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.

People do not want to die they want their suffering to be relieved.

Dr Peter Blusanovic

This speech was delivered by Dr. Peter Blusanovics at the Euthanasia Prevention Coalition Parliamentary Press conference on April 13, 2026.

My name is Dr. Peter Blusanovics, I am a Montreal family physician who has been practicing for over 30 years. I have experienced helping patients in offices, in emergency rooms and in mental health institutions. and I have treated many with mental illnesses in these settings.

And that’s why I’m here today. I want to provide a voice for our most vulnerable, those who have and are suffering from mental health.

Bill C-218 needs to pass to put a stop to euthanasia for people with mental illness.

Basic needs are not currently being met in our health care system.

Without this bill, we are condoning a bypass towards suicide, and blatantly admitting defeat.

Mental illness needs to be properly identified and treated. These Individuals do not want to die they want their suffering to be relieved.

But there is currently lack of medical support, such as physicians, psychologist and social workers. There is lack of access to psychiatric support and long waiting lists before being assessed. There is lack of financial support: lack of housings , economic security and support from family and significant others.

I will say it again that I am here to provide a voice for our most vulnerable.

I know that offering medical aid in dying provides no solution.

Everyone deserves the right to be treated with dignity and with humanity.

We are supposed to be a mature and evolved society that needs to take care of its most vulnerable .

We need to realize that the lack of proper care in our health care systems is not a good enough excuse, to offer assisted suicide as a solution.

Je m’appelle Dr. Peter Blusanovics, je suis médecin de famille à Montréal où je travail depuis plus de 30 ans. J’ai eu l’occasion d’aider des patients en cabinet, aux urgences et dans des établissements de santé mentale, et j’ai soigné de nombreuses personnes atteintes de troubles mentaux dans ces contextes.

C’est pourquoi je suis ici aujourd’hui. Je souhaite faire entendre la voix de nos plus vulnérables, ceux qui souffrent ou ont souffert de troubles mentaux.

Le projet de loi C-218 doit être adopté pour mettre fin à l’euthanasie des personnes atteintes de troubles mentaux.

Les besoins fondamentaux ne sont actuellement pas satisfaits dans notre système de santé.

Sans ce projet de loi, nous tolérons un contournement menant au suicide et admettons ouvertement notre échec.

Les maladies mentales doivent être correctement identifiées et traitées. Ces personnes ne veulent pas mourir, elles veulent que leurs souffrances soient soulagées.

Mais il y a actuellement un manque de soutien médical, notamment de médecins, de psychologues et de travailleurs sociaux. L’accès au soutien psychiatrique est limité et les listes d’attente sont longues. Il y a un manque de soutien financier : manque de logements, de sécurité économique et de soutien de la part de la famille et des proches.

Je le répète : je suis ici pour donner une voix aux plus vulnérables d’entre nous.

Je sais que l’aide médicale à mourir n’apporte aucune solution.

Tout le monde a le droit d’être traité avec dignité et humanité.

Nous sommes censés être une société mature et évoluée qui se doit de prendre soin de ses membres les plus vulnérables. Nous devons prendre conscience que l'insuffisance des soins dans nos systèmes de santé ne constitue pas une excuse suffisante pour proposer le suicide assisté comme solution.

EPC Press Conference: Suicide and Euthanasia for Mental Illness

Welcome to the Euthanasia Prevention Coalition press conference.

Alex Schadenberg

My name is Alex Schadenberg. I am the Executive Director of the Euthanasia Prevention Coalition.

I want to express is our deepest sympathy to the many families who have lost loved ones to euthanasia. Canada is surpassing 100,000 deaths by euthanasia this month, a very sad milestone.

I remember Gaetan Barrette, then the Quebec Health Minister, stating in the Quebec National Assembly in 2014 that euthanasia would be for extraordinary cases, likely 100 per year. Euthanasia now represents 8% of all deaths in Quebec.

Suicide and Euthanasia for Mental Illness

Jocelyn Downie, a long-time euthanasia academic told Canada's Parliamentary Special Joint Committee on Medical Assistance in Dying, that is studying euthanasia for mental illness alone, that parliament must stick to the March 17, 2027 timeline and permit euthanasia based on mental illness alone. Downie threatened the committee by stating:

“What will happen, if there is an extension or an exclusion, is that people will die by suicide”

Downie is saying that the answer to suicidal ideation is suicide and people will die by suicide if they do not have access to euthanasia.

The threat that people who are denied euthanasia will die by suicide is a false pressure tactic.

The Supreme Court of Canada accepted the “suicide argument” in Carter when it struck down Canada's laws that protected people from being killed by euthanasia, but the Supreme Court was also wrong.

If the premise that people will die by suicide if euthanasia is not available to them is correct then the suicide rate should go down after euthanasia became an option for Canadians who are not terminally ill.

But Canada's suicide rate has increased.

According to the Government of Canada suicide mortality statistics, there were 3,978 recorded suicide deaths in 2016, the year that Canada legalized euthanasia. In 2021, there were 3,927 recorded suicide deaths in 2021 the year that the euthanasia law expanded to Canadians who are not terminally ill. In 2023, two years after extending euthanasia to people who are not terminally ill, there were 4,735 reported suicide deaths in Canada, representing a greater than 20% increase from 2021.

I am not arguing that Canada's increase in suicide deaths was directly related to Canada's expansion of euthanasia, but I am saying that if Jocelyn Downie was correct, the suicide rate should have decreased, whereas in fact it has significantly increased.

Canada has had a massive increase in deaths by euthanasia.

Health Canada released their Sixth Annual Report on Medical Assistance in Dying in Canada on November 28, 2025 (2024 deaths) which indicated a 6.9% increase from the Fifth Annual report (2023 deaths).

The 2024 report indicates that there were 16,499 reported (MAiD) euthanasia deaths which was up by 6.9% from 15,427 in 2023.

In 2025, we know that euthanasia increased by 7.3% in Ontario and 11% increase in Alberta. I predict that in 2025, the increase in Canadian euthanasia deaths was greater than 7% with the number of euthanasia deaths being approximately 17,700.

Clearly, there is no indication that the massive growth in Canadian euthanasia deaths has resulted in a lower rate of other suicides.

Suicide rates do not decrease in jurisdictions that have legalized euthanasia or assisted suicide.

In December 2020 I responded to a statement by Senator Stanley Kutcher who said:

in jurisdictions, such as Belgium and the Netherlands, where assisted death is legal, that the suicide rates have decreased. He then stated that there is no link between assisted death and the rate of suicide in jurisdictions where it is legal.

The problem with Senator Kutcher's statement was that he was absolutely wrong.

In the article I explain that there are no jurisdictions that have legalized euthanasia or assisted suicide, that over a long period of time, have experienced a decrease in suicide deaths.

In February 2022 bio-ethicist David Albert Jones published an article titled: In Europe, suicides rise after ‘right-to-die’ is legalised. Jones provided a comparison between European countries that have legalized assisted dying and those that had not legalized it and found that countries that had legalized assisted dying experienced an increase in suicide rates compared to countries that had not legalized assisted dying who generally had a lowering of their suicide rate.

In other words, Downie is using a false argument to scare monger Members of Parliament into approving euthanasia for mental illness alone. Downie uses court decisions to uphold her position but the Justices are not suicide prevention experts and in fact are wrong in their assumption that legalizing euthanasia will prevent suicide.

Minimally speaking, legalizing euthanasia does not lead to a decrease in suicide rates and the data suggests that legalizing euthanasia or assisted suicide has a suicide contagion effect leading, long term, to higher suicide rates.

Once again, if Downie is correct, based on the massive numbers of euthanasia deaths in Canada, the Canadian rate of other suicides should have gone down, but in fact they have gone up.

We mourn 100,000 euthanasia deaths in Canada, since legalization, and we challenge the federal government not to expand Canada’s euthanasia law but to launch a study by neutral researcher on the effect of Canada’s out of control euthanasia regime.

I would not be here today, living this beautiful life if I had been given an option to receive help to be killed.

The following is the speech by Stephanie Kollmar at the Euthanasia Prevention Coalition rally on parliament hill on April 13.

Stephanie Kollmar

Thank you for the opportunity to share my story and unite with so many who understand the pain of mental health struggles. 

I was 26 when my husband took his life. To make matters worse, it was suicide by cop. 

The four years of our marriage worsened year after year with partly his pride in refusing to accept help and consistent hospital visitations that resulted in no solution. In his young mind and prideful nature, he turned to the use of street drugs instead of psychiatric support as his self-medicating choice. This of course worsened his mental state, brought abuse into our home and finally, in hopes that he would seek help by my walking away, I left with the children. 

Unfortunately, he didn't see the hope I saw. He saw the end and called 911, and upon their arrival he charged directly at the police, running full speed in his underwear down our driveway, the same police station that visited my home so many nights, chose to shoot him multiple times. He died that night January 18, 2010, in Saint-Dorothée QC at 26 years old. 

My already broken nervous system went into shock. My daughters were 6 and 2. I had been a stay-at-home mom with a full focus to help him heal and my last initiative failed. In my own grief I was dissociated, numb, struggling with guilt, and uncertain how I was going to show up for my daughters. I was fortunate to have my parents and moved in with them. Being in their Christian home started to bring back a sense of peace and regulation, but I struggled immensely to be around other families at church and to connect at a deeper level. The last thing I wanted was to feel the amount of emotional pain that was surging through my body or have people pity me. 

I tried my best to put on a smile and keep conversation short and light, but I ended up leaving the church. I couldn't sustain pretending, isolation felt safer and I had a plan to end my life.  

Though he had left me with debt after the forced house sale from his death, I had a small amount of savings and had begun working three months after he passed. I had decided once the money was gone, I estimated about six months, I would end my life and my daughters would be better off without their broken-hearted struggling mom.

I would not be here today, living this beautiful life, if I had been given an option to receive help to be killed. 

That six-month duration from May 2010 to Nov 2010, though still painful, was enough time for me to process this secret decision and recognize, I needed my daughters and they needed me.  

One day at a time I started to dream of a future again, leading me into the corporate world to begin a career, and opening my eyes to see how the trauma had affected my nervous system.  I further struggled to have meaningful connections with those around me, I was rigid, guarded and very afraid of men. A couple years went by until I finally accepted I needed to start therapy - and ultimately fell in love with my healing journey. I discovered a lot about the mind, processing, unconscious beliefs, behavioural patterns, victim mentality, attachment styles, trauma, nervous system regulation and emotional intelligence.  Adding nervous system practices that strengthen the vagal nerve, it complimented my talk therapy sessions beautifully as it began to regulate my nervous system, which strengthened my capacity for stress, disarmed my fight/flight reactions and rewire my mind to change my perspective. 

I became a better mom, and climbed the latter in the corporate world becoming a client experience director, building teams, building up people, mentoring and recognizing skills while restructuring support channels. I became a healthier, loving, motivated version of myself. In 2024, I left the corporate world to pursue deeper learning of trauma therapy through The Crisis and Trauma Resource Institute out of Alberta. To add to my nervous system regulation skills, knowing I wanted to work with the body, I studied therapeutic Swedish massage which opened the door for insurance receipt support so I could open a clinic.

Life didn't stop throwing its curve balls;  facing mental health struggles with my youngest daughter almost rocked me to my core, in fear of losing her as I did her dad  - but with great support, and being more resilient with a broader capacity for stress we made it through. 

Again, I couldn't imagine if she was offered euthanasia support at the Children's Hospital in Montreal or the Douglas mental health institute instead of the incredible knowledge-based help we received. Now studying dance full time, she's focused on her dreams and I'm able to start mine, the opening of espace d'espoir. The Space of Hope. A women focused business I've recently created to continue the care for women who have lost hope, desire to feel safe and loved - possibly for the first time, and help them reintegrate their lives into society by supporting their bodies to soften the effects of shame, pain and trauma, so they can find joy in living. 

There is no world where euthanasia should be a welcomed option. As I said today, euthanasia eliminates the opportunity for hope - and Canada should be ashamed to believe that killing those in need makes us a valued, reputable country.  People are worthy of life. 

Dr Paul Saba: In most cases the desire to die is a symptom of mental illness.

Dr Paul Saba

This is the Speech by Dr Paul Saba at the EPC Parliamentary Press Conference on April 13, 2026. 

Dr Saba is a family physicians from Lachine Quebec who is well known for his clinical experience for caring for patients with disabilities and difficult health conditions.

His presentation was delivered in English and French.

People with only a mental disorder will be euthanized as of March 17, 2027. This, despite the overwhelming evidence that people with mental disorders can be treated, and that most psychiatrists cannot determine which patient has an irremediable (irreversible) condition.

From a legal standpoint, those with mental disorders requesting euthanasia which has been euphemistically called medical assistance in dying (MAID), do not meet the condition of free and informed consent because the desire to die is in most cases a symptom of mental illness.

Bill C-218 which will be voted this week in Ottawa, would stop euthanizing (MAID) people with mental health disorders as the sole criterion. This bill must be supported by our Members of Parliament.

Dans la plupart des cas, le désir de mourir est un symptôme de maladie mentale.

90% des personnes qui mettent fin à leurs jours sont atteintes d'un trouble mental au moment de leur suicide. La plupart des personnes qui ont tenté ou réussi à se suicider ne veulent pas mourir ; ils veulent plutôt échapper à leur détresse émotionnelle

Selon une étude de la Harvard School of Public Health, 90% personnes ayant tenté de se suicider sans succès ne se sont pas suicidées après le traitement. Avec le bon traitement, le suicide a disparu.

In most cases the desire to die is a symptom of mental illness.

According to a Harvard School of Public Health study, 9 out of 10 people who attempted suicide but were unsuccessful in their attempt, did not commit suicide following treatment. With the right treatment, suicide disappeared.

One of my patient’s who couldn’t be here today, asked me to tell her story. In her 20’s she was a mother of three small children. She was involved in an abusive relationship. To end her emotional anguish she attempted suicide by hanging. Her neighbour found her and removed the cord around her neck saving her life. If she had been euthanized she wouldn’t have survived because euthanasia with a lethal injection is a guaranteed death- no survivors. Today she’s happy to be alive and mothered another son and has 4 grandchildren.

La plupart des personnes atteintes de troubles mentaux ont besoin du soutien de psychiatres, de psychologues et de travailleurs sociaux qui sont rares dans notre système de santé publique.

Beaucoup vivent dans des situations financières et sociales précaires. Ils ont besoin d’un soutien financier, notamment d’un logement abordable et d’une sécurité alimentaire.

Au Québec, le délai moyen d'attente entre la référence à un psychiatre et le traitement est de 5 mois. 

Most people with mental health conditions need support from psychiatrists, psychologists, and social workers, who are scarce in our public healthcare system.

Many live in precarious financial and social situations. They need financial support, including affordable housing and food security. 

In Quebec, the average wait time between a referral to a psychiatrist and treatment is five months.

In Quebec, where the waiting time is to see a psychiatrist after being referred is at least five months and most cases longer. In the MAID law next year a patient after being accepted for euthanasia will have a three month wait before the lethal injection is given.

With an average five month waiting time to see a psychiatrist, it’s likely that that a person would get a call to see a psychiatrist 2 months or longer after having been legally injected.

In addition to psychiatrists, psychologists and social workers we must ensure access to a wide variety of alternative treatments, including art, music, dance, pet, recreation and other therapies. We must also ensure free medications, affordable housing, and food security.

A study published in Sage Journal last year 2025 explored the potential cost savings to governments by expanding medical assisted dying to include vulnerable groups with mental illness. These groups included people those with mental health issues, the homeless, drug users, retired, elderly, and indigenous communities. They estimated projected savings of $1.273 trillion between 2027- 2047 with an estimated 2.6 million deaths in the voluntary group mostly the mentally ill and elderly populations.

I quote the authors of the journal:

"this cost-saving measure raises significant ethical concerns. Financially incentivizing MAiD could shift healthcare priorities away from providing necessary support, potentially devaluing vulnerable lives and fostering a troubling reliance on assisted death as an economic solution."

Les personnes atteintes de problème de santé mentale ont besoin de soins, de traitements et de soutien. Ils ne doivent pas être euthanasiés (AMM).

Ils doivent voter en faveur du projet de loi C-218 et non pour l’euthanasie des personnes ayant des problèmes de santé mentale. 

People with mental health problems need care, treatment, and support. They should not be euthanized (MAID). 

Members of Parliament need to vote in favour of Bill C-218, not for the euthanasia of people with mental health problems.

Previous articles and comments by Dr Paul Saba (Articles Link).

EPC: Physicians urge Canadian government not to expand euthanasia.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Dr Blusanovics, Alex Schadenberg, Dr Saba

The Euthanasia Prevention Coalition (EPC) urges Canadians to sign our petition in support of Bill C-218. (Petition Link).

The EPC held a successful bilingual press conference at the Parliamentary Press Gallery on the morning of Monday, April 13 before our rally on Parliament Hill.

(Link to the full video of the Press Conference)

Brian Passifiume reported on the EPC Press Conference for the Toronto Sun on April 13. Passifiume outlines the article by stating that Canada is set to widen eligibility criteria for euthanasia next year. Passifiume reports:

During a Monday morning news conference in West Block, members of the Euthanasia Prevention Coalition offered their support for Bill C-218, a private member’s bill intended to prevent next year’s inclusion of mental illness as the sole medical condition for seeking physician-assisted suicide.

Dr Peter Blusanovics

Dr Peter Blusanovics, a physician from Montreal Quebec with 30 years experience caring for patients in psychiatric wards. Passifiume reported him saying:

“I want to provide a voice to our most vulnerable, those who have or are suffering from mental illness,”

“Basic needs are currently not being met in our healthcare system. Without (Bill C-218,) we are condoning a bypass towards suicide, and blatantly admitting defeat.”

Mental illness, he said, needs to be identified and treated. He said those seeking to commit medical suicide aren’t seeking death, but healing.

“There is a current lack of medical support, such as physicians, psychologists, social workers — there is a lack of psychiatric support and long waiting lists to be assessed,” said Blusanovics, a physician at a Montreal psychiatric hospital.

Passifiume stated that Canada plans to extend euthanasia to people with psychiatric conditions alone starting on March 17, 2027. Passifiume reports that:

Patients seeking MAID are assigned to one of two tracks: Track one for those with terminal illnesses or whom natural death is near; and track two for those whose death is not a reasonable outcome in the foreseeable future.

Although Statistics Canada doesn’t include MAID in its annual top-10 list of most common causes of death, government figures said 16,499 Canadians died via MAID in 2024 — making medical suicide that year’s fourth most common cause of death between accidents (20,260) and strokes (13,725.)

Passifiume explained that MP Tamara Jansen introduced Bill C-218 last year to stop the implementation of euthanasia for mental illness alone in March 2027.

Dr Paul Saba

Passifiume then commented on the statements by Dr Paul Saba, a family physician from Lachine Quebec who said:

there’s no way for most psychiatrists to determine which patients’ conditions are untreatable.

“From a legal standpoint, those with mental disorders requesting euthanasia, which has been euphemistically called ‘medical assistance in dying,’ do not meet the condition of free and informed consent, because the desire to die in most cases is a symptom of mental illness,”

Passifiume ends his article by commenting on the Alberta governments proposed changes through Bill 18 to there provincial euthanasia protocols. Passifiume reports:

Last month, Alberta’s provincial legislature tabled a bill that would prevent their physicians from prescribing MAID for track two patients — citing patient safety and growing skepticism for the federal government’s efforts to expand MAID eligibility.

“The consequences of the decision are permanent and irrevocable, and because of this, we have an obligation to consider MAID with the utmost care and caution,” Alberta Premier Danielle Smith said at a news conference in Edmonton last month.

The Euthanasia Prevention Coalition urges Canadians to sign our petition in support of Bill C-218. (Petition Link).

Is Mental Illness Irremediable?

This article was published by Amy Hasbrouck on her substack on April 12, 2026.

Without adequate supports, MI under MAiD could be a death sentence.

Amy Hasbrouck

By Amy Hasbrouck

The central question when considering if Euthanasia and Assisted Suicide (E/AS) should be allowed for people whose requests arise solely from a psychiatric disability is whether mental illness is irremediable. The answer depends on many factors; the origins, causes and history of the mental illness, the infrastructure in place to support healing, whether the treatment approach is holistic or symptom-focused. Possibly the most important predictor of success is the ability to retain hope that recovery is possible. As a starting point, hope requires trust in the therapeutic relationship, but trust and the hope of recovery are both undermined by allowing E/AS for psychiatric disability alone.

While my physical and sensory disabilities might or might not qualify me for euthanasia under Canada’s Medical Assistance in Dying (MAiD) regime, it is my psychiatric disabilities (mental illnesses) that are most likely to induce me to request euthanasia.

Evolving diagnoses

The day after I graduated from secondary school in 1979, I realized that the “childhood abuse” I had experienced might be connected to the exhaustion, low self-esteem, and depressed mood I had struggled with as far back as I could remember. Since then, I’ve had two hospitalizations, and a series of diagnoses – from depression, to PTSD, to dissociative identity disorder – and I’ve been prescribed at least 15 psychiatric medications. At the moment I’m taking five meds with (unofficial) diagnoses of Complex PTSD,1 Treatment Resistant Depression,2 along with the complicating and compounding effects of ableism.

My experience supports the conclusions reached by Mark Konrad and Catherine Ferrier in their recent article “MAID: No Evidence Base for Futility and Irremediability in Psychiatric Disorders”;3 that “diagnosis and prognosis of mental disorders are unreliable,” and there is an “enormous and nonspecific variety of treatments for mental disorders.”

Origins, Causes and History

Nearly 2/3 (63.9%) of adults report having at least one Adverse Childhood Experience (ACE) such as divorce or death of a parent, physical, emotional or sexual abuse or neglect, or substance abuse by family members.4 Studies have found “a strong relationship between exposure to abuse or household dysfunction during childhood and multiple health risk factors for the leading causes of death in adulthood.” The 17% of adults with an ACE score of four or more (of which I am one) have a “12 times higher prevalence of health risks such as alcoholism, drug use, depression, and suicide attempts,” chronic illness (such as fibromyalgia and chronic fatigue) and autoimmune disorders (such as Lupus or Crohn’s disease). Yet when I asked my primary care doctor about whether Québec used ACE scores to screen for physical and mental health risks, she didn’t know what I was talking about.

I have been unable to see a psychiatrist to adjust the medications I am prescribed for symptoms of my mental illnesses since I arrived in Canada more than 22 years ago. The meds are only partially effective in managing symptoms related to Complex PTSD and depression, but I don’t know what my official diagnosis is, and despite several referrals, I have never actually spoken to a psychiatrist. I have been referred for counseling twice to professionals who had no background in working with people who have experienced disability discrimination; in one case, the therapist’s insensitivity led me to abandon the sessions, while the other therapist left a few months into the treatment. I have had limited success finding qualified therapists on my own, and I must pay for my own therapy since I do not have insurance aside from the provincial health plan.

Infrastructure for Healing

Physical security promotes healing

For me, successful treatment of mental illness depends on diverse, often intangible elements, some of which I already have in place. I have physical security in that I am lucky enough to have a home, a loving and beloved spouse, and economic stability.5 I have some social support through Adult Survivors of Child Abuse (ASCA), an online community with a focus on recovery from the effects of complex trauma. I am looking for a well-matched, skilled and respectful therapist to work with me on managing my nervous system’s dysregulation and hypervigilance. I am hopeful that someday I may recover some self-esteem and lose some of the chronic depression that drains and immobilizes me. I am aware, however, that my situation is precarious; that I am one setback away from suicidal depression, and that I do not have the full range of supports I need to meet the inevitable hazards of life.

Emotional healing

Healing from complex PTSD is – not to put too fine a point on it – complicated when you also have a disability. The usual feelings of shame and self-blame that come from long-term emotional and sexual abuse were magnified by my parents’ profound discomfort with my blindness. The discovery of my cataracts during a hospital stay for pneumonia at four months precipitated a major domestic crisis (with accompanying violence); my father thought the condition was caused by (and was therefore the financial responsibility of) the treatment I received for pneumonia, while my mother believed that the cataract diagnosis while I was hospitalized precluded the possibility that the oxygen treatment was the causal factor. Regardless, I was expected to keep up with my siblings in household chores, academics and play, even as I was shamed for blindness-related behaviours (like rocking or turning my head from side to side). These “self-soothing” behaviours, and accompanying shame, metastasized with the sexual abuse which started when I was about three years old.6

When my mother told me the bullies at school were wrong to say I was “blind as a bat” I thought she must be right because I had usable vision. I figured comments about my vision problem meant that I was just too stupid to learn how to see, since “seeing” generally meant being able to predict events based on applying learned experience. My father’s insistence that I learn touch-typing at the age of 10 – though invaluable when I studied journalism and the Law – was a double-edged sword. He wanted to be sure I would have “something to fall back on” because, after all, “boys seldom make passes at girls who wear glasses;” the response of my classmates suggested I probably wouldn’t land a husband/provider/protector. My father’s plans for my security, while insulting, also seemed sensible, since I was too stupid to see and unworthy of being seen.

Validation in a world gone mad

I left the U.S. in 2003 because I experienced the collapsing democracy and military imperialism of that era as an existential threat and profound cognitive dissonance. My job (advocating for the rights of disabled people), was threatened by state budget cuts and the failure to recognize health care as a human right. I had also been harassed and assaulted by a stranger in what was clearly a disability and gender-based hate crime, yet was denied the opportunity to report it as such at the (state) police station where I fled after the event.

My first 20 years in Canada were taken up with (re)learning French, making a marriage work and following my spouse to foreign postings, bringing the disability rights-based opposition to E/AS to Canada and Québec, and observing the continued political and social deterioration in the United States.7

I was aware of the negative effect of the E/AS work on my mental health, and did what I could to mitigate the damage. The situation was aggravated with the pandemic (and its triage policies that threw disabled people under the bus) and the inauguration of Trump 2.0; I became unable to manage the writer’s block that had been getting worse for years. This substack has taken me more than two months to write. But as I said, I got no support from provincial health services for managing psych meds or getting effective treatment.8

Treatment approaches

Holistic v. symptom-based

Recently I was reminded of the importance of a holistic approach (in the realm of physical health), when I awoke on March 14 with a 50% loss of usable vision in my “good” eye. I took it easy that day, and (to my great relief) the problem cleared up after about 36 hours. (10% of normal vision is a lot better than 5%). I am at a loss as to how to address the underlying problem; I suspect I may have had a partially detached retina due to ocular pressure caused by Continuous Positive Airway Pressure (CPAP) treatment I’ve used for 33 years to control obstructive sleep apnea. The ophthalmologist who prescribes the eyedrops for my glaucoma has never asked about the possible cause of the glaucoma, or whether it might be related to the CPAP, nor has my primary care doctor. So I don’t know which professional to consult, or how to raise my concerns, without giving the impression I am trying to tell the medical professionals how to do their job.

The same principle applies to mental health care; I believe that I probably need to do some sort of somatic-based therapy to bypass my tendency to intellectualize and avoid feeling, but am I asking too much by insisting on psychiatric support for medications specifically for Complex PTSD, or a therapist who can provide a treatment such as EMDR,9 and who understands my trauma history and experience of disability oppression?

The most appropriate therapies, the best-suited provider(s)

In November, the counsellor I had been working with for three years (who had the requisite expertise and background) abruptly terminated the therapy relationship. Since then I have interviewed several possible therapists, only to discover either that they do not provide the treatment I am looking for, or that they cannot work with me because of my location. I am searching for a therapist who is trauma informed and can work online, who is certified in EMDR and who works from a disability justice perspective.10

I have been sending the following introductory email to counsellors I find on therapist referral cites: “I’m a 64-year-old disabled, cis, white woman looking for a counsellor to work with me on complex PTSD from full-spectrum child abuse, medical trauma and ableism, as well as grown-up issues like lawyer recovery, expat status/second language self-expression, and burn out from 30 years of (draining and triggering) work opposing the legalization of assisted dying from a disability rights perspective. Specifically, I’m hoping to use adapted EMDR (I’m legally blind, so the EM part doesn’t work for me) to deal with the CPTSD; I’m open to suggestion on the other stuff.”

Hope and trust in the therapeutic relationship

Recently I got some feedback on the introductory email; I was told that it could be off-putting, or even intimidating to some potential therapists. I responded by saying “That’s kind of the point.” I don’t want to waste my time interviewing counsellors who do not understand complex trauma, or who hold medical-model views of disability, or who see assisted dying as a good idea for disabled people.11 I’m also not confident I could gain much insight in talk therapy when my nervous system reacts like a three-year-old kid who can’t see if my rampaging father is about to attack me, every time someone raises their voice. Each time I question myself about one of my criteria (“do I really need a therapist who understands ableism?” or “Do I really need to do nervous system regulation?”) I have to remind myself that I’m not asking for too much, and that I deserve to get the help I need.

Back to the question of irremediability

Is my mental illness irremediable? I hope not, and I don’t think so. I’m hoping I can cobble together the pieces of a treatment and support system into a coherent care plan for myself. But given the lack of support and help I have received from Québec’s health providers, I cannot feel assured that if I experience a sudden setback (major vision loss, death in the family) I will get the support I need without having my trauma exacerbated by the intervention of an ableist, paternalistic mental health system.

In 2022, Québec decided not to legalize euthanasia for mental illness alone, but what guarantee do I have that some well-meaning doctor or nurse practitioner might not decide that losing my remaining vision, combined with the effects of childhood trauma and any other crisis that pops up, isn’t enough to justify substituting euthanasia for suicide prevention?

Bill C-218

Disability rights activists oppose E/AS because we understand that, while cloaked in “good intentions” the state only intervenes to end disabled lives, because of the belief that disability is a fate worse than death. Bill C-218, which would prohibit MAiD for people whose request is based only on a mental illness, is a small step toward redressing the deadly, eugenic, ersatz form of “care” that is MAiD.

1 World Health Organization’s International Classification of Diseases for Mortality and Morbidity Statistics, 11th Edition, (2022), 6B41 Complex Post Traumatic Stress Disorder https://icd.who.int/browse/2024-01/mms/en#585833559.

2 Oliveira-Maia AJ, Bobrowska A, Constant E, Ito T, Kambarov Y, Luedke H, Mulhern-Haughey S, von Holt C.; Treatment-Resistant Depression in Real-World Clinical Practice: A Systematic Literature Review of Data from 2012 to 2022. Adv Ther. 2024 Jan;41(1):34-64. doi: 10.1007/s12325-023-02700-0. Epub 2023 Oct 26. https://pmc.ncbi.nlm.nih.gov/articles/PMC10796703/.

3 Konrad, M., and Ferrier, C., “Commentary: MAID: No Evidence Base for Futility and Irremediability in Psychiatric Disorders,” Psychiatric Times, April 6, 2026, https://www.psychiatrictimes.com/view/maid-no-evidence-base-for-futility-and-irremediability-in-psychiatric-disorders.

4 The ACE survey is far from complete; it does not account for medical trauma, discrimination, bullying, witnessing domestic violence, or the effects of war, natural disasters, displacement and migration. The World Health Organization’s ACE International Questionnaire takes more factors (such as discrimination, bullying and collective violence) into account, but does not include medical trauma.

5 One fly in my security ointment comes from the fact that my husband, who can no longer work and is losing mobility, finds meaning in life through helping homeless and marginalized people (some of whom are active alcoholics and drug addicts), who come to the house for loans emotional support or to do odd jobs. We have agreed that, for my sense of safety, they will only come between 1 and 5 in the afternoon, and that people who are intoxicated may not come into the house.

6 In 1991, at a workshop I gave (along with colleagues in a support group of disabled women survivors of child sexual abuse) called “Adding Incest to Injury” we presented on the multiplier effects of ableism and child sexual abuse. We described how being trained to compliance and treated as objects of medical care increased our vulnerability to sexual abuse, while the loss of control during sexual violation made us more susceptible to shame and existential confusion caused by disability discrimination.

7 Forever wars, anti-immigrant policies, the #MeToo movement in response to the predator-in-chief and the Epstein files, the failure of democracy and the backlash against diversity, equity, inclusion and accessibility.

8 From what I can gather, the only way to get comprehensive mental health services in Québec is to be in crisis, which would precipitate a response from the system that would deprive me of control over what treatment I receive and where and how I received it. This is highly triggering for a person with Complex PTSD, as I learned when I was hospitalized in 1991 and 1997, and can do more harm than the beneficial effects of the treatment.

9 Eye Movement Desensitization and Reprocessing (EMDR) therapy is an extensively researched, effective psychotherapy method in which the person focuses briefly on the traumatic memory while simultaneously experiencing bilateral stimulation, which can reduce the vividness and emotion associated with the trauma memories. Ongoing research supports positive clinical outcomes, showing EMDR therapy as a helpful treatment for disorders such as anxiety, depression, OCD, chronic pain, addictions, and Complex PTSD (Maxfield, 2019). EMDR therapy has even been superior to Prozac in trauma treatment.)

10 Disability justice is an intersectional framework and movement, coined in 2005 by queer disabled people of color, that centers the lives and leadership of marginalized disabled people. It moves beyond legal rights to address how ableism, racism, colonialism, capitalism, and heteropatriarchy intersect to harm people, the biome, and the environment)

11 FN One therapist wondered why I was working so hard to prevent people from having euthanasia if they wanted to be dead. It made me wonder if she provided suicide prevention intervention to all clients who were suicidal, or just non-disabled ones.

Amy Hasbrouck is the director of Toujours Vivant - Not Dead Yet and a past-President of the Euthanasia Prevention Coalition.