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Request for euthanasia by a psychiatric patient with undetected intellectual disability
  1. Olga Schmahl,
  2. Richard Oude Voshaar,
  3. Aïda van de Poel-Mustafayeva and
  4. Radboud Marijnissen
  1. University Center for Psychiatry, University Medical Centre Groningen, Groningen, The Netherlands
  1. Correspondence to Ms Olga Schmahl; o.c.schmahl{at}


In the Netherlands, euthanasia or assisted suicide (EAS) in psychiatric disorders is legal in certain circumstances. Guidelines recommend a second opinion to independently check diagnosis and treatment resistance. A 68-year-old patient, diagnosed with bipolar I disorder, with a request for euthanasia because of tiredness, repeated falls and racing thoughts was seen for such a second opinion. Persisting in her wish, her reluctant family and psychiatrist became convinced of euthanasia. Our disagreement with the diagnosis of bipolar I disorder upset her, but she agreed with discontinuation of psychotropic drugs. Her mobility and tiredness improved, whereafter her request for euthanasia evolved into a death wish due to completed life. Intellectual disability and an attention deficit hyperactivity disorder could explain her struggle in life. This case report shows that extending the procedure regarding EAS with an independent psychiatric evaluation is important. For our patient, this second opinion supported her to find meaning in life.

  • end of life decisions (geriatric medicine)
  • psychiatry

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  • Contributors The initial second opinion was performed by ROV and the subsequent inpatient diagnostic proces by AvdP-M. The initial draft of the case report was written by OS under close supervision of RM. All authors have commented on previous versions of the manuscript. The final manuscript was approved by all coauthors as well as the patient herself and her caring niece.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.