additional search strategies were performed, first, a backwards citation screening on all articles from the database search that were included. Secondly, forward citation tracking in google scholar using the 2016 landmark paper by Kim et al. (Kim, de Vries, & Peteet, 2016) Thirdly, we screened the table of contents of the unindexed special edition on Medical Aid in Dying of the Journal of Ethics in Mental Health on November 20 2019. Fourthly, we manually included Dutch and Belgian reports and guidelines that fall within the inclusion criteria but are not available in any online scientific database. If full texts were unavailable, we contacted the corresponding author for a copy. Source selection We included all conceptual-ethical articles, quantative and qualitative empirical studies, guidelines, case-reports and commentaries if they addressed irremediable suffering due to psychiatric illness to a background of PAD. We excluded: non-English or non-Dutch articles, articles without an available full text, articles that only mention irremediability in passing and articles addressing irremediable suffering due to nonpsychiatric illness. AR and SvV performed title and abstract screening; SvV performed full text evaluation. Data synthesis After full text evaluation, text segments from all included articles addressing irremediability were extracted from the articles and anonymized. All authors separately coded these segments which lead to the identification of recurring themes emerged from the literature. All definitions of irremediability and all the viewpoints that were found most important and representative for the debate on PAD of PPD were included after discussion between all authors. Since most of the sources were conceptual essays, no structural data charting or systematic critical appraisal was indicated. RESULTS The database searches yielded 105 unique records; the additional search strategies yielded 143 records (Figure 1). After full text evaluation 50 articles were included (table 1). Through a qualitative synthesis of the literature, we found three main arguments concerning irremediability in the debate about PAD of PPD: acceptability of uncertainty, influence of hope and role of treatment refusal. 56 | PART II - CHAPTER 4 4