Psychiatrists’ attitudes toward physician-assisted suicide: a cross-sectional survey

Medical assistance in dying (MAiD), including physician-assisted suicide (PAS), poses complex questions to psychiatry, where assessing decision-making capacity, voluntariness, and irremediable suffering is challenging. In Italy, Constitutional Court Judgment Number 242/2019 defined narrow conditions under which PAS is not punishable and excluded mental disorders (MD) as the unique reason to access PAS. This study aims to explore psychiatrists’ views on PAS. We conducted an anonymous cross-sectional online survey of psychiatrists working in public adult mental health services in the Emilia-Romagna Region (Italy) between July and September 2025. The questionnaire collected sociodemographic and professional variables, and attitudes toward PAS with 17 Likert-type items and 3 open-ended questions. We summarized responses descriptively, tested bivariate associations using chi-square analyses after dichotomizing Likert responses into agreement versus disagreement, and examined open-ended responses thematically. Of 414 eligible psychiatrists, 103 responses were collected (response rate 24.9%). Support for allowing PAS within the criteria of Judgment Number 242/2019 was substantial (89.3%). Regarding MD without somatic illness, most respondents agreed that some MD may be treatment resistant and a source of unbearable suffering (71.8%) and that a request for death may be legitimate rather than solely a symptom of psychopathology (71.9%), but fewer supported legal extension of PAS to MD (52.4%). Approximately two-third considered evaluation compatible with the therapeutic relationship (66.1%), whereas 44.7% expressed willingness to be involved in a PAS procedure for MD if legally permitted. Agreement was lowest for “tired of life/completed life” scenarios without diagnosable pathology (21.3%). Support was higher for treatment-resistant mood disorders (42.7%) and schizophrenia (42.8%) than for eating and personality disorders (28.2% and 26.2%, respectively). Religious affiliation was the only characteristic significantly associated with a more cautious stance. Over one-third (37.3%) had encountered at least one PAS request from a patient with MD. Psychiatrists largely supported PAS within the current Italian jurisprudential framework, while opinions diverged on extension to MD and were particularly cautious toward non-pathology “tired of life” requests. These region-specific findings should be interpreted cautiously, though support the need for shared professional guidance and further mixed-methods research to inform safeguards, ethical debate, and clinical practice.