Data analysis The method of analysis was a modified Grounded Theory approach, following the approach developed by Charmaz (2006). All data were entered into MAXQDA-software, version 2018.2. Coding was performed by SvV and AR. The codes were compared and disagreements were resolved through discussion, and attention was given to similar and divergent cases. Coding followed three consecutive stages. In the initial coding stage, a set of codes was created describing elements psychiatrists incorporated in their decision about IPS and challenges they faced when doing so. During the ‘focused coding’ stage, the codes were organized into potential themes, and overlap between categories was minimized. The themes were reviewed by the authors and used for revision of the topic list as described above. In the theoretical coding phase, the relationships among, and patterns between, the various themes were examined, after which the over-arching themes were refined and the final categories formulated. After 11 interviews, it was decided that theoretical saturation was reached because no new themes emerged from the last four interviews with participants from various backgrounds. Ethical approval and informed consent This study was approved by the medical ethics committee of the VU Medical Centre Amsterdam (2018.661). Participants received an information letter via mail and written informed consent was obtained. Quality criteria For reporting, the Consolidated criteria for reporting qualitative research (COREQ) were followed. The study-protocol was preregistered, during data-analysis, at the Open Science Framework under RESULTS Eleven psychiatrists were included in the study, their characteristics are described in Table 1. Initially 17 psychiatrists were invited; five did not have the required experience with PAD and one did not respond. The clinical areas of expertise of the 11 psychiatrists included: anxiety disorders, autism spectrum disorders, bipolar disorders, depressive disorders, minor mental disability, obsessive-compulsive disorders, personality disorders, psychotic disorders, and somatic symptom disorders. The sample contained both proponents, opponents and psychiatrists with moderate views on PAD. The participants lived and worked in different regions in the Netherlands. The mean interview duration was 62 minutes (range 48-77 minutes). The analysis focused on two main questions: the definition of IPS and the challenges psychiatrists face when establishing irremediability. A QUALITATIVE STUDY ON IRREMEDIABILITY | 81 5