INTRODUCTION This dissertation examined the relevance and challenges of establishing irremediability in the context of physician assisted death (PAD) for patients with psychiatric disorders (PPD). In this chapter we will first answer the main research questions, namely: I. Is establishing irremediability a morally relevant issue in the context of physician assisted death for patients with a psychiatric disorder? II. What are the main challenges when establishing irremediable psychiatric suffering in the context of physician assisted death? III. What are suitable criteria for establishing irremediable psychiatric suffering in the context of physician assisted death? After this, we will reflect on these findings, on the used research methodologies and the strengths and limitations of the research. Finally, we will give recommendations for practice and research. MAIN FINDINGS Irremediability as a morally relevant issue The first question of this dissertation is whether establishing irremediability is a morally relevant issue in the context of physician assisted death for patients with a psychiatric disorder. Chapters 2, 3 and 5 show that this is the case. Chapter 2 describes a man diagnosed with schizophrenia who requests PAD after suffering from hearing music for two decades, during the PAD assessment phase, his complaints are interpreted as compulsions and after treatment with an antidepressant and cognitive behavioral therapy he recovers. This case report illustrates the profound consequences this assessment can have on individual patients; it is a choice between life and death. The relevance of studying IPS in the context of PAD is consolidated in chapter 3, which describes an analysis of 35 casefile summaries of PPD receiving PAD. Among other findings about clinical characteristics, it showed that in four cases (11%) psychiatrists disagreed about irremediability. Remarkably, in all casefile summaries included in this study, the consulted psychiatrists agreed on all of the other demands, like mental capacity or unbearableness. This finding suggests that irremediability is the PAD-criterium yielding the highest rate of interpretive differences when applied to psychiatric suffering, suggesting that establishing IPS is challenging for practitioners. In chapter 5, eleven psychiatrists with experience in assessing patients with a PAD request are interviewed, and they confirm that establishing irremediability is a relevant and challenging issue. Therefore, in answer to the first research question, based on 118 | CHAPTER 7 7
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