TABLE 1. Participant characteristics Mean age (range) 55 (35-64) Female / Male 7 / 4 Place of work Specialized mental health clinic 5 Academic hospital 2 General hospital 3 Expertise Centre Euthanasia* 1 Experience with PAD Independent expert 10 Performed PAD** 2 Stance on PAD Proponent 2 Moderate view 6 Opponent 3 Religious background Non-believer 4 Christian upbringing, non-practicing 5 Practicing Christian 1 Missing 1 PAD = Physician Assisted Death *The Expertise Centre Euthanasia is an organization that was founded in 2011 and originated from the Dutch interest group promoting a voluntary end of life. The center was specifically founded to help people who could not go to their own doctor for a PAD request. They are also available to give advice to doctors. Between 2011 and 2020 they performed the vast majority of all physician assisted deaths for psychiatric suffering. **One participant both performed PAD and functioned as an independent expert (in separate procedures). Definition of IPS Irremediability, in general, is a prospective concept because the physician has to make a judgement about the future course of a disease. Establishing irremediability is therefore seen as synonymous to establishing a poor prognosis (Table 2, quote 1). Various participants argue that making meaningful prognostic claims about psychiatric suffering is challenging and some fear that it is impossible. In part, because the psychiatrist has to make a claim about a patient who potentially has decades to live (Table 2, quote 2). Given the limits of prospectively establishing IPS, the participants emphasize retrospective dimensions. In particular, participants state that IPS is dependent on the treatment history and underline that substantial attempts to reduce suffering should have been tried and failed (Table 2, quote 3). Most participants view psychiatric suffering and treatment as complex concepts; therefore, uncertainty is seen as unavoidable. Comparing psychiatric suffering to somatic suffering, participants mention that establishing irremediability for the latter is more certain due to the clear biological substrate of the disease and also 82 | PART II - CHAPTER 5 5