Considerations by Dutch Psychiatrists Regarding Euthanasia and Physician-Assisted Suicide in Psychiatry: A Qualitative Study
Open accessAbstract
BACKGROUND: Euthanasia and physician-assisted suicide (EAS) in psychiatry are permitted in the Netherlands under certain legal conditions. Doctors may help patients who suffer unbearably and who have no prospect of improvement from psychiatric illnesses. Although this practice is permitted, it remains controversial, and the acceptability of EAS and the conditions under which it should be allowed are still debated. As the number of psychiatric patients requesting EAS is increasing, Dutch psychiatrists are becoming more reluctant to consider EAS. OBJECTIVE: This study aims for a better understanding of Dutch psychiatrists' considerations for supporting or rejecting EAS for psychiatric patients. METHODS: The data for this qualitative study were collected through 17 in-depth interviews with Dutch psychiatrists. These interviews were held from January until June 2016 as a part of the Third Evaluation of the Dutch Termination of Life on Request and Assisted Suicide Act. RESULTS: Irrespective of their own position in the debate, most Dutch psychiatrists consider reasons for and against EAS, including moral (justice and equality, professional responsibility, compassion), epistemologic (how can one ever know the suffering is without prospect), practical, and contextual (mental health care provisions) reasons. CONCLUSIONS: The variation in views on EAS in psychiatry seems to be related to a difference in views on the nature of psychiatric diseases. Some psychiatrists stress the similarity between psychiatric and somatic diseases, whereas others stress the fundamental difference. These opposing views could be bridged by a pragmatic view, such as a 2-track approach to EAS.
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Human, financial, and material resource shortages are acute in mental health care and services.
“Human, financial, and material resource shortages [34, 45, 46] are acute in mental health care and services.”
From Medical assistance in dying for people living with mental disorders: a qualitative thematic review (2023) · cites this paper as [46]
Many people living with mental disorders face significant delays in accessing care and services or do not have access to treatments and services adapted to their condition at all.
“However, many people living with mental disorders face significant delays in accessing care and services [46] or do not have access to treatments and services adapted to their condition at all [43].”
From Medical assistance in dying for people living with mental disorders: a qualitative thematic review (2023) · cites this paper as [46]
The Dutch law has a 2-track approach where mental health care professionals have to evaluate possible MAiD requests from their patients to grant the request itself, while maintaining recovery-oriented care and being committed to suicide prevention.
“This point speaks to the 2-track approach of the Dutch law, where mental health care professionals have to evaluate the possible MAiD request from their patients to grant the request itself, while at the same time, maintaining a recovery-oriented care and being committed to suicide prevention [51, 52].”
From Debating Euthanasia and Physician-Assisted Death in People with Psychiatric Disorders (2022) · cites this paper as [51]
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 [11]
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 [11]
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“Knowing that the perceived acceptability of an intervention varies across patients [27], it can be difficult for healthcare professionals to confirm that a person’s suffering is intolerable [46].”
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van Kolfschooten, H. (2024) · AI and Ethics · doi:10.1007/s43681-024-00491-w · Cited by 3 · see citing works
“In the case of psychiatric disease, physicians put forward that it is complex to decide on “unbearable suffering, with no prospect of improvement”, also because “sui-cidal thoughts” are often considered clinical symptoms [23].”
Request for euthanasia by a psychiatric patient with undetected intellectual disability
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Self-citationFavron‐Godbout, C., Foster, I., & Racine, É. (2025) · International Journal of Law and Psychiatry · doi:10.1016/j.ijlp.2025.102114 · Cited by 1 · see citing works
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Jenniskens, E. P. G. M., & Mevenkamp, N. (2025) · BMC Medical Ethics · doi:10.1186/s12910-025-01333-y
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- Authors
- Pronk, R., Evenblij, K., Willems, D. L., & van de Vathorst, S.
- Affiliations
- Amsterdam UMC Location University of Amsterdam (NL)
- Amsterdam University Medical Centers (NL)
- Venue
- The Journal of Clinical Psychiatry
- Publisher
- Physicians Postgraduate Press, Inc
- Published
- 2019-11-05
- Volume
- 80
- Issue
- 6
- ISSN
- 0160-6689 (ISSN-L)
- 1555-2101
- OpenAlex
- W2987658588
- Cited by
- 18
- References
- 0
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 6 · 2023: 2 · 2022: 3 · 2021: 1 · 2020: 2
- FWCI
- 1.39
- Type
- journal article
- Language
- en
- Open access
- green
- pure.amc.nl
- Licence
- other-oa
- Locations
- The Journal of Clinical Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Pure Amsterdam UMC (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Funders
- Amsterdam University Medical Centers
- ZonMw
- Topics
- 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
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
- Keywords
- euthanasia, physician-assisted suicide, psychiatrists' attitudes, psychiatric patients, moral considerations, professional responsibility, compassion, mental health service delivery
- MeSH terms
- Attitude of Health Personnel, Euthanasia, Humans, Interview, Psychological, Netherlands, Psychiatry, Suicide, Assisted, Qualitative Research
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