Table 4.

Health care workers’ ethical considerations toward euthanasia in the context of adult psychiatry

	Ethical values voiced in favour of euthanasia	Ethical values voiced in critical considerations
The patient	Justice - Equality of (end-of-life) care options	Justice - Differences in patient profile, e.g., mental competence and the factor of impulsivity, ambiguity, and manipulation
The field of psychiatry	Justice - The indissociable unity of psyche and soma) 1	Justice - The inexistence of irremediableness in psychiatry1 - More caution is needed due to the higher level of ‘subjectivity’
	Responsiveness to Suffering - to the unbearableness of ‘invisible’ mental suffering - to the non-alleviability of suffering	Responsiveness to Suffering - More time is needed for the therapeutic effect of ‘hope’ to become effective - Differences in the nature and course of somatic versus psychiatric illnesses
	Protection - Against brutal suicide - Against ‘therapeutic tenacity’ that often occurs in psychiatry	Protection - Preventing suicide conflicts with allowing euthanasia - Against ‘therapeutic negligence’
		Proportionality - 24/7 crisis shelter and the therapeutic effect of (yet illegal) drugs should be tried first
The society	Justice - The law busts some myths on psychiatric illnesses as ‘Western phenomenon’2 - The law busts some myths on the malleability of life and medical omnipotence: society must accept an exit-plan	(distributive) Justice - Systemic inequities in mental health care (cf. somatic health care) should be tackled: more budget and resources for accessible and tailor-made mental health care. - Gender disparities
		Participation - ‘Social death’: the vicious circle of stigma and self-stigma leading to social exclusion

1 Only reported by (some) physicians

2 Only reported by (some) non-physicians