assessing the literature and the abovementioned studies is used as basis for a qualitative interview study among psychiatrists who have experience with patients requesting PAD (chapter 5). In the context of PAD for PPD their views are highly relevant because they belong to a small group that have practical experience with establishing IPS and the challenges that arise when actually having to do this. Qualitative research often uses interviews or focus-groups to contribute new knowledge and new perspectives in health care. In general, qualitative studies are suitable to explore complex phenomena encountered by clinicians. (Tong, Sainsbury, & Craig, 2007) From an empirical ethics perspective, qualitative research enables us to elucidate the experience of psychiatrists and compare these with theoretical literature. Finally, in part three of this dissertation, we will perform a Delphi-study to provide guidance for policy and practice (chapter 6). The main goal of Delphi-studies is “the formation of consensus or exploration of a field beyond existing knowledge and the current conceptual world”. (Jünger, Payne, Brine, Radbruch, & Brearley, 2017) In health care research specifically this method is suitable for developing consensual guidance on best practice, in this case on what clinical criteria are suitable when establishing IPS in the context of PAD. From an empirical ethics perspective, Delphi studies provide a means to foster consensus between practitioners on morally sensitive issues, by exchanging views and arguments. The analysis of arguments between various rounds can be regarded as a hermeneutic endeavor, in which the researchers contribute to the consensus formation process by identifying crucial issues and proposing options for reflection. OUTLINE In accordance with the aim, this dissertation consists of three parts. First, we will establish irremediability as a clinically relevant concept in the context of PAD for PPD. Secondly, we will identify the most important challenges that arise when establishing IPS in the context of PAD. And finally, we will draft criteria for IPS that can guide clinical decision making. Part 1: Establishing the relevance of irremediability in the context of PAD for PPD Chapter 2 describes an ethical case report of a man requesting PAD on the basis of psychosis, but who recovers after a new diagnosis and treatment. We use this case to critically reflect on the complexity of IPS in the context of PAD and give suggestions for future research. In chapter 3 we describe a study of 35 casefile-summaries of patients with a psychiatric disorder that died through PAD between 2015-2017. We looked at the clinical characteristics and reviewed the due diligence procedure, confirming that establishing irremediability is a challenge in these cases. 22 | CHAPTER 1 1