Euthanasia can allow structural coercive forces to push people toward death.

The following presentation was made by Dr Ramona Coelho to the Special Joint Committee on Medical Assistance in Dying on April 14, 2026. (Link to the meeting)

Dr Ramona Coelho

I am a family physician, Senior Fellow at the Macdonald-Laurier Institute, and an adjunct research professor at Western University.

I served on Ontario’s MAiD Death Review Committee and have published extensively on MAiD, and I speak in an individual capacity.

For twenty years, I have cared for patients with complex disabilities, mental illness, chronic pain, and social vulnerability, many facing financial instability.

Suffering is complex, shaped by psychological distress, trauma, poverty, isolation, and lack of support. Addressing it requires careful assessment, time, and care.

Community life plays a large role in mitigating suffering.

Yet in Canada, some individuals receive MAiD where suffering is driven by these unmet needs.

In my practice, I observed troubling patterns in how MAiD is introduced and assessed.

Some patients were referred immediately after a new diagnosis, others were approached repeatedly during vulnerable hospitalizations, and some were assessed and approved quickly without meaningful exploration of suffering or supports.

Ontario MAiD Death Review Committee reports contain anonymized cases, which you should all have. Across these cases, there were individuals with untreated mental illness, suicidality, addiction, isolation, and unmet social needs, demonstrating premature eligibility, inadequate safeguards, and a failure to address suffering before ending lives.

In particular, Track 2 cases reflect social vulnerability and untreated mental illness. Statistics showed nearly 30 percent of recipients lived in poverty. More were women. Many listed a lawyer, physician, or friend, not family, as next of kin, indicating social isolation. Less than half received mental health or disability supports. Fewer than 10 percent were offered housing or income support.

Although framed as choice, MAiD can allow structural coercive forces to push people toward death.

With mental illness, it is not possible to reliably determine that someone will not recover. At the same time, many Canadians wait prolonged periods for specialized psychiatric care, extending suffering and delaying recovery.

Suicidality, lack of insight, and impaired judgment are symptoms of many psychiatric conditions. They fluctuate, and recovery often occurs with time and social support, with or without treatment.

Given the lack of evidence to guide MAiD assessments for mental illness, bias and discrimination will inevitably determine who receives MAiD and who receives suicide prevention.

I invite you to read my article: Discrimination-driven deaths – Analysing Ontario Coroner Reports on Euthanasia and Assisted Suicide.

In response to claims that MAiD professionals consistently follow guidelines and that CAMAP guidance is sufficient, review the Ontario MAiD Death Review Committee cases and read my article. They illustrate gaps between guidance and practice. Also consider the risks of expanding MAiD on suicide contagion; MAiD presents death as a solution to suffering and provides the means to achieve it, with clinician support.

One witness cited a documentary on MAiD for mental illness, noting that the individuals later died by suicide, and suggested that delaying MAiD contributed to these deaths.

But why might this have occurred? Repeated exposure to messaging that frames death as the best or “dignified” response to suffering can increase resolve to end one’s life and worsen suicidality.

Suicide prevention research shows that normalizing death as a response to life suffering, combined with access to lethal means, increases suicide risk.

Further, The CPA’s consensus statement on MAiD for mental illness reflects opinion, not evidence-based medicine.

It should not reassure us that we are ready for this, nor guide life-and-death decisions.

In contrast, the International Association for Suicide Prevention states that MAiD should not be provided solely for mental illness and that suicide prevention principles must continue to apply to those near death or living with disability.

The UN Committee on the Rights of Persons with Disabilities has advised repealing Track 2 MAiD, including expansion to mental illness.

There are good reasons why Quebec, Alberta, and other provinces are not moving forward with MAiD for mental illness.

We cannot continue to delay.

A government committed to protecting all Canadians must stop MAiD for mental illness.