 2.44
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Culture Medicine and Psychiatry (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (publishedVersion, cc-by)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion, cc-by)
- RePub (Erasmus University Rotterdam) (submittedVersion, other-oa)
- Pure Amsterdam UMC (submittedVersion, cc-by)
- Funders
- NVVE
- Amsterdam UMC
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
- Keywords
- physician-assisted death, suicide, suicidality, mental illness, death wish, rational suicide, chronic suicidality, general practitioners, psychiatrists, physician judgment, end-of-life decisions
- MeSH terms
- Mental Disorders, Euthanasia, Humans, Netherlands, Psychiatry, Suicide, Assisted, General Practitioners
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