Dutch Psychiatrist warns Canada: Don't extend euthanasia to mental illness

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Dr Jim van Os

I had the opportunity to speak to the Joint Committee on Medical Assistance in Dying (euthanasia) on May 5, 2026 (Link to my testimony). 

Before my presentation, the committee featured three Psychiatrists from the Netherlands explaining their experience with euthanasia for mental illness. Dr Jim van Os, a Professor of Psychiatry at Utrecht University warned Canada not to extend euthanasia to mental illness.

Professor van Os told the Parliamentary committee:

 

The Dutch experience, in my opinion, offers a warning for Canada. For 20 years our euthanasia law left psychiatric cases largely untouched. However, over the past decade, a small group of activist physicians and organizations built a practice through sustained media campaigns.

In 2024, the Dutch Euthanasia Expertise Center (euthanasia clinic) received around 5000 requests, roughly 1000 on psychiatric grounds. Among people under 30, requests rose from about 30 per year to nearly 900 in six years. Completed euthanasia rose fivefold.

This pattern has been widely interpreted as a so-called suicide contagion effect amplified by the institutions that should safeguard against it.

This committee perhaps should keep in mind under the Dutch law physicians must agree that there are no reasonable options. Euthanasia is in principle the very last resort. Canadian law does not work this way. 

In Canada patient choice trumps the physician's professional judgment. So a doctor cannot insist that other options be tried first. That single difference will in our assessment drive Canadian numbers beyond ours. 

In 2024 the UN Committee on the Rights of Persons with Disabilities warned that the Dutch practice was unsafe. Persons with psychosocial disabilities have a fundamental human right of protection against premature death. 

Euthanasia for mental suffering cannot be cleanly separated from physician performed suicide. It is in many cases suicide carried out by a psychiatrist. 

Our research and clinical work reveal a minefield on every side.

Autonomy. Most who request euthanasia for mental suffering are traumatized, marginalized, often living in poverty without prospects.

Mental illness, by definition, compromises autonomy. Calling such a request a free expression of choice ignores the substance of the suffering.

Discrimination. The arguments that refusing euthanasia for mental suffering is discriminatory equates psychiatric suffering with terminal cancer. It is a false equivalence.

Cancer with a two-month prognosis is linear and progressive. Mental suffering is not. Recovery happens often unexpectedly through relationships, purpose, meaningful work, bonding with another person or even an animal.

The patient recovery movement insists that recovery is possible for everyone. Plasticity is the rule.

Criteria. Clinicians do not agree on irremediability, on futility, on competence. The result is something like a lottery.

Whether you receive suicide prevention or a lethal injection depends on which clinician you meet.

Substance. Recent Dutch analysis show that many who receive euthanasia for mental illness are women with unaddressed trauma. Their unconscious self-destructive dynamics get enacted in the procedure. The psychiatrist becomes recruited into a deadly outcome.

Toffrey Wayne and colleagues describe how, in the Netherlands, people with autism spectrum traits increasingly receive euthanasia for what is at root social suffering framed in medical language. The intervention should be social and existential, not lethal.

Psychiatry claims it can prevent suicide in one patient and help finalize suicide in another with the same suffering. That is incoherent. It is not autonomy, it is not anti-discrimination, it is a contradiction at the heart or our profession. 

My message to Canada.

Do not expand euthanasia to those with mental illness. The evidence is not there. The UN, the International Association for Suicide Prevention and our lived experience point the same way. 

The social trials that we run in the Netherlands show another path. Care that builds relational continuity, hope and connectedness. That is the system worth building, not procedural pathways to death.

Canadians are getting euthanasia for reasons that are illegal.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Dr John Maher

Sharon Kirkey reported for the National Post on April 22, 2026 that Psychiatrist Dr. John Maher told the Special Joint Parliamentary Committee that is weighing Canada’s plan to extend euthanasia to those with a mental disorder alone that:

People with mental illnesses are already dying assisted deaths in Canada “under the guise of flimsy medical excuses” and others will “doctor shop until death” if euthanasia is allowed for psychiatric suffering alone.

 “I and other colleagues are experiencing this: People are clearly getting MAID for reasons that are frankly illegal,”

Kirkey also reported Maher's comments that Canada's euthanasia law may lead to a suicide contagion effect:

Maher, who specializes in treating severe mental illness, also warned Canada risks a “suicide contagion” effect if medical assistance in dying (MAID) becomes seen as a legitimate option for mental suffering. He pointed to the Werther Effect, a phenomenon that refers to a rise in suicides after publicized reports of celebrity deaths by suicide.

 Rates of suicide in jurisdictions that have legalized doctor-assisted death “have risen much faster after it was legalized than before,” he said.

“Suicide contagion is a well-proven reality. Don’t pretend that it won’t happen in Canada,” he said.

Euthanasia academic activist, Jocelyn Downie told the Special Joint Parliamentary Committee a few weeks ago that preventing euthanasia for people with mental illness will lead to violent other suicides. 

Research by Jim van Os, a Professor of Psychiatric Epidemiology and Public Health at Utrecht University Medical Centre, in The Netherlands was published on April 22, 2026 by Cambridge University Press, examined the relationship between suicide and youth psychiatric euthanasia. Based on research conducted on 353 young people who had requested euthanasia that for every 10 young people who die by euthanasia based on mental illness, only one of the ten would likely have died by suicide if euthanasia was not an option.

Kirkey reported that Maher, who is editor-in-chief of the Journal of Ethics in Mental Health and works with specialized teams that treat the most severe mental illnesses said that:

“people are getting MAID for psychiatric reasons under the guise of flimsy medical excuses, prolific MAID providers are happy to assist with suicide while people are on wait lists for effective treatment (and) MAID is being offered to veterans, disabled people and people with very treatable illnesses,”

Maher said that:

 “People need lifeguards, not someone to push you under,” 

Kirkey also reported Maher as stating:

“Decades of suicide research put the lie to this: 80 per cent of suicide attempters thoughtfully plan their suicides,” he said.

“MAID is suicide par excellence, like having a wedding planner to make it all as easy as possible, even with same-day service.”

Canada has scheduled euthanasia for psychiatric conditions alone to begin on March 17, 2027. The Special Joint Parliamentary Committee is examining whether or not Canada should extend euthanasia to people with mental illness next March.

Meanwhile, Private Members Bill C-218 is being debated in parliament. If passed Bill C-218 will prevent euthanasia for mental illness alone.

Psychiatric euthanasia (youth) and suicide prevention in the Netherlands

Alex Schadenberg

Executive Director, Euthanasia Prevention Coalition

Research by Jim van Os, a Professor of Psychiatric Epidemiology and Public Health at Utrecht University Medical Centre, in The Netherlands, that was published on April 22, 2026 by Cambridge University Press, examines the relationship between suicide and youth psychiatric euthanasia.

van Os responded to the claim that youth psychiatric euthanasia is necessary to prevent violent suicide deaths. Based on research on 353 young euthanasia applicants, van Os concludes that for every 10 youth psychiatric euthanasia deaths, 9 would not have died by suicide. van Os writes:

Thus, ten youths would need to undergo assisted dying to prevent one suicide, and nine would die without a preventive purpose having been served. Empirically and ethically, the prevention argument does not appear to hold; real prevention requires other, previously well-debated factors such as relational continuity, trauma-informed care and social inclusion in response to mental suffering.

van Os presents his concerns that the number of youth psychiatric euthanasia deaths in the Netherlands has increased substantially. He writes:

Between 2020 and 2024, the number of euthanasia procedures for individuals under 30 rose from 5 to 30, a sixfold increase, representing over 9% of all premature deaths (suicide + assisted dying) in that age group.

van Os suggests that youth psychiatric euthanasia has created a Werther effect, meaning that the acceptance of youth psychiatric euthanasia has created a suicide contagion effect. 

The "suicide prevention" argument was promoted by Menno Oosterhoff, a retired Dutch Psychiatrist. van Os explains:

The suicide prevention argument in The Netherlands was most notably advocated by a retired psychiatrist, who admitted in a national newspaper to having performed euthanasia 12 times in 11 months, including young people and minors. Introducing deterministic terminology like calling patients ‘mentally terminal’, the retired psychiatrist argued that refusing assisted dying to a suicidal patient can be catastrophic in the case of a ‘false-negative’ event. 

The prevention argument has received sympathetic and emotionally charged media coverage. There is anecdotal evidence that, as a result, clinicians in The Netherlands are increasingly faced with demands by young people – and sometimes their families – that euthanasia is indicated in order to prevent a suicide.

van Os explains the data concerning young people who request euthanasia:

The recent study by Schweren and colleagues on 353 young people (<24) who applied for psychiatric assisted dying at the Dutch Euthanasia Expertise Centre found that: 47% of applicants withdrew their request, 45% were rejected, 3% died by assisted dying and 4% died by suicide during the evaluation process, translating to an annual suicide risk of around 2.9%. So in this group explicitly requesting euthanasia, the annualised suicide rate is about five-fold higher than in other high-risk psychiatric populations – but still far from universal, meaning most do not die by suicide, even after requesting assisted dying. 

No jurisdiction that has legalized euthanasia has experienced a decrease in the suicide rate, van Os explains:

Empirically, there is no population-level evidence that assisted dying reduces suicide mortality. A systematic review by Doherty and colleagues found no consistent reduction in suicide rates in countries that legalised assisted dying; in some, suicides even increased. In The Netherlands, despite growing numbers of psychiatric euthanasia cases, suicide among young women continues to rise.

van Os then examined the theory that permitting euthanasia for youth with mental illness will decrease suicide. van Os uses "generous assumptions" and found:

Thus, even under generous assumptions, and realistic sensitivity scenarios thereof, the ‘preventive’ justification for assisted dying is not convincing. The intervention eliminates far more lives than it plausibly saves.

van Os examines several other factors and concludes that theory that permitting psychiatric euthanasia reduces other suicides creates a form of collusion:

When suicide prevention morphs into medicalised facilitation of death, prevention logic collapses into complicity. The preventive claim – ‘better assisted dying than a violent suicide’ – assumes a causal substitution that cannot be empirically or ethically established. It risks transforming demoralised youth into ‘false positives’ of a system that mistakes despair for autonomy.

From a strictly epidemiological standpoint, that facts are that: (a) suicide remains a rare outcome, even among those requesting assisted dying; (b) predictive accuracy for suicide is low; positive predictive value in youth is <20%; and (c) no evidence exists that assisted dying reduces suicide rates; in any realistic model, around 10 young people die for each suicide theoretically prevented by assisted dying.

Therefore, the argument that youth euthanasia prevents suicide appears to be scientifically unfounded and morally inverted. True suicide prevention lies not in medical facilitation of death but in restoring relational continuity, trauma-informed care and societal inclusion. Compassion without critical reasoning risks becoming cruelty by proxy.

The research by Jim van Os is important as Canadian debates extending euthanasia to people for psychiatric reasons alone.

Jocelyn Downie

Recently, euthanasia activist and academic, Jocelyn Downie, argued before a Parliamentary Committee that preventing euthanasia for mental illness alone will lead to violent suicide deaths.

Downie is a long-time activist who has bought into the Oosterhoff theory that euthanasia reduces other suicides. But Downie, like the others, didn't test the theory with actual data.

Canada has experienced a massive increase in euthanasia deaths and has also experienced a massive increase in suicide deaths. If Oosterhoff and Downie are correct, the suicide rate would actually be going down, or minimally speaking, not increasing. 

There is no jurisdiction, over a long period of time, that experienced a lowering of the suicide rate after legalizing euthanasia or assisted suicide.