frequently requesting euthanasia. Three psychiatrists were involved in the euthanasia procedure. First, the patient asked his attending psychiatrist, who consulted a second psychiatrist. A third independent psychiatrist was consulted, who advised additional medicinal and psychotherapeutic treatment. The second psychiatrist, in concurrence with the attending psychiatrist, chose to disregard this advice, arguing that these were not reasonable options due to patient’s lack of motivation for further treatment, and performed euthanasia. According to the RTE, the performing psychiatrist had sufficient reasons for why he or she saw no benefit in the proposed treatment options and the process was judged as diligent. DISCUSSION Similar patients with increased access Compared to the research by Kim et al. (2016), our study shows that the percentage of female patients is fairly consistent (70% between 2011 and 2014 versus 77% between 2015 and 2017). The age distribution is also similar and the majority of patients were above 50 years old (76% vs. 74%). Depression was found in both studies to be a relatively common disorder within patients that die by PAD (55% vs. 46%). Patients suffering from (comorbid) personality disorders also continue to represent a large group within this population (52% vs. 53%). Although the changed publication policy by the RTE makes comparison between these numbers difficult, our findings suggest that more people, of similar age and with similar problems have access to PAD. We found no trend towards PAD among younger or ‘different’ psychiatric patients, which is often feared when using the slippery slope argument. Further research is needed to be able to elaborate on this finding, for instance by including severity scores such as a GAF-index. Differentiation between psychiatric and somatic cases The labeling of reports as psychiatric by the RTE shows that it can be challenging to differentiate between somatic and psychiatric grounds for PAD. Several reports, where in our opinion the suffering was mainly caused by somatic disease, were labeled under ‘psychiatric cases’. This included psychiatric patients with severe somatic morbidity or patients with serious somatic illness and secondary psychiatric complaints such as depression or anxiety. The guideline by the Dutch Psychiatric association on PAD does mention the following on somatically ill patients with psychiatric comorbidity: “If the psychiatric disorder is an important reason why the patient chooses death, the psychiatrist should in principle follow the same procedure as in [psychiatric] cases where there is no somatic-psychiatric comorbidity”. (Tholen et al., 2009) The complex EUTHANASIA OF DUTCH PATIENTS WITH PSYCHIATRIC DISORDERS BETWEEN 2015 AND 2017 | 45 3