ABSTRACT Background Physician assisted death (PAD) of patients with a psychiatric disorder (PPD) is a global issue of debate. In most jurisdictions that allow PAD, irremediable suffering is a legal requirement, how to apply the concept op irremediability to patients with a psychiatric disorder remains challenging. Aims To identify the main arguments concerning irremediability in the debate about PAD of PPD and give directions for further moral deliberation and empirical research. Methods: Systematic searches in medline, embase and psycinfo were combined with four additional search strategies. All conceptual-ethical articles, quantative and qualitative empirical studies, guidelines, case-reports and commentaries that met the inclusion criteria were included and a qualitative data synthesis was used to identify recurring themes within the literature. The study protocol was preregistered at the Open Science Framework under registration-code: thjg8. Results 50 articles met the inclusion criteria. Three main arguments concerning irremediability were found in the debate about PAD of PPD: uncertainty, hope, and treatment refusal. Conclusions: Uncertainty about irremediability is inevitable, so which level of certainty is morally required should be subject of moral deliberation. Whether PAD induces or resolves hopelessness is an empirical claim that deserves clarification. Treatment refusal in search of PAD raises questions about treatment efficacy in this patient group and about decision-making in the context of the physician-patient relationship. Going forward more attention should be given to epidemiological research and to different challenges posed by different psychiatric disorders. 54 | PART II - CHAPTER 4 4