Feeling Seen, Being Heard: Perspectives of Patients Suffering from Mental Illness on the Possibility of Physician-Assisted Death in the Netherlands
Open accessAbstract
Physician-assisted death (PAD) for patients suffering from a mental illness is allowed in the Netherlands under certain conditions but is a very controversial topic, mainly discussed by ethicists and physicians. The voice of the patient is rarely included in the debate, so we know little about what their views on the topic are. We aim to understand the views of patients with mental illness and wish to die with regard to the possibility of PAD in the Netherlands. The data for this qualitative study were collected through 21 in-depth interviews with Dutch patients who have a wish for PAD as a result of suffering from a mental illness. We identified four themes in relation to the meaning of PAD for the patients suffering from mental illness and wish to die. These themes are (1) Autonomy and self-determination, (2) ending the suffering, (3) recognition, and (4) a dignified end-of-life. The option of PAD for patients suffering from mental illnesses was considered of great importance to the patients who have a wish to die. We highlight the importance of ‘recognition’ for the situation of the patient, as this could lead to new perspective. We argue that psychiatrists need to reflect on providing this recognition in earlier phases of treatment, taking seriously and discussing a wish for PAD in treatment is beneficial to patients. It provides space for the patient to discuss their wishes and could cause them not wanting to die anymore.
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People living with mental disorders are often not taken seriously unless they have physical symptoms or somatic manifestations.
“People living with mental disorders are often not taken seriously [20, 48] unless they have physical symptoms or somatic manifestations.”
From Medical assistance in dying for people living with mental disorders: a qualitative thematic review (2023) · cites this paper as [20]
In Results > Recognition (page unavailable), respondents with mental illness describe not feeling heard or taken seriously by mental-healthcare professionals. The paper does not say that physical symptoms or somatic manifestations are required for them to be taken seriously; its findings also concern patients considering physician-assisted death, rather than people with mental disorders generally. (LLM, conf=0.87)
Experimental — accuracy not yet measuredFeeling that their suffering is acknowledged and having the opportunity to talk about their request for MAiD-MD can ease the suffering of people living with mental disorders, give them hope, build trust in the therapeutic relationship, and lead them to consider new therapeutic avenues, or decrease their desire to die.
“Feeling that their suffering is acknowledged and having the opportunity to talk about their request for MAiD-MD can ease the suffering of people living with mental disorders, give them hope, build trust in the therapeutic relationship, and lead them to consider new therapeutic avenues, or decrease their desire to die [20, 58].”
From Medical assistance in dying for people living with mental disorders: a qualitative thematic review (2023) · cites this paper as [20]
The Results (Recognition; page unavailable) say that acknowledgment gave some respondents peace of mind and could make them no longer want physician-assisted death. The Discussion (page unavailable) says talking about a death wish could open new treatment perspectives. It does not establish that these conversations build trust in the therapeutic relationship or give patients hope; it discusses hope only in response to an argument that such conversations might take it away. (LLM, conf=0.84)
Experimental — accuracy not yet measuredThe feeling of "treatment fatigue" often appears to underly the MAiD request of patients with a psychiatric disorder.
“It also corresponds with the feeling of “treatment fatigue” that often appears to underly the MAiD request of patients with a psychiatric disorder.14”
From Establishing irremediable psychiatric suffering in the context of medical assistance in dying in the Netherlands: a qualitative study (2022) · cites this paper as [14]
In Results > Ending the Suffering (page not available), respondents describe exhaustion from fighting mental illness and say PAD offered a way out of suffering. The passage supports fatigue as a reason for considering PAD, but does not establish that fatigue with treatment specifically often underlies requests. (LLM, conf=0.82)
Experimental — accuracy not yet measuredAmong the unmet needs of people living with mental disorders are care and services needs (notably lack of symptom relief), daily needs (notably satisfying relationships), and existential needs (especially difficulty finding meaning in life).
“Among the unmet needs of people living with mental disorders are those related to care and services (notably a lack of symptom relief), but also those related to daily needs (notably the need to have satisfying relationships) and existential needs (especially the difficulty of finding meaning to life) [16, 20, 68].”
From Medical assistance in dying for people living with mental disorders: a qualitative thematic review (2023) · cites this paper as [20]
Split into 3 atoms — 1 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredMAiD-MD can bring some peace of mind by offering an exit option to people who fear that their suffering will be perpetual.
“Although MAiD-MD can bring some peace of mind [18, 20, 21] by offering an exit option to people who fear that their suffering will be perpetual [22]”
From Medical assistance in dying for people living with mental disorders: a qualitative thematic review (2023) · cites this paper as [20]
For some, the mere possibility of having access to MAiD-MD could be enough to lighten the burden of their mental disorder without feeling the need to take advantage of it.
“For some, the mere possibility of having access to MAiD-MD could be enough to lighten the burden of their mental disorder without feeling the need to take advantage of it [20, 21].”
From Medical assistance in dying for people living with mental disorders: a qualitative thematic review (2023) · cites this paper as [20]
Patients with psychiatric disorders reported autonomy and self-determination, ending the suffering, recognition as being persons, and dignified end-of-life as the main reasons to request MAiD-NT.
“A further study showed that patients with psychiatric disorders reported autonomy and self-determination, ending the suffering, recognition as being persons, and dignified end-of-life as the main reasons to request MAiD-NT [33].”
From Debating Euthanasia and Physician-Assisted Death in People with Psychiatric Disorders (2022) · cites this paper as [33]
A recent empirical study reported that people living with mental disorders have no difficulty distinguishing their previous suicidal states from their state when they requested MAiD-MD.
“However, data from a recent empirical study reported that people living with mental disorders have no difficulty distinguishing their previous suicidal states from their state when they requested MAiD-MD [20].”
From Medical assistance in dying for people living with mental disorders: a qualitative thematic review (2023) · cites this paper as [20]
A Dutch empirical study reported that some people who requested MAiD-MD felt they were being refused some therapeutic options because their mental healthcare professional deemed treatment incompatible with a wish for MAiD-MD.
“A Dutch empirical study reported that some people who requested MAiD-MD felt they were being refused some therapeutic options because their mental healthcare professional deemed treatment incompatible with a wish for MAiD-MD [20].”
From Medical assistance in dying for people living with mental disorders: a qualitative thematic review (2023) · cites this paper as [20]
The Methods (Respondents; page unavailable) confirm that this was an interview study of people with mental illness who wished for physician-assisted death. But the available Results and Discussion passages do not report patients being refused therapeutic options because a provider considered treatment incompatible with that wish. Searches for refused or denied treatment and treatment options found no such account. (LLM, conf=0.72)
Experimental — accuracy not yet measuredParticipants stressed the importance of holistic, interdisciplinary assessments, and the opportunity to tell their story and exercise autonomous health decision making.
“Similarly, in keeping with prior research with patients with other health conditions and their families, participants stressed the importance of holistic, interdisciplinary assessments, and the opportunity to tell their story and exercise autonomous health decision making [25, 49].”
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References 15 · Cited by 29
- 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
- 2021-06-16
- Volume
- 46
- Issue
- 2
- Pages
- 475-489
- ISSN
- 0165-005X (ISSN-L)
- 1573-076X
- PMC
- PMC8208069
- OpenAlex
- W3170603601
- Cited by
- 29
- References
- 15
- Citations by year
- 2026: 1 · 2025: 8 · 2024: 8 · 2023: 8 · 2022: 4
- FWCI
- 4.54
- 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)
- Pure Amsterdam UMC (submittedVersion, cc-by)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion, cc-by)
- Funders
- Nederlandse Vereniging voor een Vrijwillig Levenseinde
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
- Keywords
- physician-assisted death, mental illness, end-of-life decisions, patient perspectives, autonomy, self-determination, recognition, human dignity, psychiatrists
- MeSH terms
- Mental Disorders, Death, Humans, Netherlands, Physicians, Psychiatry, Suicide, Assisted
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