most psychiatric disorders, with the possible exception of severe eating disorders, are not fatal. This means that patients with untreatable mental illnesses potentially have decades to live in which they can recover spontaneously or new treatment options can be developed that might lead to recovery. (Kirby, 2017) Second, little is known about the etiology of psychiatric suffering, complaints can increase and decrease without a clear explanation and practitioners regularly arrive at different diagnoses. As a result, prognosis is very difficult to establish, even in patients who have had many treatments. (Blikshavn et al., 2017) Another point of discussion is whether PPD who refuse certain treatments suffer irremediably. Some authors argue that a patient must try all treatments before suffering can be seen as irremediable. (Appelbaum, 2018) Others state that only treatments that are acceptable to the patient should be tried. (Dembo, Schuklenk, & Reggler, 2018) The ongoing debate indicates that, although the topic has been the subject of substantial moral deliberation, consensus has not been reached among commentators. This lack of consensus is summed up appropriately in 2016 by the ‘Special Joint Committee on physician assisted dying’ of the Canadian Psychiatric Association (CPA): “there is no established standard of care in Canada, or as far as CPA is aware of in the world, for defining the threshold when typical psychiatric conditions should be considered irremediable.” (Gaind, 2020) Apart from the conceptual debate, a few empirical studies suggest that the topic of IPS also poses a challenge in clinical practice in jurisdictions where PAD is possible for psychiatric suffering. The earlier mentioned study by Kim et al. from 2016, analyzing 66 case summaries of Dutch PPD who received PAD between 2011 and 2014, showed that in 20% of these cases psychiatrists disagreed about irremediability of suffering. Furthermore, 56% of patients had refused some sort of treatment, raising questions whether suffering can be seen as irremediable when there are still treatments available. (Kim et al., 2016) Also in 2016, a survey among 248 Dutch psychiatrists, showed that 56% of psychiatrists thought it possible to establish irremediability. This implies that 44% of psychiatrists doubted the possibility or thought establishing irremediability impossible, which indicates a notable dissensus among experts. (Onwuteaka-Philipsen et al., 2017) Finally, a 2016 qualitative interview study among 10 Dutch psychiatrists, identifies irremediability as a central challenge in the context of PAD for PPD. (Pronk, Evenblij, Willems, & van de Vathorst, 2019) OBJECTIVE The aim of this dissertation is to reach a better understanding of the relevance and challenges of establishing irremediability in the context of PAD for PPD. To do this we will take three steps. First, we will investigate whether irremediability is indeed an 20 | CHAPTER 1 1
RkJQdWJsaXNoZXIy MjY0ODMw