Finally, there was consensus that there should be limits to the number of treatments a patient has to undergo before IPS can be established. This allows for treatment refusal, which is an important theme in the debate about IPS in the context of PAD. (van Veen, Ruissen and Widdershoven, 2020) However, as none of the specific treatment refusal criteria reached consensus, no conclusions can be drawn regarding specific psychiatric treatments the patient should undergo before IPS can be established in the context of PAD. The current criterion, that only states that there should be limits, leaves room for interpretive differences between psychiatrists, patients and other stakeholders. This can be seen as an argument for a diligent assessment of IPS, which requires experience and expertise of participants, as well as joint deliberation, in order to apply the criterion to an individual case. Strengths and weaknesses A strength of this study is that we were able to access a substantial group of psychiatrists with ample experience in assessing PAD-requests, and representing different views on psychiatric PAD. A limitation of a consensus-building Delphi survey is that the structure of the questionnaire is determined by the researchers, and participants’ comments are interpreted by the project group, limiting the influence of the participants. Moreover, no widely accepted benchmark exists within the research community of what constitutes an adequate level of consensus. Also, because we had to change the criteria in between rounds we were not able to calculate response-stability for any of our questions, which could have been a valuable addition to the current qualitative analysis of response stability. (von der Gracht, 2012) Recommendations for practice and research We recommend implementing these consensus criteria in the due diligence procedures in the Netherlands and Belgium, in order to contribute to more uniformity and fewer fundamental disagreements when assessing the irremediability of psychiatric suffering in the context of PAD. The criteria should be seen as essential, but not necessarily sufficient, and have to be applied with due expertise. On a wider scale, we recommend that other jurisdictions which allow PAD for PPD, or are currently discussing options for doing so, will consider the importance of specifying minimum and essential criteria for the establishment or IPS. We hope that the criteria agreed on by Dutch and Belgian experts can be used to inform the development of guidance in other jurisdictions. We recommend that this study is replicated in other countries to see whether similar criteria are agreed upon. We also recommend to explore patient views on irremediability more deeply. A DELPHI STUDY ON IRREMEDIABILITY | 111 6