INTRODUCTION Physician assisted death (PAD) for patients with a psychiatric disorder (PPD) is a controversial topic of increasing relevance. In the Netherlands, PAD is possible for patients who are competent in their death wish and who suffer fromamedical condition that is unbearable and irremediable. Although PAD has been accessible for PPD in the Netherlands since the 1990s, until 2010 only a few cases were reported annual. Since 2011 however, there has been a remarkable rise of cases. (Dutch Regional Euthanasia Review Committees – Annual Report 2020) This increase was accompanied by a resurgence of the debate on psychiatric PAD. From the growing clinical experience and accompanying debate it is becoming clear that it is especially challenging to apply the concept of irremediability to psychiatric suffering. (Nederlandse Vereniging voor Psychiatrie, 2018; Onwuteaka-Philipsen et al., 2017) This dissertation aims to address this challenge. In this chapter I will first give a background about irremediability in the context of PAD for PPD. After which I will describe the aims, research questions, and methods. Finally, I will give an outline of this dissertation. BACKGROUND History In some ways the story of assisted death for psychiatric suffering in the Netherlands starts in 1851. This was the year that Jan Slotboom killed Johanna Pluckel, a woman suffering from depression, at her explicit request. This case and the following trial grew into an international scandal. Slotboom was convicted to be ‘hanged in a public place’ but eventually sentenced to imprisonment in a labor camp for 20 years, where he died. This and another high-profile case from the time formed the basis of the criminalization of assisting in someone’s suicide, which still applies to this day. The current debate about PAD however originates in the 1970s. General practitioners started to emphasize the tensions between the duty to alleviate suffering and the duty to not actively terminate life. Some physicians admitted that they sporadically helped people to die at their own request. Anecdotal evidence suggests that these cases mainly concerned terminal cancer patients with a limited life expectancy, people who wanted to die because of psychiatric suffering were not yet discussed. A growing societal movement advocated for more transparency and regulation of assisted death, culminating in the establishment of the ‘Voluntary Euthanasia Foundation’, in 1973. A member of this foundation, Mrs. Wertheim, helped an older lady to die at her request and was charged with assisted suicide in 1983 and was sentenced to six months of suspended imprisonment. In the verdict however the judge gave the first outlines for 12 | CHAPTER 1 1