The impact of the euthanasia assessment procedure: a qualitative interview study among adults with psychiatric conditions
Open accessAbstract
Background: Assisted dying for adults with psychiatric conditions (APC) is highly controversial but legally possible in a few countries, including Belgium. Previous research has suggested that the complex euthanasia assessment procedure may cause additional suffering in APC but may also induce positive experiences. This study reports on the impact of the euthanasia assessment procedure as experienced by APC on three counts: 1) their mental state, including death ideation; 2) their treatment trajectory; 3) their social relationships. Methods: We performed an in-depth qualitative interview study with 16 APC in Flanders, Belgium, who had voiced a euthanasia request between 2016–2020. Thematic coding was used. Findings: We interviewed 16 APC. Euthanasia assessment procedures brought out a plethora of experiences in APC, both favourable and unfavourable. Whereas thoughts of suicide remain present to a certain extent, being in the assessment procedure allows some APC to reconsider alternatives towards life, and also to attempt new treatment options. However, many APC experience ambivalence about the supposedly inherent desirability and dignity in euthanasia. Worries also surfaced about the rationale behind and effects of involvement of APCs’ social circle, and about the impact it could have on them. Conclusion: Further research, including other stakeholder perspectives, is recommended with a view to maximising favourable and minimising unfavourable impacts for all involved. In clinical practice attention to these impacts is paramount, and clear communication and management of expectations between physician and patient, seems appropriate to address the many ambivalent experiences that accompany APC during the euthanasia assessment procedure. Policy attention could in this regard go to clarifying certain sources of ambivalence and issues that are insufficiently addressed, such as modalities of relatives’ involvement.
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Qualitative evidence suggests that suicidal ideation may recur when physicians fail to adequately respond to a MAID-PS request.
“Qualitative evidence suggests that suicidal ideation may recur when physicians fail to adequately respond to a MAID-PS request.24”
From Requests for Medical Assistance in Dying by Young Dutch People With Psychiatric Disorders (2025) · cites this paper as [24]
Participants cautioned that the MAiD MI-SUMC assessment process may exacerbate suffering, through interactions with providers who may be invalidating, assessment processes that may undermine autonomy, or through an unfavorable request outcome.
“participants cautioned that the MAiD MI-SUMC assessment process may exacerbate suffering, through interactions with providers who may be invalidating, assessment processes that may undermine autonomy, or through an unfavorable request outcome, a notion supported by prior research [47, 48].”
In contrast, the option of EAS could lead to feelings of reassurance and encourage patients to refocus on treatment goals and to find relief from their suffering.
“In contrast, the option of EAS could lead to feelings of reassurance and encourage patients to refocus on treatment goals and to find relief from their suffering”
From A lived experience response to the proposed diagnosis of terminal anorexia nervosa: learning from iatrogenic harm, ambivalence and enduring hope (2023) · cites this paper as [202]
In the Belgium study, for patients granted an EAS request, ambivalence was also experienced.
“In the Belgium study, for patients granted an EAS request, ambivalence was also experienced”
From A lived experience response to the proposed diagnosis of terminal anorexia nervosa: learning from iatrogenic harm, ambivalence and enduring hope (2023) · cites this paper as [202]
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- Authors
- Verhofstadt, M., Chambaere, K., Pardon, K., Mortier, F., Liégeois, A., Deliens, L., & Audenaert, K.
- Affiliations
- Vrije Universiteit Brussel (BE)
- KU Leuven (BE)
- Ghent University Hospital (BE)
- Corresponding author
- Verhofstadt, Monica
- Venue
- BMC Psychiatry
- Published
- 2022-06-27
- Volume
- 22
- Issue
- 1
- Pages
- 435-435
- ISSN
- 1471-244X (ISSN-L)
- PMC
- PMC9235145
- OpenAlex
- W4283576794
- Cited by
- 19
- References
- 19
- Citations by year
- 2025: 2 · 2024: 10 · 2023: 7
- FWCI
- 4.41
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- BMC Psychiatry (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Ghent University Academic Bibliography (Ghent University) (submittedVersion, cc-by)
- Lirias (submittedVersion, other-oa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- OSF Preprints (OSF Preprints) (submittedVersion)
- VUBIR (Vrije Universiteit Brussel) (submittedVersion)
- Funders
- Fonds Wetenschappelijk Onderzoek (research project (G017818N) and PhD fellowship (1162618N))
- 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
- assisted dying, death ideation, suicide, treatment trajectories, interpersonal relationships, family involvement, ambivalence, physician-patient communication, euthanasia policy, Belgium
- MeSH terms
- Adult, Mental Disorders, Communication, Euthanasia, Humans, Physicians, Qualitative Research
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