Irremediable psychiatric suffering and euthanasia requests: A potential indication for psilocybin treatment
Theoretical background and rationale:Patients with severe and persistent mental illness may experience irremediable and unbearable psychiatric suffering to the extent that they consider euthanasia, legally permitted in the Netherlands under strict due-care criteria. Requests have increased to around 800 annually at the Euthanasia Expertise Center, while clinicians often face therapeutic, prognostic, and moral uncertainty. Palliative psychiatric care has been proposed, but practical frameworks remain limited. In parallel, renewed research into psychedelic therapies shows rapid and sometimes sustained effects across disorders. Psilocybin is the best investigated, with the strongest evidence base in difficult-to-treat depression, making it the primary candidate for this population.
Research question and hypothesis: Should psychedelic therapy be systematically investigated for patients with irremediable psychiatric suffering who request euthanasia? We hypothesize that psilocybin treatment may reduce suffering or alter the relationship to suffering in a subset of patients.
Methods and analysis:A scoping review of conceptual, clinical, ethical, and legal perspectives from a recent whitepaper, integrated with current literature updates and preliminary insights from an ongoing interview study among patients requesting euthanasia (PIPE-study).
Main findings:Despite many available psychiatric treatments, irremediable and unbearable suffering remains a harsh reality. The substantial number of Dutch euthanasia requests indicates an unmet need, while some patients show openness to psychedelic therapy as an investigational last-resort option.
Conclusion:We argue that psilocybin should be investigated for patients with irremediable psychiatric suffering seeking euthanasia, starting with difficult-to-treat depression, as potential benefits and the absence of new therapies justify experimental access for this population.
