TABLE 1. Continued Year Source Article type Main argument regarding irremediability Conceptual studies 2013 Berghmans et al. Physician-assisted suicide in psychiatry and loss of hope. Int J Law Psychiatry. 2013;36(5-6):436443. Case study “Offering PAS to a patient with a mental illness who suffers unbearably, enduringly and without prospect of relief does not necessarily imply taking away hope and can be ethically acceptable.” 2015 Schuklenk et al. Treatment-resistant major depressive disorder and assisted dying. J Med Ethics. 2015;41(8):577583. Essay If patients with TRD competently request PAD they should be granted access. No argument against PAD is strong enough to infringe their right to autonomy. 2015 Broome et al. De. Choosing death in depression : a commentary on ‘Treatment-resistant major depressive disorder and assisted dying .’ J Med Ethics. 2015:1-3. Commentary It is very unlikely that a patient with TRD is both competent to make decisions about ending their own life, and that the same individual has no prospect for relief of their suffering. 2015 Cowley C. Commentary on ‘Treatment-resistant major depressive disorder and assisted dying.’ J Med Ethics. 2015;41(8):585-586. Commentary “We can never be sufficiently certain of the hopelessness, and we should there-fore incline away from such a serious and irreversible decision as assisting suicide.” 2016 Pienaar W. Developing the language of futility in psychiatry with care. S Afr J Psychiatr. 2016;22(1):978. Essay 1) Gives four different and complementary definitions of futility according to Bernstein. 2) Reviews different epidemiological studies that show that treatment resistance in depression, schizophrenia, anxiety and eating disorders does exist. 2016 Kim et al. Should assisted dying for psychiatric disorders be legalized in Canada? Can Med Assoc J. 2016;188(14):337-339. Commen-tary 1) Psychiatric irremediability is inherently vague and unreliable. 2) Accepting treatment refusal ignores the core clinical imperative of helping patients through periods of sustained suffering. 2016 Olié et al. The Controversial Issue of Euthanasia in Patients With Psychiatric Illness. JAMA. 2016;316(6):656657. Essay 1) Determining whether psychiatric suffering is irremediable is complex. 2) treatment of psychological pain is currently undervalued. 2016 Hodel et al. Letter to the editor, in comment on Euthanasia or Assisted Suicide in Patients With Psychiatric Illness. JAMA - J Am Med Assoc. 2016;316(20):2153-2154. Commen-tary 1) When suffering is treatment resistant, care goals should be shifted towards patient oriented palliative care. 2) A disproportionate focus on suicide prevention can lead to a poorer quality of life for the patient. 2017 Blikshavn T et al. Four reasons why assisted dying should not be offered for depression. J. Bioeth inq. 2017;14:151157. Essay 1) Treatment resistant depression (TRD) is not a clinical entity and psychodynamic and social treatments are undervalued in research about TRD. 2) The therapeutic significance of hope must be acknowledged, for giving up hope might be a self-fulfilling prophecy. 2017 Appelbaum. Should Mental Disorders Be a Basis for Physician-Assisted Death. Psych Serv 2017;68(4):315-317. Essay When the suffering of patients who refuse treatment is seen as irremediable, a substantial proportion of people with mental disorders seeking assisted death could probably obtain relief from other available approaches. IRREMEDIABLE PSYCHIATRIC SUFFERING IN THE CONTEXT OF PHYSICIAN ASSISTED DEATH | 63 4