In 1998 the Dutch Psychiatric Association has published guidelines for physician assisted suicide in psychiatric patients that provide an adequate framework for decision making. Nevertheless they leave important questions to be answered. First, the guidelines restrict the meaning of 'assistance' to giving the patient deadly pills. Thereby aspects of assistance with suicide that do not fall under the jurisdiction of the Dutch penal code are not even explored. Second, the guidelines neglect the difficulty how to sustain a psychotherapeutic relationship with chronic suicidal psychiatric patients. The expectation of society that psychiatrists must always be able to prevent suicide by putting a patient on a ward against his will may well destroy lifesaving psychotherapeutic possibilities. Third, three dilemmas in psychotherapeutic treatment of patients with a persistent death wish are discussed. Some suggestions are put forward how to protect a psychotherapeutic relationship with chronic suicidal patients.