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Cited by 30Palliative Care and End-of-Life IssuesPalliative and Oncologic CareEthics and bioethics in healthcare

Physician Assisted Death for Psychiatric Suffering: Experiences in the Netherlands

Open access
van Veen, SMP, Widdershoven, GAM, Beekman, ATF, Evans, N.·2022·Frontiers in Psychiatry
DOI 10.3389/fpsyt.2022.895387PMC PMC9251055
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Abstract

Physician assisted death (PAD) for patients with a psychiatric disorder is a controversial topic of increasing relevance, since a growing number of countries are allowing it. General requirements for PAD include that patients possess decision-making capacity to decide on PAD and that their suffering is unbearable and irremediable. In the Netherlands PAD has been eligible for patients with psychiatric disorders since the 1990s, making it one of the few countries that can offer insights on the practice from real life experience. Much of the literature describing these experiences is only available in Dutch. This article aims to make this knowledge more widely available and provide a comprehensive overview of the experience with PAD for psychiatric suffering in the Netherlands. First, the history of PAD for patients suffering from a psychiatric disorder is described. Second, an overview of relevant rules and regulations governing the practice is given. Third, an overview is provided of the scarce epidemiological data. Finally, we will discuss two major clinical challenges; establishing irremediability and decision-making capacity.

AI snapshot

Written from the paper’s full text.

TL;DR

This narrative review summarizes the Dutch experience with physician assisted death (PAD) for psychiatric suffering, covering its history, legal due care framework, epidemiology, and two central clinical challenges: irremediability and decision-making capacity. It aims to make Dutch-language knowledge available to an international audience and reports that although PAD for psychiatric suffering remains rare, requests have risen and most are rejected.

Key findings

  • PAD for psychiatric suffering has been possible in the Netherlands since the 1990s; reported cases rose to 115 in 2021. In 2020, there were 6,938 total PADs, of which 88 (1.3%) were due to psychiatric suffering.
  • Requests greatly exceed performed PADs: an estimated 56% of Dutch psychiatrists have had a euthanasia request during their career, and about 95% of all requests are rejected. In an ECE report of 1,308 files, almost 90% of psychiatric PAD requests did not end in PAD: 20% withdrew and 68% were rejected; eight patients died by suicide after rejection.
  • Dutch law requires six due care criteria, plus a second opinion by an appropriate expert for psychiatric suffering; the Dutch Psychiatric Association guideline divides the process into request, assessment, consultation, and implementation phases.
  • Key challenges are establishing irremediability and assessing decision-making capacity. A survey of 248 Dutch psychiatrists found 56% thought irremediability could be established, while 44% doubted or thought it impossible; another survey found 65% thought they could determine capacity for a competent PAD request, 12% thought not, and 23% had doubts.

Methods

  • Narrative overview/review of the Dutch experience with PAD for psychiatric suffering, based on a literature search performed by one author and synthesis of history, rules and regulations, epidemiology, and current clinical debates.
  • Sources include Dutch law and guidelines, Regional Euthanasia Oversight Committees reports, published case summaries (e.g., 67 cases from 2011–2014 and a follow-up of 2015–2017 cases), an ECE report analyzing 1,308 patient files, surveys of psychiatrists, and qualitative/Delphi studies.
  • No new primary empirical data are reported; the article synthesizes existing Dutch sources and empirical studies.

Limitations

  • The paper states that much of the relevant literature is only available in Dutch, that epidemiological data are scarce, and that the ECE report of 1,308 files has not been peer reviewed or published in a scientific journal.
  • It notes that casefile studies are limited by the relatively low number of publicly available cases and concern only patients receiving PAD, not those requesting it.
  • Evident from the text: this is a narrative overview rather than a systematic review, and empirical research on decision-making capacity in psychiatric PAD remains scarce, with no studies yet using tools such as the MacArthur Competence Assessment Tool.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.3389/fpsyt.2022.895387

Cites

24 of 24 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 39 cited sources checked · 0 supported · 0 flagged

  • Premisecitation

    The ECE report analyzed 1,308 files of patients who requested PAD for psychiatric suffering.

    “For this report, 1,308 files of patients who requested PAD for psychiatric suffering were analyzed.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [10] Kammeraat, 2020, Psychiatrische patiënten bij Expertisecentrum Euthanasie

      Not checked in the free run.

    • Rests on an assumption: The ECE report's findings, despite not being peer reviewed or published in a scientific journal, are sufficiently reliable to be used as evidence about patients requesting PAD for psychiatric suffering.
  • Premisecitation

    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).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [5] Schoevers, 1998, Physician-assisted suicide in psychiatry: Developments in the Netherlands, Psychiatr Serv. source

      Not checked in the free run.

    • cites [6] Berghmans, 1998, Commentary on “Suicide, euthanasia, and the psychiatrist”, Philos Psychiatry, Psychol.

      Not checked in the free run.

  • Premisecitation

    The ECE report mentions eight patients who died by suicide after their request for PAD was rejected.

    “The study also mentions eight patients who died by suicide after their request for PAD was rejected.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [10] Kammeraat, 2020, Psychiatrische patiënten bij Expertisecentrum Euthanasie

      Not checked in the free run.

    • Rests on an assumption: The ECE report's findings, despite not being peer reviewed or published in a scientific journal, are sufficiently reliable to be used as evidence about patients requesting PAD for psychiatric suffering.
  • Premisecitation

    Physician assisted death (PAD) for patients with a psychiatric disorder is legally possible in only a few countries, including the Netherlands, Belgium, Luxembourg, Switzerland, and soon Canada.

    “An even more controversial topic is whether to allow PAD for patients with a psychiatric disorder, which is possible in only a few countries, such as the Netherlands, Belgium, Luxembourg, Switzerland and soon also Canada (1).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [1] Nicolini, 2020, Should euthanasia and assisted suicide for psychiatric disorders be permitted?, A systematic review of reasons Psychol Med. source

      Not checked in the free run.

  • Premisereasoning

    The End-of-Life Clinic quickly became the center of psychiatric PAD in the Netherlands.

    “The End-of-Life Clinic has quickly become the center of psychiatric PAD in the Netherlands.”
    Quote in the paperNot a substantial claim
  • Classified as probably not a substantial claim. 12
  • May combine two claims. 29

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisenone given

    The Dutch Euthanasia Act specifies six due care criteria for PAD.

    “The six ‘due care’ criteria in the euthanasia act are the following.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Dutch law requires that there is no prospect of improvement and no other solutions available before PAD is allowed; these legal demands align with the more universal view that irremediability of suffering is an important prerequisite for PAD.

    “As mentioned above, Dutch law requires that there is no prospect of improvement and that there are no other solutions available before PAD is allowed. These legal demands align with the more universal view that irremediability of suffering is an important prerequisite for PAD (13).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [13] Widdershoven, 2022, The Role of Suffering in the “Tired of Life” Debate, Am J Bioeth. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Most psychiatric disorders, with the possible exception of serious eating disorders, are not in themselves fatal; patients with untreatable mental illnesses potentially have decades to live in which they can recover spontaneously or in which new treatment options can be developed.

    “First of all, most psychiatric disorders, with the possible exception of serious eating disorders, are not in themselves fatal. This means that patients with untreatable mental illnesses potentially have decades to live in which they can recover spontaneously or in which new treatment options can be developed that can still lead to recovery (15).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [15] Medical assistance in dying for suffering arising from mental health disorders: could augmented safeguards enhance its ethical acceptability?118 KirbyJ J Ethics and Mental Health102017

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In the ECE report, the mean age of applicants was 50; 60% were women, 70% were single, 76% had a low or secondary education level, and 88% were receiving benefits.

    “The mean age of applicants was 50. Sixty percentage of the applicants were women, 70% were single, 76% had a low or secondary education level and 88% were receiving benefits.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [10] Kammeraat, 2020, Psychiatrische patiënten bij Expertisecentrum Euthanasie

      Not checked in the free run.

    • Rests on an assumption: The ECE report's findings, despite not being peer reviewed or published in a scientific journal, are sufficiently reliable to be used as evidence about patients requesting PAD for psychiatric suffering.

  • May combine two claims.

    Premisecitation

    In 2020, the total number of PADs in the Netherlands was 6938; 4480 cases (64.6%) were due to cancer and 88 cases (1.3%) were due to a psychiatric disorder.

    “In 2020, the total number of PADs was 6938, in 4480 cases the suffering was due to cancer (64.6%) and in 88 cases (1.3%) the suffering was due to a psychiatric disorder (2).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [2]

      Not checked in the free run.

  • May combine two claims.

    Premiseown data

    Although the past decade has seen a remarkable increase in PAD for psychiatric suffering, it remains relatively rare.

    “Although the past decade has seen a remarkable increase in PAD for psychiatric suffering, it remains relatively rare.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    In the ECE report, when comorbidity was taken into account, common diagnoses were depression (50%), cluster B personality disorder (22%), and trauma- and stressor-related disorders (20%).

    “When comorbidity is taken into account, common diagnoses were depression (50%), cluster B personality disorder (22%) and trauma- and stressor-related disorders (20%).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [10] Kammeraat, 2020, Psychiatrische patiënten bij Expertisecentrum Euthanasie

      Not checked in the free run.

    • Rests on an assumption: The ECE report's findings, despite not being peer reviewed or published in a scientific journal, are sufficiently reliable to be used as evidence about patients requesting PAD for psychiatric suffering.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    The ECE report has not been peer reviewed or published in a scientific journal.

    “The report, that has not been peer reviewed or published in a scientific journal, shows that patients requesting PAD often have severe and long-standing psychiatric complaints”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    A qualitative interview study showed that Dutch psychiatrists with experience in establishing IPS in the context of PAD address these challenges by focusing on retrospective elements; they do not necessarily assert that suffering will continue indefinitely, but more that the patient has done everything that reasonably can be asked to reduce suffering.

    “First, a qualitative interview study showed that Dutch psychiatrists with experience in establishing IPS in the context of PAD address these challenges by focusing on retrospective elements (18). Therefore, when establishing IPS, they do not necessarily assert that suffering will continue indefinitely, but more that the patient has done everything that reasonably can be asked to reduce suffering.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [18] van Veen, 2022, Establishing irremediable psychiatric suffering in the context of medical assistance in dying in the Netherlands: A qualitative study, CMAJ source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The Dutch Psychiatric Association guideline distinguishes four phases: the request phase, the assessment phase, the consultation phase, and the implementation phase.

    “The guideline distinguishes four phases: the request phase, the assessment phase, the consultation phase, and the implementation phase.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [9] Onwuteaka-Philipsen, 2017, Derde evaluatie Wet toetsing levensbeëindiging op verzoek en hulp bij zelfdoding

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    It is very difficult to give a reliable prognosis for psychiatric suffering, even for patients who have extensive treatment histories, because little is known about the etiology of psychiatric suffering, there are hardly any reliable biomarkers, descriptive diagnostic reliability is relatively low, and it is difficult to predict the effects of treatment.

    “Secondly, it is very difficult to give a reliable prognosis for psychiatric suffering, even for patients who have extensive treatment histories (16, 17). This has different reasons: little is known about the etiology of psychiatric suffering, there are hardly any reliable biomarkers, descriptive diagnostic reliability is relatively low and it is difficult to predict the effects of treatment (18).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [16] Fusar-Poli, 2018, The science of prognosis in psychiatry: a review, JAMA Psychiatry. source

      Not checked in the free run.

    • cites [17] Blikshavn, 2017, Four reasons why assisted dying should not be offered for depression, J Bioeth Inq. source

      Not checked in the free run.

    • cites [18] van Veen, 2022, Establishing irremediable psychiatric suffering in the context of medical assistance in dying in the Netherlands: A qualitative study, CMAJ source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The ECE report shows that patients requesting PAD for psychiatric suffering often have severe and long-standing psychiatric complaints, with 60% having a treatment history of more than 10 years.

    “The report, that has not been peer reviewed or published in a scientific journal, shows that patients requesting PAD often have severe and long-standing psychiatric complaints, with 60% having a treatment history of more than 10 years.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [10] Kammeraat, 2020, Psychiatrische patiënten bij Expertisecentrum Euthanasie

      Not checked in the free run.

    • Rests on an assumption: The ECE report's findings, despite not being peer reviewed or published in a scientific journal, are sufficiently reliable to be used as evidence about patients requesting PAD for psychiatric suffering.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisenone given

    In 1998, the first guideline regarding PAD for psychiatric suffering was published by the Dutch Psychiatry Association.

    “Four years after Chabot's arrest, in 1998, the first guideline regarding PAD for psychiatric suffering was published by the Dutch Psychiatry Association.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisenone given

    In the Netherlands, PAD is possible for patients who have a voluntary and well-considered death wish and who suffer from a medical or psychiatric condition that is unbearable and irremediable.

    “In the Netherlands, PAD is possible for patients who have a voluntary and well-considered death wish and who suffer from a medical or psychiatric condition that is unbearable and irremediable.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Until 2010, only a few cases of PAD for psychiatric suffering were reported yearly in the Netherlands; since 2011 there has been a remarkable increase, with 115 cases recorded in 2021.

    “Although PAD due to psychiatric suffering has been possible since the 1990s, until 2010 only a few cases were reported yearly. However, since 2011 there has been a remarkable increase, with 115 cases being recorded in 2021 - the most recent year for which figures are available (2).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [2]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisenone given

    In the Netherlands, assisting in the death of another person is punishable by law, but physicians who follow the due care criteria in the Euthanasia Act are exempt from prosecution.

    “In the Netherlands, assisting in the death of another person is punishable by law. However, if physicians follow due care criteria as described in the ‘Termination of Life on Request and Assisted Suicide Review Act’ they are exempt from prosecution.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    In the ECE report, almost 90% of PAD requests due to psychiatric suffering did not end in PAD: 20% withdrew the request and 68% were rejected; patients with a cluster B personality disorder as the main diagnosis were frequently rejected.

    “Almost 90% of the PAD requests due to psychiatric suffering did not end in PAD: 20% withdrew the request and 68% were rejected. Patients with a cluster B personality disorder as the main diagnosis were frequently rejected.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [10] Kammeraat, 2020, Psychiatrische patiënten bij Expertisecentrum Euthanasie

      Not checked in the free run.

    • Rests on an assumption: The ECE report's findings, despite not being peer reviewed or published in a scientific journal, are sufficiently reliable to be used as evidence about patients requesting PAD for psychiatric suffering.

  • May combine two claims.

    Premisecitation

    In the ECE report, most patients whose PAD request was granted were between the ages of 50 and 60; 28% had a diagnosis of major depressive disorder and 13% a trauma- or stressor-related disorder.

    “Most patients whose PAD request was granted were between the ages of 50 and 60, 28% had a diagnosis of major depressive disorder and 13% a trauma- or stressor-related disorder.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [10] Kammeraat, 2020, Psychiatrische patiënten bij Expertisecentrum Euthanasie

      Not checked in the free run.

    • Rests on an assumption: The ECE report's findings, despite not being peer reviewed or published in a scientific journal, are sufficiently reliable to be used as evidence about patients requesting PAD for psychiatric suffering.

  • May combine two claims.

    Interpretationreasoning

    A survey among 248 Dutch psychiatrists showed that 56% thought it possible to establish irremediability, implying that 44% doubted the possibility or thought establishing irremediability impossible, indicating dissensus among Dutch experts with real life experience in establishing irremediable psychiatric suffering.

    “A survey among 248 Dutch psychiatrists, showed that 56% thought it possible to establish irremediability. This implies that 44% doubted the possibility or thought establishing irremediability impossible, indicating dissensus among Dutch experts with real life experience in establishing irremediable psychiatric suffering (IPS).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductreasoning

    The Kim et al. and van Veen et al. studies were limited by the relatively low number of publicly available cases and the fact that they only concerned patients receiving PAD, not patients requesting PAD.

    “These studies were limited by the relatively low number of publicly available cases and the fact that they only concerned patients receiving PAD, not patients requesting PAD.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisereasoning

    In 1994, the Dutch supreme court ruling in the Chabot case confirmed that psychiatric suffering can be a justified ground for PAD, although extreme caution is advised.

    “In the ruling the judges made clear that, although extreme caution is advised, psychiatric suffering can be a justified ground for PAD.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    The number of requests for PAD based on psychiatric suffering is much higher than the number actually performed; it is estimated that 56% of all Dutch psychiatrists have had a request for euthanasia during their career, and about 95% of all requests are rejected.

    “However, the number of requests based on psychiatric suffering is much higher than the number that is actually performed. It is estimated that 56% of all Dutch psychiatrists have had a request for euthanasia during their career, and that about 95% of all requests are rejected (9, 10).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [9] Onwuteaka-Philipsen, 2017, Derde evaluatie Wet toetsing levensbeëindiging op verzoek en hulp bij zelfdoding

      Not checked in the free run.

    • cites [10] Kammeraat, 2020, Psychiatrische patiënten bij Expertisecentrum Euthanasie

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Studies of Dutch casefile summaries (Kim et al. 2011-2014; van Veen et al. 2015-2017) found that most patients who received PAD for psychiatric suffering were diagnosed with multiple psychiatric disorders (71-79%), with common diagnoses including depression (46-74%), personality disorders and personality problems (52-54%), anxiety disorders (11-23%), and PTSD (20-23%).

    “Both studies found that most patients were diagnosed with multiple psychiatric disorders (71–79%). Common diagnoses were depression (46–74%), personality disorders and personality problems (52–54%), anxiety disorders (11–23%), and PTSD (20–23%).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [11] Kim, 2016, Euthanasia and assisted suicide of patients with psychiatric disorders in the Netherlands 2011 to 2014, JAMA psychiatry. source

      Not checked in the free run.

    • cites [12] van Veen, 2018, Euthanasia of Dutch Patients with Psychiatric Disorders between 2015 and 2017, Tijdschr Psychiatr

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    There is disagreement about whether patients who refuse certain treatments can be said to suffer irremediably; a casefile study shows that 56% of Dutch patients who received PAD due to psychiatric suffering did refuse some sort of treatment.

    “Thirdly, there is disagreement about whether patients who refuse certain treatments can be said to suffer irremediably. This is not a mere theoretical discussion: a casefile study shows that 56% of Dutch patients who received PAD due to psychiatric suffering did refuse some sort of treatment (11).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [11] Kim, 2016, Euthanasia and assisted suicide of patients with psychiatric disorders in the Netherlands 2011 to 2014, JAMA psychiatry. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In the ECE report, 70% of applicants had more than one psychiatric diagnosis; the most common main diagnosis was depression (35%).

    “70% of the applicants had more than one psychiatric diagnosis. The most common main diagnosis was depression (35%).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [10] Kammeraat, 2020, Psychiatrische patiënten bij Expertisecentrum Euthanasie

      Not checked in the free run.

    • Rests on an assumption: The ECE report's findings, despite not being peer reviewed or published in a scientific journal, are sufficiently reliable to be used as evidence about patients requesting PAD for psychiatric suffering.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisereasoning

    In 2019, The End-of-Life Clinic renamed itself as the Expertise Center Euthanasia and started aiming more on supporting regular psychiatrists in performing PAD themselves.

    “The End-of-Life Clinic considered this problematic and, in 2019, renamed themselves as the Expertise Center Euthanasia (ECE) and started aiming more on supporting regular psychiatrists in performing PAD themselves.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Premisenone given

    In the Netherlands, PAD has been an option for patients with a psychiatric disorder for decades and the practice is still evolving.

    “In the Netherlands, PAD has been an option for patients with a psychiatric disorder for decades and the practice is still evolving.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The Dutch sources and data cited in this article accurately describe the practice of PAD for psychiatric suffering in the Netherlands.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisenone given

    Empirical research into the decision-making capacity of patients requesting PAD due to psychiatric suffering, for instance measured with the McArthur Competence Assessment Tool, is not yet available.

    “Empirical research into the decision-making capacity of patients requesting physician assisted death due to psychiatric suffering, for instance measured with the McArthur Competence Assesment Tool, could provide more clarity, but is not yet available.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    In a study, 53 experienced Dutch and Belgian psychiatrists agreed that a proper psychiatric diagnosis, taking into account contextual factors, is necessary for IPS; all indicated biological and psychological treatments should have been tried, at least one recovery-oriented treatment should have been tried, and if necessary substantial efforts should have been made to improve the patient's social状況

    “In another study, 53 experienced Dutch and Belgian psychiatrists were asked to reflect on potential criteria for IPS in the context of PAD (23). They agreed that a proper psychiatric diagnosis, that takes into account contextual factors, is necessary. All indicated biological and psychological treatments should have been tried, at least one recovery-oriented treatment should have been tried and if”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [23] van Veen, 2022, Irremediable psychiatric suffering in the context of medical assistance in dying: A delphi-study, Canad J Psychiatry source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Studies of Dutch casefile summaries show that all patients who received PAD on the basis of psychiatric suffering were ultimately considered capable of making an informed decision; one study showed that in 8% of cases the doctors involved had differences of opinion about patient decision-making capacity, but in another study no cases of divergent views were found.

    “Studies of Dutch casefile summaries show that all patients who received PAD on the basis of psychiatric suffering were ultimately considered capable of making an informed decision (11, 12). One study showed that in 8% of the cases the doctors involved had differences of opinion about patient decision-making capacity, but in another study no cases of divergent views were found.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [11] Kim, 2016, Euthanasia and assisted suicide of patients with psychiatric disorders in the Netherlands 2011 to 2014, JAMA psychiatry. source

      Not checked in the free run.

    • cites [12] van Veen, 2018, Euthanasia of Dutch Patients with Psychiatric Disorders between 2015 and 2017, Tijdschr Psychiatr

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Questionnaire research among Dutch psychiatrists shows that 65% think they can determine whether a patient with a psychiatric disorder is capable of making a competent PAD-request, 12% think not, and 23% have doubts.

    “Questionnaire research among Dutch psychiatrists shows that 65% think they can determine whether a patient with a psychiatric disorder is capable of making a competent PAD-request, 12% think not, 23% have doubts (9).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [9] Onwuteaka-Philipsen, 2017, Derde evaluatie Wet toetsing levensbeëindiging op verzoek en hulp bij zelfdoding

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The same group agreed that complaints should be present for at least a few years, if only to give all these treatments a chance, and that there should be limits to the number of treatments and diagnostic procedures a patient should undergo before IPS can be established.

    “They also agreed that the complaints should be present for at least a few years, if only to give all these treatments a chance. Finally, this group agreed that there should also be limits to the number of treatments and diagnostic procedures a patient should undergo before IPS can be established.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [23] van Veen, 2022, Irremediable psychiatric suffering in the context of medical assistance in dying: A delphi-study, Canad J Psychiatry source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Research shows that many patients requesting PAD suffer from long lasting and complex psychiatric disorders; this chronicity may make it more challenging to assess if the death wish is unduly influenced by the psychiatric disorder.

    “First, research shows, that many patients requesting PAD suffer from long lasting and complex psychiatric disorders (10–12). This chronicity, may make it more challenging to assess if the death wish is unduly influenced by the psychiatric disorder (25).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [10] Kammeraat, 2020, Psychiatrische patiënten bij Expertisecentrum Euthanasie

      Not checked in the free run.

    • cites [11] Kim, 2016, Euthanasia and assisted suicide of patients with psychiatric disorders in the Netherlands 2011 to 2014, JAMA psychiatry. source

      Not checked in the free run.

    • cites [12] van Veen, 2018, Euthanasia of Dutch Patients with Psychiatric Disorders between 2015 and 2017, Tijdschr Psychiatr

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Some researchers are concerned about the rigor of capacity assessments in the Netherlands, since many reports only contained a short statement about the patient possessing decision-making capacity, but lacked a description on how this was assessed.

    “However, some researchers are concerned about the rigor of the capacity assessments in the Netherlands, since many reports only contained a short statement about the patient possessing decision-making capacity, but lacked a description on how this was assessed (28).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [28] Doernberg, 2016, capacity evaluations of psychiatric patients requesting assisted death in the Netherlands, Psychosomatics. source

      Not checked in the free run.

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  • The paper relies on this without support.

    The Dutch sources and data cited in this article accurately describe the practice of PAD for psychiatric suffering in the Netherlands.

    “This article aims to bridge this knowledge gap by giving a comprehensive overview of the Dutch experience with PAD for patients with a psychiatric disorder.”

  • The paper relies on this without support.

    The ECE report's findings, despite not being peer reviewed or published in a scientific journal, are sufficiently reliable to be used as evidence about patients requesting PAD for psychiatric suffering.

    “The report, that has not been peer reviewed or published in a scientific journal, shows that patients requesting PAD often have severe and long-standing psychiatric complaints, with 60% having a treatment history of more than 10 years.”
2 of 2

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?

  • The finding that most studied cases were handled by an EE physician reflects previous research that the majority of physicians are reluctant to consider or grant requests of patients suffering from a psychiatric disorder.

    “This reflects the findings from previous research that the majority of physicians are reluctant to consider or grant requests of patients suffering from a PD”

    From The Dutch practice of euthanasia and assisted suicide in patients suffering from psychiatric disorders: a qualitative case review study (2024) · cites this paper as [9]

    The Epidemiology section (page unavailable) reports that about 95% of requests for physician-assisted death due to psychiatric suffering are rejected. The History section (page unavailable) says the End-of-Life Clinic served patients who could not find support from their own physician. These passages support reluctance in some cases, but they do not establish that a majority of physicians are reluctant to consider or grant such requests; the rejection figure counts requests, not physicians. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • Physicians are reluctant to consider or grant a patient's request for EAS based on suffering from a psychiatric disorder.

    “It is known that physicians are reluctant to consider or grant a patient’s request for EAS based on suffering from a PD”

    From The Dutch practice of euthanasia and assisted suicide in patients suffering from psychiatric disorders: a qualitative case review study (2024) · cites this paper as [9]

    The Epidemiology section reports that about 95% of Dutch requests for physician-assisted death based on psychiatric suffering are rejected, supporting reluctance to grant requests. The paper does not establish that physicians are reluctant to consider requests, and its figures concern the Netherlands rather than physicians generally. Page numbers are unavailable in our copy. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

  • The proportion of assisted suicide cases in the Netherlands involving people with mental disorders more than quadrupled between 2011 and 2022, while the total number only doubled.

    “However, this proportion more than quadrupled between 2011 and 2022, while the total number (only) doubled (23).”

    From Assisted suicide in persons with mental disorders: a review of clinical-ethical arguments and recommendations (2024) · cites this paper as [23]

    The Introduction (page not provided) reports that Dutch physician-assisted deaths for psychiatric suffering increased from 2011, reaching 115 cases in 2021. The Epidemiology section (page not provided) gives a 2020 proportion of 1.3%, but the paper provides no 2022 figures to establish that the proportion more than quadrupled or that the total number doubled between 2011 and 2022. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • In the Netherlands in 2022, of 8,720 people who died by termination of life by request or assisted suicide, 282 (3.2%) had dementia and 115 (1.3%) had one or more psychiatric disorders.

    “Of the 8,720 people who died by termination of life by request or assisted suicide in the Netherlands in 2022, 282 (3.2%) suffered from dementia and 115 (1.3%) from one or more psychiatric disorders.”

    From Assisted suicide in persons with mental disorders: a review of clinical-ethical arguments and recommendations (2024) · cites this paper as [23]

    The Introduction (page unavailable) reports 115 psychiatric physician-assisted deaths in 2021, explicitly calling it the most recent year with available figures. The Epidemiology section (page unavailable) gives 1.3% for psychiatric cases in 2020. Neither passage supports the claimed 2022 total of 8,720 or the 282 dementia cases. (LLM, conf=0.90)

    Experimental — accuracy not yet measured

  • The majority of individuals who received physician assisted death in the Netherlands were diagnosed with depression, personality disorder, or trauma and stress-related disorders.

    “Of note, the majority of individuals who received physician assisted death in the Netherlands were diagnosed with depression, personality disorder, or trauma and stress-related disorders [57].”

    From Care considerations in medical assistance in dying for persons with mental illness as the sole underlying medical condition: a qualitative study of patient and family perspectives (2024) · cites this paper as [57]

Cites

Flagged first, then by citations

Research works printed but not linked: 1

  1. van Ree, 1983, Euthanasie en hulp bij zelfdoding in een psychiatrisch ziekenhuis, Med Contact., 6, 749

Cited by

Sorted by citations

Related

Authors
van Veen, S., Widdershoven, G., Beekman, A., & Evans, N.
Affiliations
Amsterdam University Medical Centers (NL)
ORCID
Evans, N.
Venue
Frontiers in Psychiatry
Publisher
Frontiers Media SA
Published
2022-06-20
Volume
13
Pages
895387-895387
ISSN
1664-0640 (ISSN-L)
DOI
10.3389/fpsyt.2022.895387
PMC
PMC9251055
OpenAlex
W4283172177
Semantic Scholar
792523da2643acd03304c8bbd2ab7a133d9d8691
Cited by
29
References
24
Citations by year
2026: 4 · 2025: 6 · 2024: 14 · 2023: 5
FWCI
5.52
Type
journal article
Language
en
Open access
Licence
Locations
  • Frontiers in Psychiatry (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Amsterdam UMC (VU Amsterdam) - Institutional Repository (submittedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
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, Netherlands, decision-making capacity, euthanasia legislation, clinical challenges

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