INTRODUCTION Physician assisted death (PAD) is allowed in a growing number of jurisdictions, which include the Netherlands, Belgium, Luxemburg, Switzerland, Canada, Colombia, Japan, the United States and Australia. (Verhofstadt, Thienpont, & Peters, 2017) Other countries are debating legalization of PAD. Many jurisdictions explicitly ban patients with psychiatric disorders (PPD) from accessing PAD, but this is not the case in the Netherlands, Belgium, Luxemburg and Switzerland. (Shaffer, Cook, & Connolly, 2016) In Belgium and the Netherlands the prevalence of PAD due to psychiatric suffering has increased over the past years. (Dierickx, Deliens, Cohen, & Chambaere, 2016; RTE, 2018) In the Netherlands, 1.1% of all cases of PAD in 2018 was due to psychiatric suffering (67 psychiatric cases in total). (RTE, 2018) Most jurisdictions require that the patient is in an irremediable condition. This is one of the elements that make PAD of PPD more controversial than PAD of other patients. When can we say that a psychiatric disorder is irremediable? What arguments play a role regarding this core criterion for PAD? In this scoping review we systematically investigate the main arguments concerning irremediability in the debate about PAD of PPD. We will identify three core issues, namely arguments concerning uncertainty of diagnosis and prognosis, arguments concerning hope, and arguments concerning treatment refusal. We will show that the debate on these issues is not conclusive, and that there is a need for empirical research on the one hand, and normative deliberation on the other hand. METHODS While performing this systematic review the PRISMA-Scr guidelines were followed. (Tricco et al., 2018) The project was preregistered on the Open Science Framework on February 1 2019 and can be accessed there. Ethical approval or participant informed consent was not required for this study. Search A systematic search was performed in pubmed, medline and psycinfo on November 20 2019. We based our search on the PALETTE-guidelines. (Zwakman, Verberne, Kars, Hooft, & Delden, 2018) The search strategy combined three components and their synonyms: psychiatry, irremediability and physician assisted death. A list of search terms and the syntax for pubmed can be found in appendices 1 and 2. No language or publication year filters were used. After completing the database search, four IRREMEDIABLE PSYCHIATRIC SUFFERING IN THE CONTEXT OF PHYSICIAN ASSISTED DEATH | 55 4
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