The questions people then ask are: can the psychiatrist refuse this? Do I have to look for someone else? What does the law say?

This page describes the situation in the Netherlands, where PsychosisNet comes from. Rules differ from country to country. Ask what your rights are where you live.

Suppose you have cancer and you want to stop your medication

Suppose someone has cancer and gets chemotherapy for it. The chemotherapy works well, but the person tells the doctor that he wants to stop the chemo all the same, because he experiences his life as complete and does not want to go on. May the doctor then refuse to taper off the chemo? The answer is: no. If the person is mentally competent, the doctor has to cooperate in tapering off the chemotherapy and guide the person as well as possible in what comes next. In the Netherlands this is laid down in the law on the medical treatment contract (WGBO), which all doctors have to keep to.

What about antipsychotic medication?

When people who use antipsychotic medication consider tapering off, there are many questions and worries. Is it safe? What are the risks? What are the alternatives? A development in Dutch health care strengthens the right of the person to take an active part in decisions about their own treatment, a concept called ‘shared decision-making’.

What is shared decision-making?

In January 2020 the Dutch law was tightened. Shared decision-making is now central. The wishes, considerations and preferences of the person are asked about explicitly and are involved in medical decisions. The idea is that people who are actively involved in their own care can make better, informed decisions that are more in line with their own values and preferences.

What does this mean for people who use antipsychotic medication? If someone is stable and mentally competent, the psychiatrist cannot ignore the wish to taper off medication. Even if the psychiatrist sees certain risks, the person still has the right to decide about his or her own body and treatment. The psychiatrist can record his or her concerns in the medical file, but the decision has to be made together with the person.

The advantages of shared decision-making

Research has shown that people who are actively involved in their care:

• are more satisfied with their decisions
• know more about their condition and the treatment options
• are more inclined to keep to their treatment

Care professionals also find more satisfaction in their work when they involve people in decisions.

Support in the process

Various tools have been developed to help doctors and the people they treat with shared decision-making. These tools can help to make the options clear, to discuss the risks and advantages of different treatment options and to identify the wishes and preferences of the person. These tools are needed, because not all psychiatrists know the law yet, or the freedom people have to start a tapering process, also when this brings risks.

In the philosophy of the recovery movement this is called ‘the dignity of risk’. It is the freedom to experiment and to learn from it over time. Recovery is a winding process of falling and getting up again. An experiment can fail, but that does not mean the person cannot learn from it.

Conclusion

Tapering off antipsychotic medication is an important decision. In the Netherlands, thanks to the tightened law, people now have the clear right to be actively involved in this decision. Psychiatrists cannot simply refuse because they see risks.

You have the right to ask questions, to voice your worries and to take an active part in decisions about your own health. Working together with your care provider means that you can make an informed choice that suits you best.

Read more: Tapering off: more than a medical risk and Reducing or quitting antipsychotics.

Prof. dr. Jim van Os, Chair Division Neuroscience, Utrecht University Medical Centre. Jim works at the interface of ‘hard’ brain science, health services research, art and subjective experiences of people with ‘lived experience’ in mental healthcare. 

Jim has been appearing on the Thomson-Reuter Web of Science list of ‘most influential scientific minds of our time’ since 2014. In 2014 he published his book ‘Beyond DSM-5‘, and in 2016 the book ‘Good Mental Health Care’. In 2026 he published 'Wat psychisch lijden is'.

Want to read more?

Blogs by Jim van Os can be read here

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