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Cited by 40Suicide and Self-Harm StudiesPalliative and Oncologic CarePalliative Care and End-of-Life Issues

Psychiatric euthanasia, suicide and the role of gender

Open access
Nicolini, Marie E., Gastmans, Chris, Kim, Scott Y.H.·2022·The British Journal of Psychiatry
DOI 10.1192/bjp.2021.95PMC PMC8777112
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Abstract

The preponderance of women among persons who request and receive euthanasia and assisted suicide based on a psychiatric condition, as shown by data from The Netherlands and Belgium, is virtually unexplored. We provide a critical discussion of this gender gap, and propose that it can inform a key debate point in the controversy over the practice, namely its conflict with suicide prevention.

Integrity signals

Registry

Crossref · 10.1192/bjp.2021.95

Cites

27 of 27 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

28 of 98 cited sources checked · 0 supported · 0 flagged · accuracy not yet measured

  • Interpretationreasoning

    When combined with the gender gap in psychiatric EAS, ideation-to-action theories of suicide support the hypothesis that differences between psychiatric EAS and suicide are based not on impulsivity but on suicide capability.

    “Next, we turn to ideation-to-action theories of suicide, arguing that, when combined with the gender gap in psychiatric EAS, such theories support the hypothesis that differences between psychiatric EAS and suicide are not based on impulsivity, but rather on the notion of suicide “capability”.”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites [14] source

      The section “Suicide and Physician-Assisted Death for Persons With Psychiatric Disorders: How Much Overlap?” discusses shared characteristics of psychiatric physician-assisted death and suicide, but does not address the proposed explanation for their differences. Searches for the gender gap, ideation-to-action theories, impulsivity, and suicide capability found no passage evaluating that hypothesis. The citing sentence also frames the hypothesis as the citing authors’ own argument. (LLM, conf=0.76)

      Experimental — accuracy not yet measured
    • cites [15]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [16]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • Rests on an assumption: The gender gap in psychiatric EAS and its meaning have received virtually no discussion.
  • Interpretationcitation

    Portrayals that treat people who die by suicide and people who die by EAS as fundamentally different rest on unfounded assumptions.

    “Such contrasting portrayals of persons who die by suicide versus those who die by EAS as fundamentally different rely on unfounded assumptions.(11)”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [11] source

      The Findings (page unavailable) report that psychiatric patients requesting euthanasia had also experienced suicidal thoughts or attempts, and some considered suicide if their requests were denied. That overlap challenges a categorical separation, but the study does not assess portrayals of people who die by suicide versus EAS or establish that such portrayals rest on unfounded assumptions. (LLM, conf=0.81)

      Experimental — accuracy not yet measured
  • Premisecitation

    Women make a higher number of non-lethal suicide attempts before a lethal attempt.

    “Furthermore, the robust finding that women show a higher number of non-lethal attempts prior to a lethal attempt is consistent with the claim that through repeated attempts, women gradually increase their capability and the lethality of their attempts.(13, 16, 18, 23)”
    Quote in the paperSubstantial claim1 of 4 sources checked
    • cites [13] source
    • cites [16]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [18]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [23] source

      The 'Relative Risks of Suicidal Behaviour' section (p. 1) says rates of deliberate self-harm are usually higher in females than males. It does not say that women who die by suicide made more non-lethal attempts beforehand, or compare the number of prior attempts by sex. (LLM, conf=0.87)

      Experimental — accuracy not yet measured
  • Interpretationcitation

    Through repeated suicide attempts, women gradually increase their capability and the lethality of their attempts.

    “Furthermore, the robust finding that women show a higher number of non-lethal attempts prior to a lethal attempt is consistent with the claim that through repeated attempts, women gradually increase their capability and the lethality of their attempts.(13, 16, 18, 23)”
    Quote in the paperSubstantial claim1 of 4 sources checked
    • cites [13] source
    • cites [16]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [18]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [23] source

      The Relative Risks of Suicidal Behaviour section (p. 1) says deliberate self-harm rates are usually higher in females, and Gender Differences in the Nature of Suicidal Acts (p. 1) describes an excess rate of self-harm in females. Neither passage establishes that women have more non-lethal attempts before a lethal attempt or that repeated attempts gradually increase their capability or lethality. (LLM, conf=0.82)

      Experimental — accuracy not yet measured
  • Findingcitation

    The women-to-men ratio in psychiatric EAS (2.3:1) is virtually identical to the ratio among suicide attempters, not completers.

    “The women:men ratio in psychiatric EAS (2.3:1) is virtually identical to that of suicide attempters, not completers.”
    Quote in the paperSubstantial claim2 of 4 sources checked
    • cites [3]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [17]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [26] source

      The Sexual violence and mental health section mentions suicide attempts among women who experienced rape or attempted rape, but gives no women-to-men ratio for suicide attempts. Searches for psychiatric EAS, 2.3:1, and sex ratios for suicide attempts versus deaths found no passage addressing the claimed comparison; page numbers were not available in our copy. (LLM, conf=0.76)

      Experimental — accuracy not yet measured
    • cites [27] source

      In Empirical and Theoretical Foundations > Theoretical Perspectives, the paper reports a women-to-men ratio of 3:1 for non-lethal suicide attempts and a men-to-women ratio of 4:1 for suicide deaths in the United States. That supports the contrast between attempters and completers, but the reported attempt ratio is not 2.3:1, so the claim of a virtually identical ratio is stronger than this source establishes. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
  • Classified as probably not a substantial claim. 7
  • May combine two claims. 19

  • Classified as probably not a substantial claim.

    Premisecitation

    Ideation-to-action theories focus on suicide capability, which determines the transition from suicidal ideation to suicidal behavior.

    “Rather than emphasizing the role of suicide risk factors, it focuses on the concept of suicide “capability”, which determines the transition from suicidal ideation to (lethal and non-lethal) suicidal behavior.”
    Quote in the paperSubstantial claim2 of 6 sources checked
    • cites [14] source

      The section “Suicide and Physician-Assisted Death for Persons With Psychiatric Disorders: How Much Overlap?” discusses similarities between psychiatric physician-assisted death and suicide, but does not address ideation-to-action theories or suicide capability. Searches for the transition from suicidal ideation to behavior and for acquired capability found no relevant passage in our copy; no page number was available. (LLM, conf=0.74)

      Experimental — accuracy not yet measured
    • cites [15]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [16]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [17]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [18]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [19] source

      The Discussion (page unavailable) distinguishes factors associated with suicidal ideation from those associated with acting on suicidal thoughts. It does not describe ideation-to-action theories, identify suicide “capability” as the determining concept, or establish a transition to both lethal and non-lethal behavior. (LLM, conf=0.84)

      Experimental — accuracy not yet measured

  • Classified as probably not a substantial claim.

    Premisecitation

    Current explanations for the difference between psychiatric EAS and suicide emphasize an alleged difference in the role of impulsive action.

    “Current explanations for the difference between psychiatric EAS and suicide describe different phenomena, with emphasis on the alleged different role of impulsive action in both cases.(7, 10, 11)”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites [7] source
    • cites [10]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [11] source

      The Findings (page unavailable) describe patients weighing suicide against euthanasia and making advance arrangements; the Discussion, Main findings (page unavailable) calls the wish to die “well-considered.” These passages support a distinction in deliberation, but the paper does not say that current explanations emphasize a different role for impulsive action in psychiatric EAS and suicide. (LLM, conf=0.82)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    The role of impulsive action in suicide has been overstated, and only a very small amount of suicidal behavior occurs without planning.

    “Their key reliance on impulsivity can be challenged, as the role of impulsive action in suicide has been overstated and only very little suicidal behavior (lethal or non-lethal) occurs without planning.(13–15)”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites [13] source
    • cites [14] source

      The section “Suicide and Physician-Assisted Death for Persons With Psychiatric Disorders: How Much Overlap?” (page not provided) discusses similarities between suicide and psychiatric physician-assisted death, but does not address how often suicidal behavior is impulsive or unplanned. Searches for impulsive action and for suicidal behavior without planning found no passage supporting either part of the claim. (LLM, conf=0.70)

      Experimental — accuracy not yet measured
    • cites [15]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation

    Suicide capability includes practical factors such as knowledge of and access to highly lethal means and psychological factors such as fearlessness of death and pain tolerance, all of which can be acquired over time.

    “Within this framework, “capability” includes practical factors (knowledge of and access to highly lethal means) and psychological factors (fearlessness of death, pain tolerance), both of which can be acquired over time.(14–19)”
    Quote in the paperSubstantial claim2 of 6 sources checked
    • cites [14] source

      The section “Suicide and Physician-Assisted Death for Persons With Psychiatric Disorders: How Much Overlap?” (page not provided) discusses characteristics and motivations of people who die by suicide, but does not describe suicide capability in terms of access to lethal means, fearlessness of death, or pain tolerance. Searches for those terms and for acquired capability found no supporting passage in our copy. (LLM, conf=0.77)

      Experimental — accuracy not yet measured
    • cites [15]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [16]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [17]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [18]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [19] source

      The Methods section (page unavailable) measures suicidal ideation, plans, and attempts, while the Discussion (page unavailable) addresses mental disorders and progression to attempts. Searches for fearlessness of death, pain tolerance, lethal means, and acquired capability found no passage in our copy defining capability or saying these factors can be acquired over time. (LLM, conf=0.75)

      Experimental — accuracy not yet measured

  • Classified as probably not a substantial claim.

    Premisecitation

    Ideation-to-action theories of suicide focus on the process from suicidal ideation to suicidal behavior.

    “For this purpose, we will consider the usefulness of ideation-to-action theories, which focus on the suicidal process from suicidal ideation to behavior.(14–16)”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites [14] source

      The section on overlap between suicide and psychiatric physician-assisted death discusses suicidal thoughts, motivations, and suicide attempts, but does not describe ideation-to-action theories or their focus. Searches for those theories and for the transition from suicidal thoughts to behavior found no passage addressing the claim. (LLM, conf=0.78)

      Experimental — accuracy not yet measured
    • cites [15]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [16]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Classified as probably not a substantial claim.

    Premisecitation

    Guidelines define irremediability exclusively in terms of treatment options for the underlying psychiatric condition.

    “In fact, they define the criterion exclusively in terms of treatment options for the underlying psychiatric condition.(12, 33)”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [12] source

      The Case management and outreach and Somatic treatment options for SB sections discuss treatments for suicidal behaviour, but neither defines irremediability or describes guidelines for assessing it (page numbers unavailable). Searches for irremediability and psychiatric treatment options found no passage addressing the claimed criterion. (LLM, conf=0.76)

      Experimental — accuracy not yet measured
    • cites [33] source

      The Discussion mentions a Dutch psychiatric euthanasia guideline and says Belgium has no official guideline, but it does not describe how any guideline defines irremediability. Searches for irremediability, treatment options, and guideline criteria found no passage stating that the criterion is defined exclusively by treatment options for the underlying condition. (LLM, conf=0.74)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    In most countries, including the Netherlands, men are 2 to 3 times as likely as women to die by suicide, while women are about twice as likely (2.1:1) to attempt suicide.

    “Men are 2 to 3 times as likely to die by suicide than women in most countries, including in the Netherlands, while women are about twice as likely (2.1:1) to attempt suicide.(3, 17, 26, 27)”
    Quote in the paperSubstantial claim2 of 4 sources checked
    • cites [3]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [17]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [26] source

      The Sexual violence and mental health section mentions suicide attempts among women who experienced rape or attempted rape, but gives no comparison with men. Searches for the 2.1:1 ratio, suicide death rates, and sex differences in attempts found no passage supporting the claimed figures for the Netherlands or most countries; page numbers were unavailable. (LLM, conf=0.76)

      Experimental — accuracy not yet measured
    • cites [27] source

      The Conclusions and Future Directions section says male suicides outnumber female suicides worldwide, while more females engage in non-lethal suicidal behavior. The Theoretical Perspectives section gives U.S. ratios of 4:1 for deaths and 3:1 for non-lethal attempts; it does not substantiate the claimed 2–3:1 and 2.1:1 ratios or the Netherlands-specific figure. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    The psychological components of suicide capability include the ability to face death and to enact something painful to one's own body.

    “The important psychological components of capability involve the ability to face death and to enact something painful to one’s own body. (16, 19)”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [16]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [19] source

      The Discussion distinguishes suicidal ideation from acting on suicidal thoughts, but does not describe an ability to face death or inflict pain on one’s own body. Searches for those components and for fear of death and pain tolerance found no passage addressing the claimed components of suicide capability. No page numbers were available in our copy. (LLM, conf=0.75)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    In Flanders, there are 3 suicides and an estimated average of 28 suicide attempts per day, amounting to 1,095 suicides and over 10,000 suicide attempts per year, or 9 attempts per suicide.

    “For example, in a country like Belgium with 11 million inhabitants -and with notoriously high suicide rates- the region of Flanders counts 3 suicides and an estimated average of 28 suicide attempts per day.(30) This amounts to 1,095 suicides and over 10,000 suicide attempts per year – 9 attempts for every suicide.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [30] source

      The Epidemiology section (p. 3) gives a worldwide estimate of about 20 suicide attempts per suicide death and says the ratio varies by country. Searches for Flanders, Belgium, the daily and annual counts, and the nine-to-one ratio found no passage substantiating the regional figures. (LLM, conf=0.75)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Current guidelines are silent on whether suicidal ideation and behavior should play a role in defining irremediability, potentially exacerbating the risk of error.

    “Currently, guidelines are silent on whether suicidal ideation and behavior should play a role in how “irremediability” is defined, potentially exacerbating the risk for error.”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [12] source

      The Definitions and assessment section discusses terminology for suicidal behaviour, and the Case management and outreach section discusses suicide-risk assessment (page numbers unavailable). Neither addresses whether guidelines include suicidal ideation or behaviour in defining irremediability, or whether silence on that question increases the risk of error. Searches for “irremediability” and the claimed guideline language found no relevant passage. (LLM, conf=0.72)

      Experimental — accuracy not yet measured
    • cites [33] source

      The Discussion (page unavailable) says Belgium had no official guideline for evaluating psychiatric euthanasia requests and warns that a wish to die can be a symptom of mental illness. It does not say whether existing guidelines address suicidal ideation or behavior in defining irremediability, or that silence on this point increases the risk of error. (LLM, conf=0.82)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Interpretationcitation

    People requesting and receiving psychiatric EAS tend to be similar to people attempting suicide, a finding corroborated by emerging data.

    “Persons requesting and receiving psychiatric EAS tend to be similar to those attempting suicide, a finding corroborated by emerging data from the practice of psychiatric EAS.(3, 11, 28, 29)”
    Quote in the paperSubstantial claim1 of 4 sources checked
    • cites [3]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [11] source

      The Findings (page unavailable) report that some psychiatric patients requesting euthanasia had suicidal thoughts or had attempted suicide, supporting an overlap. The Patients section (page unavailable) reports that nine of the 26 patients received euthanasia and two died by suicide. The study does not compare people requesting or receiving psychiatric EAS with a group of suicide attempters, so it does not establish the broader claimed similarity. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
    • cites [28] source
    • cites [29]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation

    Gender-based violence affects 35% of women worldwide and is a gendered environmental risk factor for mental disorders and suicidal behavior that is common among people requesting psychiatric EAS.

    “For example, gender-based violence, affecting 35% of women worldwide, is a clear example of a gendered environmental risk factor for mental disorders and suicidal behavior that is common among persons requesting psychiatric EAS,(28, 29) and an important public health issue for which prevention and management remains suboptimal.(36, 37)”
    Quote in the paperNot a substantial claim1 of 4 sources checked
    • cites [28] source
    • cites [29]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [36] source
    • cites [37] source

      The Results (Sociodemographic status) report that 77 of 100 psychiatric euthanasia requesters were women, but do not report whether they experienced gender-based violence. Searches for gender-based violence and trauma or abuse histories found no passage supporting the 35% worldwide figure or the claim that such violence is common among requesters or a risk factor for their mental disorders and suicidal behavior. Page numbers were not available in our copy. (LLM, conf=0.76)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Findingcitation

    In a recent analysis of 74 personality-related disorder cases receiving psychiatric EAS, cognitive therapies were reported in 14% and dialectical behavior therapy in none, while 47% had attempted suicide once and 36% multiple times before their request.

    “However, in a recent analysis, we found that these interventions are rare among persons receiving psychiatric EAS: cognitive therapies were reported in 14% and dialectical behavior therapy in none of the 74 included personality-related disorder cases, while 47% had attempted suicide once and 36% multiple times prior to their request.(29)”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [29]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Interpretationreasoning

    The pool of potential psychiatric EAS requestors and the associated risk for error may be larger than previously assumed.

    “We argue that the pool of potential psychiatric EAS requestors and the associated risk for error might be higher than previously assumed, and explain how current guidance might contribute to this risk.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The gender gap in psychiatric EAS and its meaning have received virtually no discussion.

  • May combine two claims.

    Premisecitation

    Men more often use hanging or firearms, whereas women frequently choose self-poisoning.

    “For example, men tend to use methods such as hanging or fire-arms, while women often choose self-poisoning.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [18]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [21] source

  • May combine two claims.

    Interpretationreasoning

    Impulsive action is neither necessary nor sufficient for suicide and cannot account for the difference between suicide and psychiatric EAS or for their different gender distributions.

    “Impulsive action is neither necessary nor sufficient for suicide and cannot explain the difference between suicide and psychiatric EAS, nor its different gender distributions.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    Assuming that imitation patterns do not apply to psychiatric EAS is tenable only if clinical profiles are distinct, but not if they appear similar.

    “To assume that the same patterns do not apply is only tenable if the clinical profiles are distinct, but not if they appear similar.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    The relation between suicide and psychiatric EAS is not based on impulsivity; capability is more likely to explain why some patients resort to EAS rather than suicide.

    “This suggests that the relation between suicide and psychiatric EAS is not based the problematic concept of impulsivity. Rather, capability is more likely to explain why some patients resort to EAS rather than suicide.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    The gender paradox in suicide is closely related to the gender gap in psychiatric EAS; women turn to psychiatric EAS as a suicide method they are capable of using.

    “The notion of capability that they invoke suggests that the “gender paradox” in suicide is closely related to the gender gap in psychiatric EAS: women resort to psychiatric EAS as a form of suicide of which they are “capable”.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    The debate about error in psychiatric EAS has mainly concerned potential errors in assessing irremediability, unbearable suffering, or decision-making capacity.

    “Regardless of where one stands, the dispute has so far mainly referred to potential errors in assessing the irremediability of the person’s psychiatric condition, their unbearable suffering or their decision-making capacity.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [32] source

  • May combine two claims.

    Interpretationreasoning

    The distinction between suicide as impulsive and psychiatric EAS as planned is not well-grounded empirically and does little to refute the claim that psychiatric EAS is in tension with suicide prevention.

    “However, this distinction is not well-grounded empirically and does little to refute the claim that psychiatric EAS is in tension with suicide prevention.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    The capability framework provides a natural explanation of the gender gap in psychiatric EAS and conforms better to the suicide literature than an impulsivity-based explanation.

    “The above capability framework suggests a natural explanation of the gender gap in psychiatric EAS and better conforms to the known literature on suicide than an explanation based on impulsivity.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: EAS is a painless and highly lethal method of death that is professionally and socially approved in countries where it is legal.

  • May combine two claims.

    Premisecitation

    Evidence-based treatments for suicidal behavior, both pharmacological and psychological, are available, yet only around 60% of people with suicidal ideation and behavior receive any.

    “Furthermore, while established evidence-based treatments for suicidal behavior exist, including pharmacological and psychological treatment, only about 60% of people with suicidal ideation and behavior receive treatment.(15)”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [15]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Interpretationreasoning

    The difference between expected mortality through suicide and through EAS could be highest in subgroups with low capability, so the cost of error per individual may be higher.

    “That is, the difference between expected mortality rates through suicide versus through EAS could be highest in these subgroups and the risk for error may, on average, come at a higher cost for each individual.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    The findings raise important implications for the practice of psychiatric EAS and public policy.

    “This raises important implications for the practice of psychiatric EAS and public policy.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    The findings of this analysis raise implications for policy and research that go beyond psychiatry.

    “Hence, the findings of this analysis raise implications for policy and research that go far beyond the boundaries of psychiatry.”
    Quote in the paperNot a substantial claim
26 of 26

  • The paper relies on this without support.

    The gender gap in psychiatric EAS and its meaning have received virtually no discussion.

    “While this is one of the most consistent finding emerging from the research on the topic, the gender gap and its meaning have received virtually no discussion.”
    “Despite being empirically well-established, the gender gap in psychiatric EAS has been underexplored so far.”

  • The paper relies on this without support.

    EAS is a painless and highly lethal method of death that is professionally and socially approved in countries where it is legal.

    “EAS is a painless and highly lethal method of death, that is professionally and socially approved in countries where it is legal.”

  • The authors state this as an assumption.

    A significant proportion of people engaging in suicidal behavior might consider psychiatric EAS at some point during their suicidal process as it becomes better known.

    “It is reasonable to assume that a significant proportion of these persons might consider psychiatric EAS at some point during their suicidal process, as psychiatric EAS becomes better known as an option.”
3 of 3

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Female patients are notably overrepresented in psychiatric cases, although these comprise a small fraction of total cases.

    “For instance, it was shown that female patients are notably overrepresented in psychiatric cases, although these comprise a small fraction of total cases [17,18].”

    From Trends in assisted dying among patients with psychiatric disorders and dementia in Belgium: A health registry study (2025) · cites this paper as [17]

    The Introduction reports that women account for 69–77% of people who request and receive euthanasia based on a psychiatric condition, supporting their overrepresentation in psychiatric EAS cases. The passages do not establish that psychiatric EAS cases comprise a small fraction of all EAS cases; searches for that proportion found no supporting passage. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Among 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 [68]

    The Discussion (page not available in our copy) raises unmet treatment needs among people at risk for suicide who request psychiatric euthanasia, supporting the care-and-services aspect for that narrower group. It does not identify lack of symptom relief, satisfying relationships, or difficulty finding meaning in life as unmet needs. (LLM, conf=0.83)

    Experimental — accuracy not yet measured

  • More women than men attempt suicide.

    “more women than men attempt suicide”

    From Patients <i>requesting</i> and <i>receiving</i> euthanasia for psychiatric disorders in the Netherlands (2023) · cites this paper as [15]

Cites

Flagged first, then by citations

Research works printed but not linked: 6

  1. Onwuteaka-Philipsen, 2017, Derde Evaluatie Wet Toesting Levensbeeindiging op Verzoek en Hulp bij Zelfdoding. [Third Evaluation of the Dutch Termination of Life on Request and Assisted Suicide Act.]
  2. 2017, Levenseindekliniek kan de vraag niet aan en zoekt tientallen nieuwe artsen
  3. 2001, Gender Disparities in Mental Health
  4. 2018, Euthanasia Code 2018: Review Procedures in Practice
  5. Vancayseele, 2018, Kenmerken Suicidepogingen in Gent en Vlaanderen
  6. 2019, Age-Standardized Suicide Rates

Cited by

Sorted by citations

Related

Authors
Nicolini, M. E., Gastmans, C., & Kim, S. Y. H.
Affiliations
  • National Institutes of Health (US)
  • KU Leuven (BE)
Corresponding author
Nicolini, Marie E.
ORCID
Venue
The British Journal of Psychiatry
Publisher
Royal College of Psychiatrists
Published
2021-07-27
Volume
220
Issue
1
Pages
10-13
ISSN
  • 0007-1250 (ISSN-L)
  • 1472-1465
DOI
10.1192/bjp.2021.95
PMC
PMC8777112
OpenAlex
W3185984811
Cited by
40
References
27
Citations by year
2026: 5 · 2025: 18 · 2024: 9 · 2023: 5 · 2022: 2 · 2021: 1
FWCI
3.07
Type
journal article
Language
en
Open access
Licence
www.cambridge.org/core/terms (unspecified)
Locations
  • The British Journal of Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • Lirias (submittedVersion)
Funders
National Institutes of Health
Topics
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
  • 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
assisted suicide, gender differences, women, suicide prevention, end-of-life decisions
MeSH terms
Mental Disorders, Euthanasia, Female, Humans, Netherlands, Suicide, Assisted

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-09-28.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-09-28.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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