questions about the robustness of the findings. Finally, the studies were performed in the Netherlands and Belgium. Therefore, the findings and expert opinions voiced throughout this dissertation reflect a specific time and context, which should be taken into account when applying the findings in other countries or cultures. Based on this dissertation we recommend that clinicians adopt a retrospective view when establishing irremediability in the context of PAD. We also suggest that they are mindful of ‘treatment fatigue’ when working with patients that have a PAD request or persistent psychiatric complaints. On an organizational level we suggest that the consensus criteria can be used when the Dutch and Belgian guidelines on PAD for PPD are updated. For future research we recommend to include the perspectives of other stakeholders, especially patients, on IPS. Also, we recommend to repeat the research in other countries. We suggest to study treatment fatigue in patients with persistent psychiatric complaints and recommend to make the national registry of the Regional Euthanasia Review Boards available for in-depth research. In conclusion; establishing IPS in the context of PAD is a morally relevant and complex activity. Psychiatrists are asked to make a life-or-death decision while facing profound uncertainty. However, by engaging in a meaningful dialogue with the patient and by adopting a retrospective view on irremediability, it is possible to come to a careful decision that finds the right middle between carelessness and overcautiousness. Consensus criteria are now available to help the psychiatrist with the challenging - but not impossible - task of establishing the irremediability of psychiatric suffering in the context of physician assisted death. SUMMARY | 139 A