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Euthanasia/assisted death on the basis of a mental disorder 

Nicolini, M.E., Jardas, E., Zarate, C.A., Gastmans, C., Kim, S.Y.H. Irremediability in psychiatric euthanasia: Examining the objective standard. Psychological Medicine 2022, 1-19. pdf here 


Summary: This study shows that prediction accuracy in treatment-resistant depression is about 50%, posing problems for the objective standard that clinicians are supposed to follow when assessing prognosis in patients with a mental disorder who request euthanasia. 

Nicolini, M.E., Gastmans, C., Kim, S.Y.H. Psychiatric euthanasia, suicide and the role of gender. British Journal of Psychiatry. 2021; 220(1), 10-13. pdf hereReceived the Royal College of Psychiatrists Article of the Month Award.


Summary: This is the first paper to look at the striking finding that women are overrepresented among psychiatric euthanasia cases (about 75% are women) and what this tells us about the practice and its relation with suicide prevention. 


Nicolini, M.E., Gastmans, C., Kim, S.Y.H. Parity arguments for ‘physician aid-in-dying' for psychiatric disorders: Their structure and limits. American Journal of  Bioethics 2019; 19(10): 3-7. pdf here

Summary: The parity argument states that if we allow euthanasia/assisted death for physical disorders, we should also allow it for mental disorders. This paper argues that the argument is misguided in its focus on suffering - the relevant distinction to examine is the difference between mental and physical disorders.

Nicolini, M. E., Kim, S.Y.H., Churchill, M. E., Gastmans, C. Should euthanasia and assisted suicide for psychiatric disorders be permitted? A systematic review of reasons. Psychological Medicine 2020; 50(8): 1241-1256.  pdf here

Summary: The debate over psychiatric euthanasia started in the mid-90s, yet a comprehensive overview of the professional debate was still lacking 25 years later. This systematic review fills this gap and identifies the main arguments for and against the practice, outlining avenues for future research and directions for the debate. 

Nicolini, M.E., Peteet, J.R., Donovan, G.K., Kim, S.Y.H. Euthanasia and assisted suicide of persons with psychiatric disorders: The challenge of personality disorders. Psychological Medicine. 201950(4): 575-582. pdf here

Summary: Over 50% of psychiatric euthanasia cases in Belgium and the Netherlands involve people with personality difficulties, i.e. people who experience difficulties in interpersonal relations. Symptoms such as feelings of hopelessness and meaninglessness overlap with the "unbearable suffering" requirement for euthanasia, raising questions as to how patients are evaluated. This study is the first to establish the problems emerging in these evaluations, and evidence for how clinicians' own unaddressed dynamics affect the process and outcome. 

Euthanasia/assisted death on the basis of dementia 


Nicolini, M.E. Physician aid in dying for dementia. The problem with the early versus late disease stage distinction. Frontiers in Psychiatry. 2021; 12(1653).  pdf here

Kim, S.Y.H., Mangino, D., Nicolini, M.E. Is this person with dementia (currently) competent to request euthanasia? A complicated and under-explored question. Journal of Medical Ethics. 2021; 47:e41. pdf here

Kim, S. Y.H., Nicolini, M.E., Mangino, D. R., De Vries, R.G. What we can learn from published reports of euthanasia in persons with dementia: A reply to Marijnisssen et al. American Journal of Geriatric Psychiatry. 2020.  pdf here

Mangino, D.R., Nicolini, M.E., De Vries, R.G., Kim, S.Y.H. Euthanasia and assisted suicide of persons with dementia in the Netherlands. American Journal of Geriatric Psychiatry. 201928(4): 466-477.  pdf here


Other Publications

De Vocht, J., Stam, D., Nicolini, M.E., Lamaire, N., Laroy, M., Vande Casteele, T., & ... Van den Stock, J. Psychopathology in premanifest C9orf72 repeat expansion carriers.

Journal of Neurology Neurosurgery & Psychiatry. 2021; jnnp-2021-327774. pdf here

Nicolini, M.E. From Mental Health Act admission to medical assistance in dying. Unraveling the conceptual questions. International Network for the History of Neuropsychopharmacology Controversies. 2022.  pdf here


Nicolini, M.E., Wendler, D. Inherent conflict of interest in clinical research: A call for effective guidance. American Journal of Bioethics. 2020; 20(10):94-96. pdf

Grady, C., Shah, S., Miller, F., Danis, M., Nicolini, M.E., Ochoa, J., Taylor, H., Wendler, D., Rid, A. So much at stake: ethical trade-offs in accelerating SARS-Cov-2 vaccine development. Vaccine 2020; 38(41): 6381-6387. pdf here

Rid, A., Shah, S., Miller, F., Danis M., Nicolini, M.E., Ochoa, J., Taylor, H., Wendler, D., Grady, C. Ethical trade-offs in vaccine development and distribution: Response to Gurwitz. Vaccine. 2021; 39(2): 1028-1029  

Nicolini, M.E., Vandenberghe, J., Gastmans, C. Substance use disorder and compulsory commitment to care: A care-ethical decision-making framework. Scand J Caring Sci. 2018; 32(3):1237-1246. pdf here

In Dutch  

Nicolini, M.E., Kim, S. Y.H. Euthanasie bij persoonlijkheidsstoornissen. [Dutch summary of paper published in Psychol Med] Neuron. 2019. pdf here

Nicolini, M.E. Ethische handvaten voor procedure gedwongen opname bij verslaving. Kiezen voor dialoog. [Ethical tools for compulsory commitment in persons with substance use disorders. Choosing dialogue] Zorgwijzer (Zorgnet Icuro). 2018 pdf here

Nicolini, M.E. Wie wij zijn. [Who we are] F. Koerselman (2016). Prometeus Amsterdam. ISBN 978-90-351-3699-1, 255pp. Tijdschrift voor Psychoanalyse 2018; 24(3).  pdf here

PhD Thesis

Nicolini, M.E. Euthanasia and assisted suicide for psychiatric disorders. Clinical and ethical perspectives. PhD Thesis. May 2021. KU Leuven. pdf here


Nicolini, M.E. Euthanasia and assisted suicide in psychiatry: An overview of the field. Forthcoming iEthics in Psychiatry. Springer, 2nd ed. (Spring 2024)

Nicolini, M.E., Grady, C. Special considerations for clinical research. In Medical Professionalism: Theory, Education, and Practice. Oxford University Press (Spring 2024) 

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