Canadian woman offered euthanasia as a "treatment option" during a mental health crisis.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Kathrin Mentler

Kathrin Mentler (37), a Canadian who lives with chronic suicidal thoughts, recently told Michelle Gamage reporting for The Tyee on August 9 that she was offered euthanasia while seeking help during a mental health crisis.

This is the first clear story of a counsellor offering euthanasia as a treatment option for mental illness and an illustration why there was a 24% increase in British Columbia euthanasia deaths in 2022.

Mentler has experienced depression, anxiety and chronic suicidal thoughts for many years but recently the Assessment Centre at the Vancouver General Hospital offered her euthanasia. Gamage explains:

“That day my goal was to keep myself safe. I was thinking of maybe trying to get myself admitted to hospital because I was in crisis,” she says.

Mentler says she told the counsellor she was scared she’d “never not feel horrible.” She also disclosed her history of mental illness and self-harm.

Mentler was then told by the counsellor that the mental health system was "completely overwhelmed" that there were no available beds and the earliest that she could talk with an available psychiatrist was November.

Gamage reports what happened next:

“It was pretty disheartening and made me feel helpless,” Mentler says. “I’m coming here because I’m looking for help and you’re telling me there is no help.”

That’s when the counsellor asked Mentler if she’d ever considered medically assisted suicide.

Mentler says she was “shocked” and “sickened” because she came to the Access and Assessment Centre for help, “not for recommendations on how to kill myself.”

She says the counsellor explained how MAID worked and said lots of patients asked about it, adding patients don’t “suffer” because they take benzodiazepines before receiving the lethal injection.

The counsellor then told Mentler that she was relieved when another patient who was unable to get treatment drowned. Mentler told Gamage that:

The story — and the counsellor’s “relief” — disturbed Mentler. She says it felt like the counsellor was making a judgement that it was better for that patient to have died.

“That made me feel like my life was worthless or a problem that could be solved if I chose MAID,” Mentler says.

Mentler has filed a complaint with Vancouver Coastal Health and asked for the Access and Assessment Centre to give her her files from that day.

Sonu Gaind

Gamage asked Dr. Sonu Gaind, chief of psychiatry at Sunnybrook Health Sciences Centre in Toronto and a professor at the University of Toronto, about his thoughts on this case. Gamage reported Gaind's response:

Making MAID accessible for someone with mental illness is “disturbing” because it’s extremely difficult to assess a patient and make the call as a doctor about whether or not they’ll recover.

Using depression as an example, he says 60 to 70 per cent of patients will fully recover after a year even if they do not use any kind of treatment. He also notes that doctors are only right 47 per cent of the time when they say a patient will never recover from depression — which means “we’ll be wrong more than half the time but we won’t know what half we’ll be wrong for,” when assessing patients for MAID. 

Gamage challenged Gaind, who supports euthanasia for terminally ill people, with the argument that it is discriminatory to deny euthanasia to non-terminally ill people. Gaind responded:

“I’m not legally allowed to drive without glasses,” Gaind says. “That’s not discriminatory. That’s recognizing real and important differences between people.”

In cases such as Mentler’s, when a person is experiencing a mental health crisis, it’s “ludicrous” to say a counsellor is respecting a patient’s autonomy by suggesting MAID, he adds.

Gamage asked the euthanasia lobby group, Dying With Dignity, for a response, which she did not receive. Gamage noted that DWD's website states:

Dying with Dignity’s website has a page about “myths and facts.” This page states it’s a myth that “clinicians are inappropriately recommending MAID to patients who are not eligible or as an alternative to treatment.” Clinicians are only allowed to respond to questions about MAID and “only nurse practitioners and physicians involved in care planning and consent processes have a professional obligation to initiate a discussion about MAID,” the page says.

Gamage explained that this doesn’t line up with Health Canada’s Model Practice Standard, which says clinicians should bring up MAID if they think MAID would align “with the person’s values and goals of care.” 

Andrea Woo reported for the Globe and Mail on August 9 that the counsellor offered MAiD (euthanasia) as a risk assessment tool to gauge how suicidal Mentler was at the time.

I am not a mental health expert, but offering death to determine how suicidal a person is, at the time, appears counter-intuitive. When someone is experiencing suicidal ideation, the offer of death would reinforce the suicidal ideation. Further to that, the counsellor spoke about another patient who died by drowning. Someone who is experiencing suicidal ideation might view that comment as a suggestion that death by drowning is preferable to living.

Mixing mental health counselling and treatment with euthanasia undermines the patient's life. 

 Thank you Kathrin Mentler for telling your story.