Irremediable psychiatric suffering in the context of physician assisted death: a Delphi-study

Abstract

AbstractBackgroundPatients with a psychiatric disorder (PPD) are eligible to request physician assisted death (PAD) in a small but growing number of jurisdictions, including the Netherlands and Belgium. For this request to be granted, most of these jurisdictions demand that the patient is competent in her request, and that the suffering experienced is unbearable and irremediable. Especially the criterion of irremediability is challenging to establish in patients with psychiatric disorders.AimsTo establish what criteria Dutch and Belgian experts agree to be essential in characterising irremediable psychiatric suffering (IPS) in the context of PAD.MethodA two round Delphi procedure among psychiatrists with relevant experience.ResultsThirteen consensus-criteria were established: five diagnostic and eight treatment-related criteria. Diagnostically, the participants deem a narrative description and attention to contextual and systemic elements necessary. Also, a mandatory second opinion is required. The criteria concerning treatment show that extensive biopsychosocial treatment is needed, and the suffering must be present for several years. Finally, in the case of treatment refusal, the participants agree that there are limits to the number of diagnostic procedures or treatments a patient must undergo.ConclusionsConsensus was found among a Dutch and Belgian expert group on essential criteria for establishing IPS in the context of PAD. These criteria can be used in clinical decision making and can inform future procedural demands and research.