Table 3:

Participants quotes about challenges in establishing irremediable psychiatric suffering

1“Most people who request MAiD on psychiatric grounds do not suffer from 1 disorder. … [Take] a patient who complains most about depression, but she is also an adolescent, she is traumatized … she has psychosomatic complaints and there are systemic problems due to a symbiotic relationship between mother and daughter. … What expert is best equipped to independently assess this patient [and come to a conclusion about irremediable psychiatric suffering]? … I think that it is better to have a more generalized perspective in this case, than focus on 1 specific disorder.” (P10)
2“Recently [I saw] a woman with a very serious social phobia, who was completely stuck in her life … [after additional diagnosis] she turned out to be autistic. … But then I immediately think, this [new diagnosis] is just a conclusion from a number of questionnaires or interviews. So, I am not exactly sure what the value is of such a new diagnosis.” (P1)
3“You look at goals that have been set; have they been achieved? Was there enough commitment? Was the patient motivated? You will also try to understand the content of the therapy and ask the patient about this as well.” (P9)
4“For example, when assessing someone with a mood disorder, I want to read in the correspondence or hear from the patient that the usual steps in the guidelines have been followed.” (P8)
5“Those kinds of therapies give a different dimension to the patient’s experience. [We have to try to help patients to accept] that everything will not go back to the old level of the past, when they were not yet ill and everything was still possible, and start a new phase of life with limitations.” (P9)
6“In psychiatry, it is almost never the case that there are no treatment options at all, you can also give recovery-based care, or supportive care, or long-term clinical care with daytime activities. I mean, there is always some form of care possible. Because people usually do not die from it.” (P10)
7“It is almost never possible to predict anything in psychiatry. … And at the same time, I also think it is a bit cowardly to keep saying that [there are always treatment options], because that gets you nowhere. … I think ultimately you don’t help people with this point of view.” (P7)
8“He was just tired, he was fed up with it, he thought [starting a new treatment] made no sense at all.” (P1)
9“Our evidence-based guidelines [are based on people who wanted to be treated], it has never been shown that a treatment can be effective if someone does not want it at all. Regardless of whether it is practically feasible. So, I think there is a great tension there that our profession has no answer to.” (P4)
10“I think that someone’s motivation can be influenced when MAiD turns out to be a real possibility if it all doesn’t work. And if you, as a patient, dare to trust that this possibility [MAID] is there at the end of the tunnel, then you may continue that tunnel for a bit longer.” (P10)
11“If there are realistic treatment options that can be tried within a reasonable period of time, and someone refuses, I think it is also reasonable that the [MAiD] procedure should stop.” (P4)
12“I think it is a matter of balancing. What treatment options are there? And what should someone do for that? And does that then outweigh any expected effect? And after how long can you expect that? And you also take into account someone’s treatment history; is someone still susceptible to change?” (P1)
  • Note: MAiD = medical assistance in dying.