Is Euthanasia Psychiatric Treatment? The Struggle With Death on Request in the Netherlands
Open accessAbstract
A 42-year-old married woman with three children was referred to our department for treatment of treatment-resistant depression. Pharmacotherapy, psychotherapy, and ECT were unsuccessful. We applied deep brain stimulation, which was partially effective and reduced depressive symptoms by 30%, but the patient still suffered. During our struggle to find optimal deep brain stimulation parameters in the course of treatment, the patient requested that her general physician provide euthanasia. Following guidelines in the Netherlands, our team was consulted, but we disapproved because her suffering was not prospectless and there still were treatment options with deep brain stimulation. Although we had treated her intensively for 2 years, our advice was disregarded. Eight weeks later we received the obituary of the patient.
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MAiD-MD can generate issues of transference and countertransference, particularly given the enduring relationship that some patients have with their healthcare professional.
“MAiD-MD can generate issues of transference and countertransference, in particular given the enduring relationship that some patients have with their healthcare professional [2, 28, 53, 59, 60, 71, 76].”
From Medical assistance in dying for people living with mental disorders: a qualitative thematic review (2023) · cites this paper as [53]
On p. 2, Denys says a request for physician-assisted death can carry the weight of transference and countertransference and asks whether the psychiatrist–patient therapeutic relationship can bias judgment. The paper does not specifically link those issues to the enduring length of some patient–professional relationships. (LLM, conf=0.85)
Experimental — accuracy not yet measuredMAiD-MD seems complicated to reconcile with suicide prevention, which is a well-established societal responsibility.
“Therefore, MAiD-MD seems complicated to reconcile with suicide prevention [53, 54], with suicide prevention being a well-established societal responsibility [47].”
From Medical assistance in dying for people living with mental disorders: a qualitative thematic review (2023) · cites this paper as [53]
MAiD-MD requests place a significant emotional burden on the healthcare professionals who receive and assess them, particularly if they are conscientious objectors or if these requests make them feel powerless to protect people with mental disorders.
“MAiD-MD requests place a significant emotional burden on the healthcare professionals who receive and assess them [24, 55], particularly if they are conscientious objectors [45] or if these requests make them feel powerless to protect people with mental disorders [41, 53].”
From Medical assistance in dying for people living with mental disorders: a qualitative thematic review (2023) · cites this paper as [53]
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Self-citationMehlum, L., Schmahl, C., Berens, A., Doering, S., Hutsebaut, J., Kaera, A., Kramer, U., Moran, P. A., Renneberg, B., Ribaudi, J. S., et al. (2020) · Borderline Personality Disorder and Emotion Dysregulation · doi:10.1186/s40479-020-00131-9 · Cited by 42 · see citing works
Verhofstadt, M., Pardon, K., Audenaert, K., Deliens, L., Mortier, F., Liégeois, A., & Chambaere, K. (2021) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2021.09.032 · Cited by 32 · see citing works
What medical conditions lead to a request for euthanasia? A rapid scoping review
Rahimian, Z., Rahimian, L., López‐Castromán, J., Ostovarfar, J., Fallahi, M. J., Nayeri, M. A., & Vardanjani, H. M. (2024) · Health Science Reports · doi:10.1002/hsr2.1978 · Cited by 22 · see citing works
The debate about physician assisted suicide and euthanasia in Ireland – Implications for psychiatry
Clarke, C., Cannon, M. D., Skokauskas, N., & Twomey, P. (2021) · International Journal of Law and Psychiatry · doi:10.1016/j.ijlp.2021.101747 · Cited by 12 · see citing works
La pratique de l’euthanasie et du suicide assisté pour motif psychiatrique
Guérinet, L., & Tournier, M. (2021) · L Encéphale · doi:10.1016/j.encep.2020.10.002 · Cited by 8 · see citing works
Medical assistance in dying for people living with mental disorders: a qualitative thematic review
Favron-Godbout, C., & Racine, E. (2023) · BMC Medical Ethics · doi:10.1186/s12910-023-00971-4 · Cited by 6 · see citing works
“Therefore, MAiD-MD seems complicated to reconcile with suicide prevention [53, 54], with suicide prevention being a well-established societal responsibility [47].”
BackgroundMedical assistance in dying: the downside
Attia, J., Jorm, C. M., & Kelly, B. J. (2020) · BMJ Supportive & Palliative Care · doi:10.1136/bmjspcare-2020-002350 · Cited by 4 · see citing works
Who's Afraid of Murderous Rage? When Euthanasia Colludes with Self-Destructiveness
Najjarkakhaki, A., Frederickson, J. J., & Bloothoofd, G. (2025) · Psychodynamic Psychiatry · doi:10.1521/pdps.2025.53.1.002 · Cited by 4 · see citing works
Is Assisted Dying Really a Matter for Medical Regulation?
Hardes, J. J. (2025) · The Journal of Law Medicine & Ethics · doi:10.1017/jme.2025.10117 · Cited by 4 · see citing works
Teo, M. T. L. (2024) · Journal of Medical Ethics · doi:10.1136/jme-2023-109644 · Cited by 3 · see citing works
Euthanasie en psychisch lijden
Lemmens, W. (2019) · Algemeen Nederlands Tijdschrift voor Wijsbegeerte · doi:10.5117/antw2019.2.002.lemm
Assistierter Suizid und aktive Suizidhilfe
Deisenhammer, E. (2020) · NeuroTransmitter · doi:10.1007/s15016-020-7441-x
Jesus, A. D., & Valeria, V. (2020)
Favron‐Godbout, C., & Racine, É. (2023) · Figshare · doi:10.6084/m9.figshare.24432000
The Dutch debate on youth psychiatric euthanasia and suicide prevention
van Os, J. (2026) · BJPsych Bulletin · doi:10.1192/bjb.2026.10231
Psychological Suffering and the Right to Die: An Islamic Legal Assessment of Euthanasia Requests
Baydar, T. E., & Çelik, R. E. (2026) · Religions · doi:10.3390/rel17060635 · Cited by 1 · see citing works
- Authors
- Denys, D.
- Affiliations
- Netherlands Institute for Neuroscience (NL)
- Corresponding author
- Denys, Damiaan
- ORCID
- Denys, Damiaan
- Venue
- American Journal of Psychiatry
- Published
- 2018-09-01
- Volume
- 175
- Issue
- 9
- Pages
- 822-823
- ISSN
- 0002-953X (ISSN-L)
- 1535-7228
- OpenAlex
- W2889223010
- Cited by
- 16
- References
- 1
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 2 · 2023: 1 · 2021: 3 · 2020: 5 · 2019: 1
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- American Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (publishedVersion, other-oa)
- KNAW Research Portal (The Royal Netherlands Academy of Arts and Sciences) (publishedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Electroconvulsive Therapy Studies
- 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 › Ethics and bioethics in healthcare
- Keywords
- euthanasia, deep brain stimulation, treatment-resistant depression, psychiatric treatment, end-of-life decisions, physician consultation, patient suffering
- MeSH terms
- Mental Disorders, Humans, Netherlands, Psychiatry, Suicide, Assisted, Euthanasia, Active, Voluntary
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