Although psychiatric suffering has been a legitimate ground for physician assisted death in the Netherlands for decades, it has also been rarely used. For this reason, it has hardly even been a consideration within mental health care. This situation has changed rapidly over the past decade. Patients experiencing psychiatric suffering are more frequently asking for physician assisted death and, increasingly, their requests are being granted. The increase in requests means that psychiatrists are asked to judge the legal criteria for physician assisted death more regularly. In the Netherlands, for a request to be considered, the patient has to make a competent request and their suffering must be unbearable and irremediable. The establishment of irremediability, however, appears to be particularly challenging when it concerns psychiatric suffering. In this dissertation we investigate irremediable psychiatric suffering in the context of physician assisted death. We discuss its relevance, the main challenges that arise during the assessment procedure and ways of coping with these challenges. Finally, we provide consensus criteria.