Conference Agenda

Introduction

In the Netherlands, a growing number of people request medical assistance in dying (MAID) on grounds of psychological suffering, of which approximately 10% are granted. Although suicidality is common among individuals with severe and/or persistent psychiatric disorders, little is known about its nature and trajectory among those who seek MAID for psychological reasons. This study describes the history and current presence of suicidality in MAID applicants, as well as their perceived help needs.

Methods

Applicants to Expertisecentrum Euthanasie (EE), the sole healthcare institution in the Netherlands specialized in MAID, are invited to complete a questionnaire within one week of registration. The questionnaire assesses current and past suicidality, treatment history, perceived support, and barriers to seeking help.

Preliminary Results

A total of 148 applicants participated (64.2% female; mean age = 39.2 years, range = 17-78. All reported a history of suicidality, and 82.4% had made at least one suicide attempt. At registration, 16.2% were receiving treatment specifically for suicidality. Over a quarter (27.0%) reported unmet support needs, particularly for open, non-judgmental conversations with their clinician. Barriers to seeking help included negative past experiences, lack of energy to start new treatment, and fear of involuntary admission.

Conclusions

Suicidality appears to be widespread and often long-lasting among people requesting MAID on psychiatric grounds. Many report unmet support needs, as well as negative experiences with previous help-seeking that hinder further engagement with care. These findings highlight opportunities to strengthen suicide prevention and better align care with these patients’ needs, while also being sensitive to their prior experiences in mental healthcare.

Please note: We are also submitting in conjunction with oral abstracts by Dr. Lizanne Schweren and Dr. Thomas Niederkrotenthaler. If all proposals are accepted, it is our hope that we can organize them as a session on MAID and suicide prevention.

Background
In the Netherlands, individuals may legally request Medical Assistance in Dying (MAID) on the basis of psychiatric suffering, a practice that remains ethically and clinically controversial. MAID requests often, but not always, co-occur with suicidality. Although related, these phenomena may differ in intent, temporal dynamics, and clinical management. Little is known about individuals who express a wish for MAID and subsequently die by suicide, nor about how bereaved relatives understand the role of such wishes within trajectories of suicidality and care.

Objective
This study aims to (1) examine sociodemographic, clinical, and care-related characteristics of individuals who expressed a wish for MAID prior to suicide, and (2) explore how bereaved relatives describe the significance of this wish in the development of suicidality and the care process.

Methods
Data were drawn from an ongoing national mixed-methods psychosocial autopsy study in the Netherlands (2023–present). For the quantitative component, questionnaire data from bereaved relatives were analyzed and compared between individuals who had expressed a wish for MAID (n=176) and those who had not (n=361), using logistic regression analyses.

For the qualitative component, 22 interviews in which a MAID wish was discussed were selected from a larger interview sample and analyzed using Interpretative Phenomenological Analysis until theoretical saturation.

Results
Analyses are ongoing. Preliminary expectations are that individuals who expressed a wish for MAID differ in psychiatric history, chronicity of symptoms, and engagement with mental healthcare. Relatives are expected to describe diverse ways in which MAID wishes interacted with suicidality and care trajectories.

Conclusion
This study will provide empirical insight into the relationship between MAID wishes and suicidality and may inform clinical guidance on discussing death wishes in mental healthcare.

This abstract is submitted alongside related oral abstracts by Dr. Schweren, Dr. Crawford and Dr. Niederkrotenthaler, with the aim of forming a session on MAID and suicide prevention.

At 9-8-8: Suicide Crisis Helpline, Canada’s national suicide prevention service, approximately one percent of callers and texters are initiating conversations about MAID. In Canada, MAID is available to consenting adults who meet specific eligibility criteria. Since 2021, adults with non-terminal illnesses have had to access MAID, and further expansion to include people living with mental disorders as their sole underlying medical condition (MD-SUMC) is scheduled for March 2027. Currently, there is a dearth of evidence-based practice standards for how suicide prevention services ought to support service users inquiring about MAID. To address this gap we are completing a scoping review of related academic literature, and a review of news media that addresses both MAID and suicide. We ask two interrelated questions: 1) What is the conceptual relationship between MAID for non-terminal disorders and suicide/suicidality? 2) How is the relationship between suicide/suicidality and MAID represented to the Canadian public through news media? Using the PRISMA extension for scoping reviews, we have identified 50 studies that address both MAID and suicide, from 2012 to 2025. Through our media analysis we have identified 803 media articles in the Canadian media that report on both MAID and suicide within the article, from 2014 to 2025. We will present results from both arms of this environmental scan and discuss the similarities and differences between how suicidality and MAID, and any overlap between them, are described in the scientific literature and how this tenuous relationship is presented to the public. The media analysis will also consider included articles alongside media guidelines for safe reporting on suicide. The presentation will end with evidence-based guidance gleaned from the scoping review and recommendations for how news media can improve reporting about suicidality and MAID.

Introduction: Assisted suicide (AS) was legalized in Austria in 2022. The topic has been discussed controversially in the Austrian public, which has been reflected in the media reporting. Information about the content of media reports on AS is currently lacking. The aim of this study was to analyze newspaper media items on AS from Austrian daily newspapers based on media guidelines for the reporting on suicide and to adapt them in the process to the specific topic of AS.

Methods: Media items from 11 Austrian newspapers from the time period 2017 to 2022 were retrieved based on 12 predefined keywords. A total of n = 906 articles were analyzed with regard to 12 characteristics advised against in media guidelines and 7 recommended characteristics. We compared the quality of media items between three time periods: period 1 (before the initiation of legislation change regarding AS in Austria, 01/2017–12/2019), period 2 (around the decision of legalization of AS, 01/2020–12/2021), and period 3 (after the implementation of AS in Austria, 01/2022–12/2022).

Results: Several characteristics advised against in suicide reporting guidelines (e.g., romanticization/glorification) were frequent across all periods, while recommended characteristics (e.g., references to mental health services) were less common. Comparison across time showed that stigmatization and romanticization declined after AS was implemented, whereas reporting on (potential) epidemics of AS peaked before its implementation.

Discussion: This content analysis revealed distinct patterns in media reporting on AS and showed that reports were less aligned with media guidelines than previous analyses on non-assisted suicide. This research highlights the importance of specific aspects of media guidelines in the context of AS.

Please note: We are submitting in conjunction with oral abstracts by Drs. Schweren and Crawford. If all proposals are accepted, we hope to organize them as a session on MAID and suicide prevention.