TABLE 1. Overview of included articles. Subdivided into conceptual studies, legal studies, guidelines and empirical studies. Year Source Article type Main argument regarding irremediability Conceptual studies 1998 Schoevers et al. Physician-Assisted Suicide in Psychiatry: Developments in the Netherlands. Psych serv 1998;49(11):1475-1480. Essay Predictions of outcome for individual patients are not very reliable and more complicated than in somatic medicine, therefore we should not allow physician assisted death (PAD) for psychiatric patients. 1998 Berghmans R. Commentary on “Suicide, euthanasia, and the psychiatrist”. Philos Psychiatry, Psychol. 1998;5(2):131-135. Commentary Describes the view of the Dutch Supreme Court that a patient’s situation cannot be considered hopeless if he or she freely refuses a meaningful treatment option. 1998 Burnside JW. Commentary on “Suicide, Euthanasia, and the Psychiatrist.” Philos Psychiatry, Psychol. 1998;5(2). Commentary The uncertainty that stems from the nature of psychiatric illness and the long survival both complicate PAD of PPD compared to PAD for somatic disease. 2000 Kissane et al. Demoralisation, depression and desire for death : problems with the Dutch guidelines for euthanasia of the mentally ill. Aust N Z J Psychiatry. 2000;34:325-333. Essay 1) The demoralization syndrome can be seen as a separate clinical entity from depression. 2) Counter transferal feelings of hopelessness should be accounted for when considering PAD for IPS. 3) Prognostic uncertainty is substantial in psychiatry; therefore PAD should be banned. 2002 Kelly et al. Euthanasia, assisted suicide and psychiatry: A Pandora’s box. Br J Psychiatry. 2002;181(OCT.):278-279. Editorial With the exception of severe neurodegenerative diseases it is essentially impossible to describe any mental illness as incurable because it is extremely difficulty to predict what disease progression will be. 2006 Naudts et al. Euthanasia : the role of the psychiatrist. Br J Psychiatry. 2006;(188):405-409. Essay 1) The DSM is a scientifically weak basis on which to base an important decision as PAD. 2) The prognosis of IPS is too uncertain; therefore PAD should not be available for psychiatric patients. 2007 Appel JM. A Suicide Right for the Mentally Ill. Hastings Cent Rep. 2007;37(3):21-23. Commentary The window of opportunity for discovering effective treatment is longer in psychiatry than in somatic medicine, but the patient should be able to decide if he or she wants to wait for this. 2010 Lopez et al. Medical Futility and Psychiatry : Palliative Care and Hospice Care as a Last Resort in the Treatment of Refractory Anorexia Nervosa. Int J Eat Disord. 2010;43(4):372-377. Case study Treatment of anorexia nervosa can become futile, therefore a palliative approach may be warranted. 2011 Vandenberghe J. De ‘ goede dood ’ in de Vlaamse psychiatrie. Tijdschr Psychiatr. 2011;53:551-553. Commentary Discusses the complexities of giving up hope and of labelling suffering due to a personality disorder as irremediable. 2013 Brown et al. Withdrawal of nonfutile life support after attempted suicide. Am J Bioeth. 2013; 13(3):3-12. Case report Treatment refractoriness is an empirical observation where the prognosis must be known and poor. If the prognosis is uncertain (assisted) suicide is not rational. 2013 Cowley C. Euthanasia in psychiatry can never be justified. A reply to Wijsbek. Theor Med Bioeth. 2013;34(3):227238. Commentary 1) Because of the uncertain prognosis of depression, we should err on the side of keeping patients alive. 2) If patients truly want to die (unassisted) suicide is an option that better safeguards autonomy. 62 | PART II - CHAPTER 4 4