Limitations The most important limitations are the following. First, the publicly available database that contained the casefile summaries that were used in chapter 3 posed a significant limitation. As mentioned in the chapter itself, the selection-criteria for publishing these summaries are unclear, raising questions about representability and possible selectionbiases. During the period in which research for this dissertation was done unsuccessful attempts were made to gain access to a complete and more transparent database of casefiles of PPD that have died through PAD. Secondly, the relatively small number of psychiatrists involved in the interview study poses a limitation. More interviews could have provided more robust and reliable data on the challenges psychiatrists face when establishing IPS in the context of PAD and how they handle these challenges. The third limitation is that the studies presented here are based on the Dutch and Belgian perspective on IPS in the context of PAD. These two countries can be considered exceptional when it comes to PAD for psychiatric suffering. Therefore, the findings and expert opinions voiced throughout this dissertation reflect a specific time and context, which should be taken into account when assessing of the findings are relevant in other countries or cultures. RECOMMENDATIONS Recommendations for clinical practice Several recommendations for clinical practice in countries where PAD for PPD is allowed, such as the Netherlands and Belgium, can be made based on the findings in this dissertation. The suggestion to regard IPS mainly as a retrospective concept has clinical consequences. This view releases psychiatrists from the unreasonable task to make precise prognostic claims while it still enables them to acknowledge the irremediability of the patient’s situation. It also justifies psychiatrists in emphasizing that all reasonable treatments are tried before IPS can be established. On an organizational level, the findings in this dissertation can inform revisions of the Dutch and Belgian guidelines on PAD for psychiatric suffering. Both guidelines include chapters on irremediability, which give a description of the concept and broadly indicate how it should be applied in clinical practice. The interview study can inspire a section on the main challenges of establishing IPS and provide direction on how to deal with these challenges. Also, as mentioned above, the retrospective view on irremediability can help psychiatrists in the process of shared decision making. The 128 | CHAPTER 7 7