individual patients who wish their suffering to be ended. (Berghmans, Widdershoven, & Widdershoven-Heerding, 2013) Participants mention differences in professional opinion when establishing IPS. An earlier casefile study of PPDs who died through PAD showed that there was disagreement between physicians about IPS in 11% of cases. (van Veen, Weerheim, Mostert, & van Delden, 2018) Although the number of cases in this earlier study is relatively low, differences in professional opinion do raise questions about the clarity of the concept of IPS and the potential for a high degree of subjectivity in its use in clinical settings. More clarity and higher levels of unicity, would be of great value to clinical practice in Canada and the rest of the world, and can be achieved by examining whether psychiatrists with relevant experience can agree upon clinical criteria for IPS in the context of PAD, for instance by using the Delphi-methodology. When establishing IPS, participants face different challenges regarding diagnosis. The participants mentioned that most patients who request PAD are diagnosed with more than one psychiatric disorder. This finding is in line with earlier studies reporting that 71-79% of psychiatric patients that died through PAD in the Netherlands were classified with more than one psychiatric disorder. (Kammeraat & Kölling, 2020; Kim, de Vries, & Peteet, 2016; van Veen et al., 2018) This raises questions about whether all distinct treatment protocols for each disorder must be followed completely before IPS can be established. Also, it raises questions about the current Dutch guideline which states that an independent psychiatrist ‘with specific expertise about the patient’s disorder’ should be consulted. In practice, it may prove difficult to identify which expert is best suited, and therefore, as one participant mentioned, an independent assessment by a psychiatrist with a more generalized view might be more suitable. For a low-populated country such as Canada, it may be better to adjust the Dutch requirement, because it may sometimes be a challenge to find an independent psychiatrist within reasonable travel distance, let alone a psychiatrist with specific expertise. The participants also describe challenges regarding treatment when establishing IPS in the context of PAD. They mention that it can be difficult to evaluate the quality of earlier treatments. They also struggle to find a reasonable limit to demanding more interventions that try to diminish suffering by altering the patient’s perception of the complaints, which is a confirmation of earlier conceptual work in this topic that identified this as a specific challenge for psychiatry. (Blikshavn, Husum, & Magelssen, 2017) Also, participants recognize a form of ‘treatment fatigue’ among PPD requesting PAD, due to their often long treatment history. The term ‘treatment fatigue’ has been researched in the context of HIV and type 1 diabetes, but it has not yet received attention in psychiatry. (Heckman, Mathew, & Carpenter, 2015) Clinicians can already A QUALITATIVE STUDY ON IRREMEDIABILITY | 87 5