From Nosography to Biography: A Four‐Level Framework for Evaluating Irremediability in Medical Assistance in Dying for Mental Health

The assessment of “irremediability” in mental health constitutes the most complex bioethical challenge within medical assistance in dying laws, given the structural uncertainty inherent in psychiatry. This article proposes a four‐level analytical framework designed to transform diagnostic ambiguity into a prudent and auditable decision. In the first level (technical), “incurability” is delimited as a nosographic judgment based on treatment futility and traceability, as opposed to “irremediability” as a clinical‐pragmatic judgment. The second level (phenomenological) defines irremediability as a ‘frozen temporality’ and a closure of the biographical horizon, where suffering becomes structural. The third level (ethical) advocates for “relational autonomy” and the two‐track approach as safeguards against both therapeutic obstinacy and abandonment, ensuring that intensive rehabilitation coexists with the request. Finally, the fourth level (legal) analyzes how certain euthanasia legislations integrate biographical functionality, moving beyond a purely biological paradigm. It is concluded that the transition from a nosographic model to a biographical one allows for the respect of individual autonomy and life history without abdicating clinical responsibility, offering a decision‐making standard that harmonizes technical rigor with compassion.