Physician-assisted suicide in psychiatry: developments in The Netherlands
Abstract
Physician-assisted suicide can now be officially and legally carried out for psychiatric patients in The Netherlands who request it, provided that criteria are met. The authors describe two recent cases of psychiatric patients whose suicides were assisted by their psychiatrist. They critically examine the guidelines for physician-assisted suicide in psychiatry. The criteria address the decision of the patient to be assisted with suicide, which must be voluntary and well considered, and the patient's desire to die, which must endure over time. The patient's suffering must be unacceptable, and the disorder incurable. The authors conclude that important aspects of psychiatric practice are not addressed in the guidelines, which were originally developed for use in somatic medicine. The assessment of treatment prognosis in psychiatry is not accurate enough to allow a final decision about incurability. Boundaries of the psychiatric therapeutic relationship are violated in physician-assisted suicide. The therapist's inability to objectively assess the patient's wish to die is overlooked. Because the general public will continue to ask for clarity on the issue of euthanasia and physician-assisted suicide, the authors believe that an open discussion of both ethical and professional issues is the best option.
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Surveys of Dutch psychiatrists have shown wide variation in how 'incurability' is defined and in what constitutes an adequate trial of treatment.
“Surveys of Dutch psychiatrists have shown wide variation in how ‘incurability’ is defined and in what constitutes an adequate trial of treatment.18”
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 [18]
The introduction of MAiD-MD into the continuum of care can affect the therapeutic relationship, which is closely correlated with patients' hope for improvement, a key facilitator of recovery.
“The introduction of MAiD-MD into the continuum of care can affect the therapeutic relationship [17, 48, 59], which is closely correlated with patients’ hope for improvement [37], a key facilitator of recovery [23, 52].”
From Medical assistance in dying for people living with mental disorders: a qualitative thematic review (2023) · cites this paper as [59]
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 [59]
The Netherlands uses 'euthanasia' as a blanket term of physician assisted suicide as well as MAiD, as these practices are not legally exclusive.
“For example, the Netherlands uses ‘euthanasia’ as a blanket term of physician assisted suicide as well as MAiD, as these practices are not legally exclusive.18”
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 [18]
The Chabot ruling inspired the practice that in cases of psychiatric PAD, an independent consultation from another expert is mandatory.
“Furthermore, this ruling inspired the practice that in the case of psychiatric PAD, an independent consultation from another expert is mandatory (5, 6).”
From Physician Assisted Death for Psychiatric Suffering: Experiences in the Netherlands (2022) · cites this paper as [5]
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- Authors
- Schoevers, R. A., Asmus, F. P., & Tilburg, W. V.
- Affiliations
- Mentrum (NL)
- ORCID
- Schoevers, Robert A.
- Venue
- Psychiatric Services
- Published
- 1998-11
- Volume
- 49
- Issue
- 11
- Pages
- 1475-1480
- ISSN
- 0022-1597 (ISSN-L)
- 1075-2730
- 1557-9700
- OpenAlex
- W2121375194
- Cited by
- 28
- References
- 35
- Citations by year
- 2026: 1 · 2024: 1 · 2023: 1 · 2022: 3 · 2020: 3 · 2019: 2 · 2016: 2 · 2013: 2 · 2012: 1
- FWCI
- 0.46
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychiatric Services (publishedVersion)
- PubMed (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
- DigitalGeorgetown (Georgetown University Library) (submittedVersion)
- Funders
- Health~Holland
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Keywords
- physician-assisted suicide, euthanasia, psychiatric patients, Netherlands, desire for death, therapeutic relationship, professional ethics, patient autonomy
- MeSH terms
- Depression, Female, Humans, Middle Aged, Netherlands, Physician-Patient Relations, Psychiatry, Stress, Psychological, Transference, Psychology, Suicide, Assisted, Guidelines as Topic, Personal Autonomy, Persons with Psychiatric Disorders, Mentally Ill Persons, Government Regulation, Trust
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