To investigate the experience of psychiatrists who completed assessment procedures of euthanasia requests from adults with psychiatric conditions (APC) over the last 12 months. Between November 2018 and April 2019 a cross-sectional survey was sent to a sample of 753 psychiatrists affiliated with Belgian organisations of psychiatrists to gather detailed information on their latest experience with a completed euthanasia assessment procedure, irrespective of its outcome (i.e. euthanasia being performed or not). Information on 46 unique cases revealed that most APC suffered from comorbid psychiatric and/or somatic disorders, and had received different kinds of treatment for many years prior to their euthanasia request. Existential suffering was the main reason for the request. The entire procedure spanned an average of 14 months, and an average of 13.5 months in the 23 cases that culminated in the performance of euthanasia. In all cases, the entire procedure entailed multidisciplinary consultations, including with family and friends. Psychiatrists reported fewer difficulties in assessing due care criteria related to the APC’s self-contemplation – for example, unbearable suffering on top of the due care criteria related to their medical condition; incurability due to lack of reasonable treatment perspectives. In a few cases in which euthanasia was the outcome, not all legal criteria were fulfilled in the reporting physicians’ opinions. Both positive and negative experiences of the assessment procedure were reported: for example, reduced suicide risk for the APC; an emotional burden and a feeling of being pressured for the psychiatrist. This study confirms that euthanasia assessment in APC entails a lengthy process with diverse complexities, and psychiatrists require support in more than one respect if the assessments are to be handled adequately. Thorough evaluation of current guidelines is recommended: that is, to what extent the guidelines sufficiently address the complexities around (e.g.) assessing legal criteria or involving relatives. We formulate various avenues for further research to build on this study’s insights and to fill remaining knowledge gaps.

旨在调查过去 12 个月内完成患有精神疾病的成年人 (APC) 的安乐死请求评估程序的精神科医生的经验。2018 年 11 月至 2019 年 4 月期间，对隶属于比利时精神病学家组织的 753 名精神病学家进行了一项横断面调查，以收集有关他们完成安乐死评估程序的最新经验的详细信息，无论其结果如何（即正在执行安乐死或不是）。46 个独特病例的信息显示，大多数 APC 患有共病精神和/或躯体疾病，并且在要求安乐死之前多年接受了不同类型的治疗。存在的痛苦是提出这一请求的主要原因。整个过程平均持续14个月，23例最终实施安乐死的平均时间为13.5个月。在所有情况下，整个程序都需要进行多学科咨询，包括与家人和朋友的咨询。精神科医生报告称，在评估与 APC 自我反思相关的应有护理标准时遇到的困难较少，例如，除了与其医疗状况相关的应有护理标准外，还存在难以忍受的痛苦；由于缺乏合理的治疗观点而无法治愈。在少数以安乐死为结果的案例中，报告医生的意见并未满足所有法律标准。报告了评估程序的积极和消极经验：例如，APC 的自杀风险降低；精神科医生的情感负担和压力感。这项研究证实，APC 中的安乐死评估需要一个漫长且复杂的过程，如果要充分处理评估，精神科医生需要不止一个方面的支持。建议对现行指南进行彻底评估：即指南在多大程度上充分解决了（例如）评估法律标准或涉及亲属的复杂性。我们制定了进一步研究的各种途径，以本研究的见解为基础，并填补剩余的知识空白。