INTRODUCTION Physician assisted death (PAD), also known as medical assistance in dying, has been legalized in an increasing number of jurisdictions around the world. (van Veen, Ruissen, & Widdershoven, 2020) In 2023, Canada will join a small group of countries that allow PAD for persons with a psychiatric disorder (PPD). In the Netherlands, PAD for irremediable psychiatric suffering (IPS) has been approved by jurisprudence since the 1990s and it became regulated by law since 2002. The last decade has seen a marked increase in cases. In 2020, PAD was performed 88 times for psychiatric suffering (1.3% of all PAD cases). (RTE year raport, 2020) The number of requests by patients with a psychiatric disorder is much higher, but 90% do not end in PAD. Sometimes requests are retracted by patients, but most are denied by psychiatrists. (Kammeraat & Kölling, 2020) The main legal requirements in the Netherlands are that the patient must be able to make a competent request, that the patient’s suffering must be unbearable and irremediable, and that the patient and physician have to agree that there are no other reasonable treatment options. Also, an assessment by an independent physician and, in case of psychiatric suffering, a third assessment by an independent psychiatrist, preferably with specific expertise regarding the patient’s disorder, are required. (RTE: Code of Practice, 2015) While there are concerns about decision-making capacity, the central dilemma of PAD for PPD appears to revolve around applying the concept of irremediability to psychiatric disorders. The 2018 guideline by the Dutch Psychiatry Association defines IPS in the context of PAD as follows: “irremediability means that there is no longer any prospect of alleviating, mitigating, enduring or removing suffering. There is no longer a reasonable treatment perspective.” Elsewhere the guideline states that reasonable treatment perspective means that “there is a prospect of improvement with adequate treatment, within a foreseeable period, and with a reasonable ratio between the expected results and the burden on the treatment for the patient.” (NVvP, 2018) A recent scoping review identified a multitude of conceptual articles addressing irremediability in the context of psychiatric PAD, but few empirical studies. (van Veen et al., 2020) This suggests that the assessment of the irremediability of psychiatric suffering is particularly difficult relative to suffering arising from other types of conditions. Surveys estimate that 46% of Dutch psychiatrists received an explicit PAD request at least once in their career, and 4% actually assisted in the death of a PPD. (OnwuteakaA QUALITATIVE STUDY ON IRREMEDIABILITY | 79 5