division between soma and psyche does not get much attention in the debate about psychiatric PAD. It is however relevant when different or stricter rules are implemented for ‘psychiatric’ PAD cases, like in the RTE Code of Practice. Ambiguity about this division might lead to insufficient diligence or unjustified restraint in individual PAD cases. Further discussion about what makes a case primarily ‘psychiatric’ could prevent this. PAD and suicide Several findings suggest that patients who commit suicide are different than those that die through PAD. First, we found that two third of the PAD-patients seem to have no history of suicide attempts. Kim et al. found that half of the patients they studied attempted suicide. (Kim et al., 2016) Secondly, these groups also seem to differ epidemiologically. For instance, while Dutch men are two times more likely to die by suicide than women, they are only a minority among Dutch PAD patients where women outnumber men three to one. (CBS, 2017) This finding is important because suicidal patients and patients seeking PAD are often displayed as a similar group. (Boer, 2017) The difference might be explained by the fact that patients who die by suicide cannot request PAD because they are dead. It is also possible that the difference is explained by male-female differences, such as impulsivity. Or it might mean that the argument that PAD prevents ‘inhumane’ suicides is unsubstantiated. Further research should elaborate on this finding. Mental competence Although most of the reports describe patients suffering from severe and complex psychiatric disorders, all of them were found mentally competent to decide about their own death. A possible explanation is that physicians only report and cooperate in cases of euthanasia that meet due care criteria. This could mean that concerns about the vulnerability of psychiatric patients receiving PAD are unsubstantiated. Another explanation is that the assessment lacks due diligence. Further research should focus on how competence is assessed and the process that allows the RTE to pass this as sufficiently diligent. Strengths and weaknesses The strength of the study is that the online RTE-reports are one of few accessible sources to quantitatively study psychiatric PAD in the world. The fact that a substantial number of reports have been published over the years now allows us to study trends by comparing our research to the earlier study by Kim et al. (Kim et al., 2016) The main weakness of this study is the nature of the online RTE-reports. The goals of publishing RTE reports are to educate and to further societal debate. The studied 46 | PART I - CHAPTER 3 3
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