Suicidality and needs among people seeking medical assistance in dying based on psychological suffering: a protocol of a prospective longitudinal observational study

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Abstract
Introduction: The number of requests for medical assistance in dying (MAID) based on psychological suffering has significantly increased in recent years. People that request MAID based on psychological suffering often have a long-term history within mental health care that has not (yet) led to recovery. The risk of death by suicide in this group is high. Relatively little is known about people who request MAID based on psychological suffering and their death wish. The lack of knowledge results in a lack of targeted counseling options and suicide prevention for people who request MAID based on psychological suffering. The current study therefore focuses on the characteristics, psychological processes and support needs of people who request MAID based on psychological suffering, and how death wishes and suicidality develop during and after a MAID request. The aim of this research is to contribute to better care and support for this vulnerable group. Methods: To answer the questions above we conduct a prospective longitudinal observational study. Participants twice complete a digital questionnaire: one shortly after registering with Expertisecentrum Euthanasie (EE) for their MAID request and one six months after completing the first questionnaire. Participants are 16 years or older and have requested MAID at EE based on psychological suffering. Ethics and dissemination: The study was approved as a study subject to the Medical Research Involving Human Subject Act (WMO) by the METC of Amsterdam UMC. Risks of participating in the study are low and explicit attention is paid to participant safety. The study results will be disseminated through scientific publication, conferences, and a webinar for mental health professionals. Based on participants support needs, a plan will be developed for support services to prevent suicide by people who requested MAID based on psychological suffering. Thus, the study will contribute to better counseling and suicide prevention for this vulnerable group.

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