International laws, regulations and guidelines PAD remains highly controversial around the world. A clear example of this is that the World Medical Association recently renewed their viewpoint that PAD is not acceptable under any circumstances. (WMA, 2019) However, a growing number of countries are legalizing a form of PAD. Different countries and states have set up divergent procedural and legal frameworks, often leading to an implicit or explicit exclusion of psychiatric suffering as justifiable grounds for PAD. Countries that allow PAD only for terminal somatic suffering include: Colombia, Japan, New Zealand, South Africa and several states in Australia and the United States of America. (Shaffer, Cook, & Connolly, 2016) In all these jurisdictions, psychiatric disorders are implicitly excluded as legitimate grounds for PAD because the suffering must be terminal or death must be reasonably foreseeable. The countries that do allow PAD for psychiatric suffering are the Netherlands, Belgium, Luxemburg, Switzerland, Spain and Canada. (Rada, 2021) The Netherlands, Belgium and Luxembourg have clear and comprehensive PAD laws that explicitly allow PAD for psychiatric suffering. The Dutch situation is described in detail above and the laws and procedures in Belgium and Luxembourg are very similar, meaning that in all three countries irremediability is a central demand. The Flemish association for psychiatry published a guideline in 2017 in which they further elaborate on the legal requirements, this largely follows earlier Dutch guidelines and states that the bar for irremediability of psychiatric suffering should be set high. All reasonable treatment perspectives have to be exhausted according to the diagnosis specific guidelines. According to the Flemish guideline, reasonable treatment perspectives meet three main requirements: improvement with adequate treatment must be possible, within a manageable time period and with a reasonable relationship between the expected results and burdens of the treatment. Finally, the guideline states that attention must also be given to social interventions and recovery-based approaches. (VVP, 2017) The Netherlands, Belgium and Luxemburg are regularly seen as the first countries to allow PAD for psychiatric suffering. However, strictly speaking, PAD for psychiatric suffering has been possible for a longer time in Switzerland. Article 115 of the Swiss penal code, which came into effect in 1942, states that anyone can assist in the death of another competent person. The only two legal demands are that the person assisting should not have selfish motives and that the person who wants to die ultimately ends their lives themselves, for instance by opening a prepared infusion pump with a lethal drug. In spite of these sparing legal demands, in practice more criteria have to be met. This is mainly because the preferred lethal drug is only available on doctor’s prescription, and the Swiss Academy for Medical Sciences has drawn up guidelines for when such a prescription may be issued. In these guidelines irremediability plays a central part: INTRODUCTION | 17 1