Philipsen et al., 2017) The experiences of psychiatrists who have handled PAD requests can be seen as an important source of knowledge about the challenges of establishing IPS in practice. The aim of this study is to learn how experienced psychiatrists define psychiatric suffering as irremediable in the context of a PAD request, and what challenges they face while establishing IPS. METHODS This is an in-depth interview study with eleven Dutch psychiatrists who have experience in assessing IPS in the context of a PAD request. Participant selection The participating psychiatrists were contacted through e-mail after being purposefully sampled from the authors’ extended professional networks with the help of a Dutch foundation of young psychiatrists ( Psychiatrists who performed an independent consultation during a PAD-procedure and psychiatrists who performed PAD themselves were included. Both proponents, opponents and psychiatrists with moderate views on PAD for PPD were purposively included. The participants’ stance on PAD for PPD was confirmed during the selection procedure. Data collection A topic list was assembled based on the clinical and ethical experience of the authors (supplement 1). Additional items were identified through a thematic analysis of the literature, that was performed for a simultaneously ongoing systematic review of relevant literature. (van Veen et al., 2020) The topic list was piloted on two senior psychiatry residents, which did not lead to substantial changes. After interview five, based on interim-analysis and discussion amongst the authors, the topic list was slightly revised. In the new topic list, the focus was shifted from the precise Dutch legal requirements to themes that emerged in the interviews, including: hope, powerlessness, doubt and treatment motivation. After interview 7, minor adjustments were made. Some topics were rephrased and the order of topics was changed to better match the clinical decision-making process of the participants. Participants were interviewed at their place of work or at a place of their choice. During the interviews, only the participant and interviewer (SvV) were present. Field notes were made. All interviews were conducted in Dutch, audio-recorded and subsequently transcribed. The relevant quotes were translated to English by a native English speaker. The authors of this study have different stances on PAD for PPD, ranging from moderate opposition to conditional support. 80 | PART II - CHAPTER 5 5