‘My message to Canada: do not expand’: Dutch psychiatrists warn on MAID 

Euthanasia for mental suffering can be the equivalent of suicide carried out by a doctor and it’s irresponsible to frame MAID as a way to prevent people from dying by suicide at their own hands, parliamentarians heard this week.

Dutch psychiatrists issued a blunt warning to senators and MPs during the seventh and final meeting of a special joint committee deliberating the expansion of MAID (medical assistance in dying) to people whose sole underlying medical condition is mental illness.

“My message to Canada: do not expand. The evidence is not there,” Dr. Jim van Os, a professor of psychiatry at Utrecht University Medical Centre in the Netherlands said.

Requests for MAID on mental health grounds have risen sharply in the Netherlands, where psychiatric euthanasia has been legal since 2002. Requests have grown from fewer than five cases per year to roughly 1,000 in 2024. Meanwhile, cutbacks in mental health services for the most severely distressed have left people languishing on wait lists, van Os said.

Of 219 people granted euthanasia for one or more psychiatric illnesses in 2024, 30 deaths were among people under 30; 111 involved people aged 30 to 60 and most of the requests were for depression.

Dutch law requires that no reasonable options are left and that death by euthanasia be considered a “ very last resort,” van Os said.

“Canadian law does not work this way,” he said. Doctors can’t insist all possible treatments be tried first. “That single difference will, in our assessments, drive Canadian numbers beyond ours.”

“Euthanasia for mental suffering cannot be cleanly separated from physician-performed suicide,” van Os added.

“It is, in many cases, suicide carried out by a psychiatrist.”

When later asked by Liberal MP Greg Fergus whether that was a fair comment or exaggeration, van Os said it is “virtually impossible” to distinguish between a rational, well-thought out request for MAID and an impulsive one.

“Therefore what often happens is that individuals indeed suffer and express a death wish as a result of their mental suffering, which results from a mental disorder, and are granted euthanasia so that the doctor performs the suicide,” he said.

Most requesting MAID for mental illness in the Netherlands are traumatized, marginalized, often living in poverty and disproportionately women, the committee heard.

Psychiatric euthanasia has gradually become “normalized” in the Netherlands, said Dutch psychiatrist Dr. Wilbert van Rooij, who has been in practice for nearly 30 years. Rooij said he’s seeing more vulnerable and “often relatively young patients who are in principle treatable” requesting MAID but who aren ’ t getting adequate care because mental health services have steadily eroded.

Expanding MAID to the mentally ill will “reshape the moral landscape of care” by asking doctors to decide “not only when life can no longer be cured but when it no longer should continue,” Rooij said.

“That is a burden psychiatry was never designed to carry.”

However, Dutch psychiatrist Dr. Sisco van Veen, who chairs a committee tasked by the Dutch Psychiatric Association now updating guidelines for psychiatric MAID, and who has been following debates in Canada closely, said psychiatric euthanasia remains relatively rare in the Netherlands, representing about two per cent of all MAID cases.

While it’s fundamentally important to respect a person’s autonomy, “mercy is even more important,” van Veen said.

“Because of this, I think it’s hard to justify excluding patients for psychiatric disorders whose suffering can be immense or, in other words, unbearable.”

Psychiatric MAID should be available for a small group of patients, he said, adding that while it’s complicated, it is not impossible for doctors to distinguish a “rational or competent death wish from an incompetent death wish.”

“I do think we need different due diligence criteria but I’ve seen some documents from Canada which give me confidence that you are preparing for that, ” van Veen said.

While there have been individual cases in the Netherlands where people died by suicide after their request for MAID was denied or delayed, van Veen said it is “irresponsible to call MAID a form of suicide prevention.”

At its first hearing in March, the committee was warned that if the federal government keeps excluding people with mental illness from accessing MAID, people will die by suicide.

Bloc Québécois MP Claude DeBellefeuille said it was “completely unacceptable” that the committee was hearing from Dutch psychiatrists and not the Canadian Psychiatric Association.

Helen Long, CEO of Dying with Dignity Canada, accused the committee of largely excluding people living with mental illness. “No other patients have been erased from the conversation about them the way persons with mental illness have been,” she said.

While several experts have testified that it’s impossible to predict when a mental disorder has become incurable, “certainty about the future is not a requirement to access MAID” for physical suffering, Long said.

“There is plenty of uncertainty in many medical conditions but people with physical disorders are informed about the uncertainties and engage in dialogue with clinicians to talk about risks and their own values,” she said.

“It is only people with mental illness to who we say your views do not matter.”

The exclusion of MAID for mental illness is set to be lifted in March 2027 unless new legislation is passed that would delay, or permanently halt, euthanasia for psychiatric suffering alone.

The 17-member committee is due to submit its recommendations to Parliament by Oct. 2.

National Post

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