Medical assistance in dying on psychiatric grounds in adolescents and young adults: a narrative review

Medical Assistance in Dying on psychiatric grounds (MAID-PG) for adolescents and young adults (AYAs) has become a focal point of ethical, clinical, and political debate, despite representing a small proportion of overall MAID cases. This narrative review synthesises scientific literature, official reports, clinical guidelines and public discourse concerning MAID-PG in AYAs in jurisdictions where the practice is legally permitted, particularly the Netherlands and Belgium. The available empirical evidence is limited, recent and heterogeneous. Cohort data suggest that most MAID-PG requests from young individuals are withdrawn or rejected, and completed cases remain rare. In some cases, evidence-based treatments had not been fully explored. Clinical guidelines emphasise caution, multidisciplinary assessment, and careful evaluation of decision-making capacity and irremediability, particularly given developmental considerations and the fluctuating course of psychiatric disorders. Three central ethical tensions emerge: (1) balancing respect for autonomy with developmental plasticity, (2) assessing irremediability within imperfect mental healthcare systems and (3) the influence of highly visible cases on public discourse versus the need for nuanced, case-by-case evaluation. Significant knowledge gaps remain. Further empirical research and investment in youth mental healthcare are needed to support ethically robust clinical practice.