2017-24). This case is described in further detail below. In 19 of the 35 online published cases (54%), involvement of the End-of-Life Clinic was described. Highlighted reports Case 2016-5: a woman with a personality disorder and therapy resistant depressive symptoms A woman, between 60-70 years old, diagnosed with bipolar II and unspecified personality disorder, suffered from recurrent depressive episodes for fifteen years. On several occasions during this period, she attempted suicide. Treatment had not improved her mood and functioning. When she requested euthanasia, her attending psychiatrist and general practitioner would not support this request after which the patient consulted the EOL-clinic. A psychiatrist of the EOL-clinic took her request under consideration and consulted another independent psychiatrist who concluded that the patient was competent in her request and that all meaningful treatment options had been exhausted. Finally, a SCEN-doctor concluded that the due care requirements had been met, after which euthanasia was performed. The RTE judged the process as diligent. Case 2017-24: failure to adequately consult an independent psychiatrist Between 2015 and 2017, one case did not meet the due diligence requirements according to the RTE. It concerns a man, between 40-50 years old, with a long-term treatment history of various psychiatric disorders. His final diagnosis was a schizoid personality disorder. Seven months before euthanasia took place, an independent specialized psychiatrist was consulted to assess whether autism was a more suitable diagnosis, which was not the case in the expert’s opinion. Six months before euthanasia, a new psychiatrist took over treatment. The patient requested euthanasia but the psychiatrist would not support this request. At this point, the patient consulted the EOL-clinic and the case was assigned to one of their general practitioners, who consulted a SCEN-doctor who was not a psychiatrist. In summary, three psychiatrists, a general practitioner, and a specialized euthanasia consultant were involved during the process leading up to this patient’s euthanasia. Afterwards, the RTE judged that it was made sufficiently clear that the patient suffered unbearably and that there was no prospect of improvement. What made them judge the case as insufficiently diligent was the lack of consultation by a specialized psychiatrist in the context of an PAD request and the absence of an independent mental competency assessment. Case 2016-78: disagreement about the prospect of improvement between consulted psychiatrists The patient was a man between 30 and 40 years old with a schizoaffective disorder and unspecified personality problems, suffering mostly from depressive complaints and 44 | PART I - CHAPTER 3 3