France's euthanasia law is disturbing.

Dr. Mark Komrad

The following comments were provided by Dr. Mark Komrad, M.D., DFAPA, ACP, Faculty of Psychiatry, Johns Hopkins, University of Maryland, Tulane, and LSU

You may have heard that France’s National Assembly overrode their Senate’s objection to a proposed euthanasia law, and legalized it. A review by the French constitutional court has since upheld it, with a some of important clarifications, a couple of which are disturbing:

1. Like Canada and Benelux countries, the law allows both US style assisted suicide (oral prescription) AND euthanasia (IV lethal injection by doctor). [In all jurisdictions that permit both, typical 99%+ of patients choose euthanasia, to outsource the suicide to the physician].
2. Pharmacists retain the right to conscientious objection, and can refuse to dispense lethal meds, even when ordered.
3. Although religious institutions (Hospice’s, nursing homes) can refuse to provide the killing services, that is only if there is a nearby facility willing to provide the euthanasia. If not, then the right of religious-based objection is overridden, and the religious facility then MUST provide euthanasia to qualified patients! This resembles what we’re seeing in Canada, where some religious institutions’ conscientious objections have been overwritten on this issue.
4. Patients who lack capacity due to dementia, low IQ, etc. and have legal guardians, can be euthanized by doctors’ decision. Though the physician, who must consult the legal guardian those guardians DO NOT HAVE VETO POWER over the doctor’s decision, which is final. This is actually one of the most severe developments in the international spread of euthanasia laws.*

We are horrified by the implementation of this law in France and are gravely concerned with the countless French citizens who are now at risk of deadly harm, particularly people with disabilities.

Response to: The Paradox of Assisted Suicide.

Mara Buchbinder's thesis: The Paradox of Medical Aid in Dying suggests that legalizing assisted suicide is popular because the practice is rare. Buchbinder also asserts that legalizing assisted suicide improves the death experience because patients can plan and discuss their death.

Dr's Pies, Geppert, Komrad and Hanson respond.

Dear Colleagues,

As psychiatrists and medical ethicists, we strongly disagree with anthropologist Mara Buchbinder, Ph.D.’s “Perspective” in the New England Journal of Medicine. [1] We believe Buchbinder’s thesis ignores the central, ethical issue underlying physician-assisted suicide (PAS) and offers several fallacious justifications for PAS.

First: nowhere in Buchbinder’s analysis is there any discussion of whether PAS is ethically justified, or consistent with the values of Hippocratic medicine. Many prominent medical organizations have repeatedly said it is not. [2,3,4]

Furthermore, it is a morbid irony to assert that an "unintended benefit" of MAID laws is to help "…start new conversations about what matters most to patients in the final stages of serious illness…” Does Buchbinder seriously believe that such intimate physician-patient conversations require legislation authorizing medically-assisted suicide on demand?

In truth, discussing MAID with a terminally ill patient narrows the conversation and orients the patient toward death as the preferred option. Responsible palliative care identifies options based on the patient’s actual goals and values [5]

Equally fallacious is Buchbinder’s reference to “this potential of MAID to control uncertainty” stemming from “the current historical moment.” The implication that a patient’s anxiety over “political unrest, economic instability, [and] climate change” is appropriately addressed by offering medically assisted suicide is stunning in its perversity.

As medical ethicist Dr. Leon Kass has observed, “We must care for the dying, not make them dead.” [6]

Respectfully,

Ronald W. Pies, MD 
Cynthia M.A. Geppert, MD, PhD, MA, MPH, MSBE, DPS, MSJ 
Mark S. Komrad, MD 
Annette Hanson, MD

References

1. Buchbinder M. The Paradox of Medical Aid in Dying. NEJM 395;5 July 30, 2026 [attached]

2. Snyder Sulmasy L, Mueller PS; Ethics, Professionalism and Human Rights Committee of the American College of Physicians. Ethics and the Legalization of Physician-Assisted Suicide: An American College of Physicians Position Paper. Ann Intern Med. 2017 Oct 17;167(8):576-578

3. American Medical Association Code of Ethics. https://code-medical-ethics.ama-assn.org/ethics-opinions/physician-assisted-suicide

4. WMA Declaration on Euthanasia and Physician-Assisted Suicide. (2019). https://www.wma.net/policies-post/declaration-on-euthanasia-and-physician-assisted-suicide/

5. Geppert CM. Futility in Chronic Anorexia Nervosa: A Concept Whose Time Has Not Yet Come. Am J Bioeth. 2015;15(7):34-43. doi: 10.1080/15265161.2015.1039720. PMID: 26147264.

6. Kass L. Dehumanization Triumphant. First Things. Aug. 1, 1996. https://firstthings.com/dehumanization-triumphant/

Euthanasia: No Evidence Base for Futility and Irremediability in Psychiatric Disorders

This commentary was published by The Psychiatric Times on April 6, 2026.

By Dr's Mark Komrad and Catherine Ferrier

Dr Mark Komrad

As Canada approaches the planned implementation of their medical euthanasia program—or medical aid in dying (MAID)—for patients with sole psychiatric illnesses in March 2027, the Canadian Parliament is again studying the advisability of this decision. Here, we make an argument as to why these practices should remain closed to individuals with psychiatric disorders.

Unlike many other kinds of illnesses, futility or irremediability cannot be reliably resolved by clinicians in cases of psychiatric disorders, especially for any one particular individual. As Sonu Gaind, MD, past president of the Canadian Psychiatric Association and chair of the Toronto Expert Advisory Group on MAID for mental illness, wrote, “An extensive review of the literature shows that we cannot predict irremediability when it comes to mental illness. . . There is a big difference between being able to predict the declining course of a well-known medical ailment with understood biology, even if not with 100% certainty, versus making unpredictable assessments about the course of mental illnesses.”1 Some reasons for this follow.

Diagnosis and Prognosis of Mental Disorders Are Unreliable

Prognosis, the ability to predict the course of any illness—with or without treatment—depends on accurate identification of what the illness is, so that we can mine scientific evidence about the course of that illness. Because psychiatric conditions are based on patient’s history and clinical observation of the individual (rather than other kinds of validations, like blood tests, imaging studies, etc) the reliability of psychiatric diagnosis is limited. Studies have shown that clinicians agree on a patient’s formal psychiatric diagnosis between 66% to 75% of the time.2 Also, over time, psychiatric diagnoses are liable to be changed, much more than diagnoses of somatic illnesses. So, the unreliability and instability of psychiatric diagnoses mean that predicting the course of a patient’s condition, the prospect of its remission, and its response to any or all treatment, are too elusive to declare any one case “untreatable” or “futile.” The level of uncertainty in the science of psychiatric prognosis is very high.3

Inability to Know Which Suicides to Prevent and Which to Provide

Because of these unpredictable aspects, allowing MAID for some psychiatric patients, but not for all, poses a profound and irresolvable clinical conundrum—how to distinguish those patients for whom suicide should be prevented from those for whom it should be provided. The chairs of all 17 academic departments of psychiatry in Canada expressed profound concern about allowing MAID for mental disorders for this reason.4 Imagine a likely scenario if MAID were legalized for psychiatric disorders: a psychiatric inpatient ward where some patients are being treated for suicidal thinking or behavior, perhaps involuntarily, but others on the same ward might be deemed eligible to receive MAID. Besides the moral injury to the clinicians, how confusing it would be for the patients in that milieu! Now scale up this conundrum to the general population where, nationally, some suicides for mental disorders are not prevented, but provided. That will impact the taboo against suicide—a vital component of suicide prevention in general. A taboo (“it is not good to commit suicide”) is different than stigma (“you should be ashamed if you try it”). Indeed, because of MAID’s dampening taboo, there is growing evidence that the rates of “ordinary suicide” in jurisdictions that have MAID (specifically Oregon, Switzerland Netherlands, Belgium5 and Australia6) have risen much faster after it was legalized than before, strongly suggesting the emergence of “suicide contagion”—a well-known public health phenomenon. The mixed messages of the provided vs the prevented suicides are profoundly impactful, particularly on those with mental illness, who already struggle with impairment in rational reflection about suicide as an option.

Enormous and Nonspecific Variety of Treatments for Mental Disorders

The breadth of treatments for psychiatric illnesses is wider than for somatic treatments. There is much less specificity for any one medication, therapy, or procedure for a mental disorder. Treatments for psychiatric disorders are much less precise than for somatic disorders.7 For example, a medication that might be effective for schizophrenia will also be effective for bipolar disorder, anxiety, posttraumatic stress disorder, insomnia, eating disorder, and others. Psychiatric treatments come in many modalities from over 100 pharmaceuticals of different actions to several hundred bona fide methods of talk therapy and physical treatments,8 like electroconvulsive therapy, transcranial magnetic stimulation, and many others. The response of several patients with a similar psychiatric condition can be highly variable,9 more so than for nonpsychiatric conditions, requiring a much more robust trial-and-error approach. Patients typically require more than one kind of treatment for optimal benefit. There is not widespread availability for so many of these various treatments, particularly some cutting-edge treatments like psilocybin, clozapine, ketamine, and dialectical behavior therapy. Some are available only in academic centers and some are wielded primarily by subspecialists in a certain condition, who may be difficult to access, as they are scarce, with long waiting lists to see them. Waiting lists for such specialists in Canada can be far longer than the 90-day wait for Track 2 MAID.10 Off-label treatments are especially common in psychiatry, even when there is a good evidence base, so they may be difficult to get approved.11 Therefore, not every treatment is available to every psychiatrist, and indeed, not every psychiatrist is even aware of the full scope of treatment options, or is trained in them.12

The Challenge of Evaluating Capacity to Consent to MAID

Capacity to consent to treatment is more elusive in the setting of mental illness. The most respected bioethics textbook in the world, Principles of Biomedical Ethics, written by Beauchamp and Childress, defines autonomy as: “Self-rule that is free from both controlling interference by others and from inner limitations.”13 Mental illnesses and their associated cognitive and emotional distortions are the quintessential inner limitations. The state-of-the-art of capacity assessment is a highly complex one, which was developed for far less serious existential issues than to make the decision to end one’s life. It was developed for capacity to stand trial, write a will, consent to surgery, etc. Even at that level, capacity assessment requires specialized training that even most psychiatrists do not have. It is a skill that is provided mostly by certain psychiatric subspecialists—forensic psychiatrists and consultation-liaison psychiatrists who work on medical and surgical wards. Even in the Netherlands, a country that has had 2 decades to develop experience with psychiatric MAID, one study showed that 92% of psychiatric patients receiving euthanasia had inadequate capacity assessment,14 because there were no agreed upon standards for such an assessment for approving a suicidal wish in that cohort where suicidal feelings are particularly endemic.

Those With Mental Illness Are More Marginalized and More Vulnerable

Family physician Ramona Coelho has written: “When feeling like a burden, or when loneliness, depression, or fear of prolonged suffering are the factors driving the decision, the choices for MAID are not made in true freedom but are borne of anguish and desperation... Suffering can distort autonomy.”15 Mental illness can indeed cause severe suffering. One might even consider it the “most human” form of suffering. That marginalization makes individuals more vulnerable to requesting MAID, which has been widely documented in Canada. Those with chronic and severe mental illnesses are among the most marginalized citizens of all. They are overrepresented in the lowest socioeconomic quintile of the population.16 They are more likely to be underresourced, disabled, unhoused, and stigmatized than people with other medical conditions. Franklin Roosevelt famously said, “necessitous men are not free men.” Those with mental illness are disproportionally necessitous.

MAID Inverts the Fundamental Ethos of Mental Health Professions

It is already challenging for physicians to get out the way of death, and to refer patients for palliative care. Further, to administer the means to actively produce death is anathema to medical ethics, but particularly for psychiatrists, whose daily work and fundamental ethos is to prevent suicide. This is why the American Psychiatric Association is opposed to any intervention to produce death for those with mental illness.17 Mental health professionals typically have longer and more frequent encounters with individual patients than other physicians and health care professionals. Helping individuals deal with despair, demoralization, suffering, and hopelessness is a core mission in the mental health professions. Psychiatric clinicians address symptoms, but also build coping mechanisms, mobilize support systems, and even help people make meaning of unresolved suffering. Mental health experts are skilled at accompanying patients in their afflictions and have specific training and experience on how to avoid absorbing a patient’s hopelessness and nihilism, a skill set which is independent of any psychiatric diagnosis. To create a facilitated path to suicide by opening MAID in the setting of mental health treatment is a profound, indeed revolutionary, and perilous inversion of that professional ethos for individual patients, and for public mental health.

Dr Komrad is a psychiatrist on the teaching staff of Johns Hopkins Hospital in Baltimore, Maryland. He is also a clinical assistant professor of psychiatry at the University of Maryland in Baltimore and on the teaching faculty of psychiatry at Tulane University and Louisiana State University in New Orleans, Louisiana. He is also a founding member of the international physicians’ organization Doctors Say No.

Dr Ferrier is a family physician working in the Division of Geriatric Medicine of the McGill University Health Centre. She is an assistant professor in the Department of Family Medicine at McGill University in Montreal, Quebec, Canada, and is the president of the Physicians’ Alliance Against Euthanasia.

References are attained by linking to the original article (Article 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.

Euthanasia of the mentally ill in the Netherlands is increasing.

This article was published by National Review online on March 9, 2026.

Wesley Smith

By Wesley J. Smith

As the West lunges toward propagating a right to be made dead, the deleterious societal impacts of being legally “MAIDed” (killed by “medical assistance in dying”) are becoming increasingly clear. A recent professional analysis published in the Psychiatric Times illustrates the lethal influence on mentally ill suicidal people — including youth — in the Netherlands.

Article: Euthanasia for young people and psychiatric reasons in the Netherlands (Read).

From “Psychiatric Euthanasia in the Netherlands: Young People, Procedural Medicine, and the Limits of Psychiatry” (citations omitted):

Requests for euthanasia on psychiatric grounds have risen sharply, with a disproportionate increase among young adults and, more recently, minors. The Dutch model, once presented internationally as careful and balanced, is now attracting attention for a different reason: growing uncertainty about whether psychiatry has crossed a boundary it cannot coherently justify.

This increase has had a deleterious impact on suicidal youth:

The numerical trend among youth underscores why concern has intensified. For many years, psychiatric euthanasia in the Netherlands was virtually nonexistent. Between 2002 and 2010, only 1 or 2 cases per year were reported across all age groups. This changed markedly after 2011. According to data published by the Regional Euthanasia Review Committees, the number of psychiatric euthanasia cases increased from 2 in 2011 to 138 in 2023, followed by a further sharp rise to 219 cases in 2024, representing an increase of roughly 60% in a single year.

When euthanasia deaths are considered alongside suicides, assisted dying now accounts for a growing proportion of premature deaths among young adults, particularly young women, raising serious concerns about contagion effects, shifting cultural norms, and the population-level consequences of introducing medicalized death into the care landscape for youth with mental suffering.

The phenomenon of “doctor shopping” (as I call it) has long been a problem with legalized euthanasia and assisted suicide. The problem also exists in the Netherlands. The authors point to a retired psychiatrist who has repeatedly MAIDed mentally ill patients whom other psychiatrists had refused to terminate:

Menno Oosterhoff, a retired Dutch psychiatrist whose actions have profoundly shaped public perception. In an 11-month period, he performed 12 euthanasia procedures for mental suffering, including cases involving youth and at least 1 minor. He publicly described his trajectory as a moral awakening, introducing the term “mentally terminal” to suggest an analogy between mental suffering and terminal somatic illness. The concept has no grounding in psychiatric science or developmental psychology, but it proved rhetorically powerful. . . .

Colleagues reported troubling practices. Young patients were sometimes redirected toward euthanasia pathways while their treating teams were still actively engaged and believed meaningful improvement was possible. The message implicit in such interventions was that persistence in treatment could be bypassed if even one clinician was willing to declare suffering irremediable. The clinical authority of ongoing therapeutic relationships was thus undermined by a parallel pathway oriented toward death.

As we have seen before, a rogue euthanasia death doctor can become a celebrated media figure, helping spread the euthanasia virus:

Oosterhoff recorded euthanasia conversations with a minor and made them available online. The material was later removed as the footage caused significant distress among clinicians, ethicists, and child psychiatrists. Yet, rather than prompting restraint, it increased his visibility. He became a frequent guest on television talk shows and published a bestselling book, positioning himself as a moral pioneer. . . .

Patients can search for permissive clinicians, and once euthanasia has been suggested by one professional, it becomes exceedingly difficult for others to refuse. Social media and sympathetic media coverage amplify these dynamics, producing contagion effects. Requests spike after high-profile stories, particularly among young women.

The authors conclude:

The Dutch experiment with psychiatric euthanasia, particularly in youth, can no longer be described as cautious, balanced, or exemplary. What has emerged over the past decade is an unstable configuration in which activism, procedural regulation, and moral avoidance increasingly substitute for clinical humility and epistemic restraint. Practices that appear on paper to respect individual autonomy generate, at the population level, predictable and troubling effects: contagion phenomena following media exposure, forum shopping among clinicians, widening diagnostic claims of irremediability, and the steady medicalization of social, developmental, and existential distress.

(This analysis is consistent with other studies showing that legalizing and advocating assisted suicide increase suicides overall.)

Euthanasia for young people and Psychiatric reasons in the Netherlands.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

In the Netherlands, euthanasia for psychiatric reasons and for young people have increased substantially over the past few years.

Jim van Os, MD, PhD, Wilbert van Rooij, MD, Mark S. Komrad, MD, DFAPA wrote a research article that was published in the Psychiatric Times on March 5, 2026 examining these issues.

The authors examine the Netherlands euthanasia data and suggest that there was "professional restraint" in the early years of the euthanasia law since the law did not prohibit euthanasia for young people or based on mental illness. The authors explain that euthanasia for these groups, in the early years, was almost non-existent. They write:

The numerical trend among youth underscores why concern has intensified. For many years, psychiatric euthanasia in the Netherlands was virtually nonexistent. Between 2002 and 2010, only 1 or 2 cases per year were reported across all age groups. This changed markedly after 2011. According to data published by the Regional Euthanasia Review Committees, the number of psychiatric euthanasia cases increased from 2 in 2011 to 138 in 2023, followed by a further sharp rise to 219 cases in 2024, representing an increase of roughly 60% in a single year.

Within this expansion, youth euthanasia cases are increasingly prominent. Between 2020 and 2024, the number of euthanasia cases for individuals under 30 rose from 5 to 30, a 6-fold increase, representing over 9% of all premature deaths (suicide + assisted dying) in that age group in the Netherlands. When requests rather than completed euthanasia are considered, the numbers are worrying. Given that an estimated 3% of youthful (<24 years) applicants receive euthanasia, the estimated number of youthful applicants in 2024 would total 7300.

The authors suggest that the majority of Psychiatrists in the Netherlands remain reluctant to participate in euthanasia but a small group of psychiatrists have has actively promoted psychiatric euthanasia as an expression of compassion and respect for autonomy and they have established a group called the Dutch, Knowledge Center for Euthanasia in Mental Disorders (KEA) that is actually an activist group. The authors explain:

According to its website, its aim is to increase knowledge and societal acceptance of euthanasia for mental suffering, to improve access to euthanasia trajectories, and to support and advocate for patients with mental illness who request euthanasia, as well as their relatives and involved professionals. While presenting itself as a foundation for recognition and dignity, KEA operates as an activist organization, lobbying policymakers, engaging strategically with media, and exerting public pressure on dissenting professionals.

The authors continue:

In this framing, complex mental suffering rooted in trauma, social marginalization, developmental vulnerability, and failures of care are increasingly presented as a medical dead end. Structural deficits in mental health services, including long waiting lists and fragmented care, fade into the background. Professional hesitation is reframed as cruelty or paternalism rather than as clinical prudence.

This is an important statement for Canada to consider. Since Canada also has massive structural deficits in mental health services and long waiting times, promoters of euthanasia for mental illness would also argue that it is a cruel paternalism to deny a person death by euthanasia.

The authors then describe the role of Menno Oosterhoff in creating an atmosphere of acceptance for youth and psychiatric euthanasia. The authors write:

This shift has been personified by Menno Oosterhoff, a retired Dutch psychiatrist whose actions have profoundly shaped public perception. In an 11-month period, he performed 12 euthanasia procedures for mental suffering, including cases involving youth and at least 1 minor. He publicly described his trajectory as a moral awakening, introducing the term “mentally terminal” to suggest an analogy between mental suffering and terminal somatic illness.

The concept has no grounding in psychiatric science or developmental psychology, but it proved rhetorically powerful. Oosterhoff recorded euthanasia conversations with a minor and made them available online.9 The material was later removed as the footage caused significant distress among clinicians, ethicists, and child psychiatrists. Yet, rather than prompting restraint, it increased his visibility. He became a frequent guest on television talk shows and published a bestselling book, positioning himself as a moral pioneer.

Colleagues reported troubling practices.9 Young patients were sometimes redirected toward euthanasia pathways while their treating teams were still actively engaged and believed meaningful improvement was possible. The message implicit in such interventions was that persistence in treatment could be bypassed if even one clinician was willing to declare suffering irremediable. The clinical authority of ongoing therapeutic relationships was thus undermined by a parallel pathway oriented toward death.

Canada has had a similar experience with Dr Ellen Wiebe's euthanasia practise. 

Euthanasia for psychiatric issues in the Netherlands has turned suicide prevention efforts upside down. The authors write:

A central justification advanced by proponents is that psychiatric euthanasia prevents violent or lonely suicides. While emotionally compelling, this claim fails empirically. Epidemiological analysis demonstrates that even under optimistic assumptions, euthanasia functions as a profoundly inefficient and harmful preventive strategy. Approximately 9 young individuals would need to die by euthanasia to prevent 1 suicide.

This result reflects a fundamental base-rate problem. Even among high-risk psychiatric populations, suicide remains a rare event. Introducing euthanasia as a sanctioned outcome reframes suicidality from a symptom requiring containment into a potential treatment endpoint, an acceptable “treatment plan.” For youth with trauma histories and narrowed future perspectives, this can entrench death-focused thinking rather than alleviate it.

The activities of KEA and the Thanet group caused a group of psychiatrists to submit their concerns. The authors explain:

A group of psychiatrists submitted a letter to the Dutch Public Prosecution Service to raise alarm about the activities of the KEA foundation and Thanet, a web-based pro-euthanasia initiative. This letter argued that the combined media activism of KEA and the policy-driven pressure created by Thanet substantially contributed to the well-known Werther or contagion effect,15 as repeated television appearances and newspaper stories were followed by a sharp rise in euthanasia requests from youth, raising serious concern that the Netherlands was drifting toward a harmful and irresponsible practice.

The authors call on International guidelines to fill in the blanks in countries like the Netherlands and Canada who lack defined guidelines. They write:

The emergence of such institutional guidelines should be understood not as a solution, but as a symptom. They reflect the absence of a coherent national framework capable of holding together legal permissibility, clinical uncertainty, developmental science, and moral responsibility. Youth with severe mental suffering do not primarily need more refined procedures for death. They need time, continuity, relational safety, and systems capable of holding despair without prematurely foreclosing the future. The Dutch system, as it currently functions, offers certainty where humility is required and procedural clarity where ethical wisdom is lacking. No one can say with confidence where this trajectory will end. What is increasingly clear is that psychiatry, positioned as arbiter of death in the lives of youth, is being asked to carry a responsibility it cannot ethically or scientifically sustain.

This article is particularly important for Canada. Canada also lacks definitive guidelines and Canada has approved euthanasia for mental illness to officially begin on March 17, 2027. Canadians need to examine the Netherlands data and then reject euthanasia for youth and for mental illness. 

Professor of Psychiatry speaks about assisted suicide and suicide.

On Suicide Prevention day (September 10), Professor Mark Komrad, clinical professor of psychiatry from Maryland, was interviewed by Dr Gillian Wright with Our Duty of Care (UK) on the challenges of assisted suicide for psychiatrists as it relates to suicide prevention. What can we learn from the Oregon model of assisted suicide, where the law has expanded and where financial considerations often outweigh ethical concerns, creating a troubling precedent in medical practice? 

(Link to the podcast)

Gillian Wright MD of Our Duty of Care in the UK interviewed Professor Komrad for their podcast.. Topic—why assisted suicide and ordinary suicide can’t be easily separated as two different “types of suicide.” He also discussed flaws in the Oregon law permitting assisted suicide and their subsequent experiences and misadventures. 

Professor Mark Komrad

Professor Komrad was quoted, last week, by a member of the House of Lords in the UK who heard the interview and spoke about it in the House of Lords debate concerning the pending Kim Leadbeater (UK) assisted suicide.  

Listen to this podcast interview, and / or wish share it with your networks: (Link to the podcast)

Proposed UK Assisted Dying Bill Fails Public Safety Test

This letter was published in the British Medical Journal.

Dear Editor,

As the UK Parliament prepares to debate assisted dying, its impact on those with mental health conditions, particularly eating disorders, must be urgently considered. If legalised, the proposed bill may enable patients with treatable eating disorders who have life-threatening malnutrition and/or feel suicidal to qualify for assisted death. Looi (1) highlights global expansion in assisted dying laws, yet gaps in safeguarding vulnerable groups remain.

Research suggests assisted dying laws have already led to preventable deaths of young people with eating disorders in multiple countries (2). At least 60 individuals with eating disorders have died through physician-assisted death, including in jurisdictions limiting the practice to terminal conditions. Of these, one-third involved women under 30. These deaths raise profound ethical concerns, as many patients were severely depressed or suicidal when deemed eligible.

These patients did not have concurrent terminal illnesses. Rather, clinicians asserted their eating disorders were “untreatable,” offering limited substantiating evidence. Some practitioners suggested patients had “terminal anorexia,” a term not recognised by any medical authority (3). Downs et al. (4) described it as a “nosological free-for-all,” highlighting the danger of inventing new illness classifications to justify ending vulnerable lives under the guise of medical treatment. Empirical efforts to validate terminal anorexia have raised significant questions about its validity (5). Anorexia nervosa is not a terminal condition; almost all the medical complications of eating disorders are reversible with nutrition and weight restoration (6).

The proposed bill aims to restrict eligibility to terminal illness — in practice, this safeguard is porous. In Oregon US, officials interpret “terminal illness” as any condition expected to cause death within six months if untreated (7). Patients with non-terminal conditions can become terminal by choosing to forego life-extending treatments, such as dialysis. This has led to deaths in patients with non-terminal conditions; including anorexia, arthritis, and hernias (8). The wording of the proposed U.K. bill similarly allows for this broad interpretation, offering minimal protection to vulnerable patients (9).

Assessing capacity to make a life-ending decision is particularly fraught in patients with malnutrition or mental distress (10, 11) who may appear lucid and articulate, yet struggle to process information fully. Evidence suggests that clinicians’ judgments of capacity in these patients are often inconsistent (11). In Oregon, only three individuals who received lethal prescriptions (1%) were referred for psychiatric evaluation in 2023, down from 33% in previous years (12), raising concerns that evaluators have become less cautious about capacity and psychiatric comorbidities.

Moreover, evidence from jurisdictions where assisted dying is legal reveals weak oversight and opaque reporting mechanisms (13). For example, U.S. oversight agencies confirmed anorexia nervosa has been documented as a terminal illness in cases of assisted death; however, these cases are hidden in public reports under the broad category “Other Illnesses” (2). Officials declined to disclose the exact number of cases, and agencies have limited authority to investigate potential misapplications of the law.

In the UK, the Court of Protection has already allowed treatment withdrawal and palliative care for eating disorders deemed ‘untreatable’ (14). However, researchers have raised concerns that many patients are labeled 'untreatable' without having received adequate treatment (4). If the proposed bill passes, “palliative care for eating disorders” may expand to assisted dying, undermining protections for those with complex, often stigmatised mental health conditions.

Evidence from other jurisdictions should serve as a stark warning to UK policymakers. The question before Parliament is not only whether individuals have the right to die, but whether assisted dying can be safely implemented within the NHS. Evidence from other countries shows that safeguards intended to protect vulnerable patients from medically-assisted suicide have failed. We urge MPs to weigh these findings carefully and vote against the bill—it fails the public safety test.

Chelsea Roff
Executive Director, Eat Breathe Thrive

James Downs
Peer Researcher and Expert by Experience

Agnes Ayton
Consultant Psychiatrist in Eating Disorders
Oxford Health NHS Foundation Trust

Ashish Kumar
Chair, Faculty of Eating Disorders, RCPsych
Clinical Director at Mersey Care Foundation Trust

Angela Guarda
Professor of Psychiatry and Behavioral Sciences Director
Eating Disorders Program Johns Hopkins School of Medicine

Patricia Westmoreland
Medical Director, ACUTE Center for Eating Disorders & Severe Malnutrition Department of Psychiatry, University of Colorado

Philip Mehler
Founder, ACUTE Center for Eating Disorders & Severe Malnutrition
Professor of Medicine, University of Colorado

Mark S. Komrad
Faculty of Psychiatry
Johns Hopkins School of Medicine, Tulane, and University of Maryland

Paul Appelbaum
Dollard Professor of Psychiatry, Medicine & Law
Columbia University

Ronald W. Pies
Professor Emeritus of Psychiatry
SUNY Upstate Medical University

Annette Hanson
Assistant Professor
University of Maryland

Catherine Cook-Cotton
Licensed Psychologist, Professor and Researcher
University at Buffalo (SUNY)

Anita Federici
Clinical Psychologist
Center for Psychology and Emotion Regulation

Hope Virgo
Founder of #DumptheScales, Author,
Mental Health Campaigner

Ali Ibrahim
Consultant Psychiatrist, Eating Disorders

Suzanne Baker
Family & Carer Representative, FEAST UK

Marissa Adams
Peer Research & Expert by Experience

References
1. Looi, M. K. (2024). Assisted dying laws around the world. bmj, 387.
2. Roff, C., & Cook-Cottone, C. (2024). Assisted death in eating disorders: a systematic review of cases and clinical rationales. Frontiers in Psychiatry, 15, 1431771.
3. Gaudiani, J. L., Bogetz, A., & Yager, J. (2022). Terminal anorexia nervosa: three cases and proposed clinical characteristics. Journal of eating disorders, 10(1), 23.
4. Downs, J., Ayton, A., Collins, L., Baker, S., Missen, H., & Ibrahim, A. (2023). Untreatable or unable to treat? Creating more effective and accessible treatment for long-standing and severe eating disorders. The Lancet Psychiatry, 10(2), 146-154.
5. Robison M, Udupa NS, Abber SR, Duffy A, Riddle M, Manwaring J, Rienecke RD, Westmoreland P, Blalock DV, Le Grange D, Mehler PS, Joiner TE. "Terminal anorexia nervosa" may not be terminal: An empirical evaluation. J Psychopathol Clin Sci. 2024 Apr;133(3):285-296. doi: 10.1037/abn0000912. PMID: 38619462; PMCID: PMC11062513.
6. Westmoreland P, Krantz MJ, Mehler PS. Medical Complications of Anorexia Nervosa and Bulimia. Am J Med. 2016 Jan;129(1):30-7. doi: 10.1016/j.amjmed.2015.06.031. Epub 2015 Jul 10. PMID: 26169883.
7. Stahle F. Notarized Questions to Oregon Health Authority. January 2018. Available online: https://drive.google.com/file/d/1XopTDjBA2SAVBGBxpDazNN899eTHixSe/view
8. Oregon Health Authority. Oregon Death with Dignity Act: 2021 Data Summary (2022). Available online at: https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARC...
9. Leadbeater K. Terminally Ill Adults (End of Life) Bill. Nov 11, 2024. https://bills.parliament.uk/bills/3774 [Accessed 14th November 2024].
10. Van Elburg, A., Danner, U. N., Sternheim, L. C., Lammers, M., & Elzakkers, I. (2021). Mental capacity, decision-making and emotion dysregulation in severe enduring anorexia nervosa. Frontiers in Psychiatry, 12, 545317.
11. Elzakkers, I. F. F. M., Danner, U. N., Grisso, T., Hoek, H. W., & van Elburg, A. A. (2018). Assessment of mental capacity to consent to treatment in anorexia nervosa: A comparison of clinical judgment and MacCAT-T and consequences for clinical practice. International journal of law and psychiatry, 58, 27–35. https://doi.org/10.1016/j.ijlp.2018.02.001
12. Oregon Health Authority. Oregon Death with Dignity Act: 2023 Data Summary (2024). Available online at: https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARC...
13. Raikin, A. (2024). A pattern of non-compliance. The New Atlantis. 11 November 2024.
14. Cave, E., & Tan, J. (2017). Severe and enduring anorexia nervosa in the England and Wales Court of Protection. International Journal of Mental Health and Capacity Law, 23(17).

Canada's euthanasia slippery slope.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

An article written by Meagan Gillmore and published in Canadian Affairs on July 19, 2024 refers to Canada's euthanasia law as a slippery slope. This article is important for how it covers Canada's euthanasia law but also how several American death lobby leaders respond.

Gillmore interviewed Ian McIntosh, a Canadian who lives in Virginia. Gillmore writes:

But reports of Canada’s permissive medical assistance in dying (MAID) laws, and stories of people accessing it due to poverty or disability, fill him with “profound concern and disbelief,” he said from northern Virginia, his home since 2016.

McIntosh, originally from Ontario, says if someone had told him in 2015 and 2016, when Canada’s first MAID law was being crafted, that Canada would eventually allow adults without terminal illnesses to qualify for MAID, he “would have said this is out of some horror novel, some dystopian novel.”

Thaddeus Pope

Gillmore quotes Thaddeus Pope, an American euthanasia activist and bio-ethicist, who states:

“When people say, ‘slippery slope,’ the implication is that the thing at the bottom of the slope is a place you do not want to be,”

“I don’t think the thing at the bottom of the slope is actually a thing to avoid, even if we were sliding there,”

“I don’t think we are, but even if we were sliding toward Canada, I don’t think that’s a bad thing.”

Thaddeus Pope stated on his Blog that:

I make some comments in this new article in Canadian Affairs. The article contrasts MAID laws in the United States and Canada. I argue that Canada is a model, not an anti-model.

Pope confirms the point that we have been making for several years. The American assisted suicide lobby wants to expand their laws from assisted suicide to euthanasia. In other words, the American assisted suicide lobby is not satisfied with limiting assisted deaths to doctors prescribing lethal poison, but rather they want to follow Canada's lead and allow doctors and nurses to lethally administer the poison.

Assisting a suicide is what is currently permitted in 10 US states but the assisted suicide lobby want to transform their laws to permit doctors and nurses directly killing their patients (euthanasia) which is a homicide and is what occurs in Canada.

Anita Cameron

Gillmore interviews Anita Cameron from Not Dead Yet. Gillmore writes:

Despite differences in law, philosophical arguments supporting and opposing MAID are similar in both countries. So are concerns that MAID will put people in vulnerable situations — including people with disabilities and those living in poverty — at increased risk of being explicitly or implicitly coerced into ending their lives.

Anita Cameron, director of minority outreach at Not Dead Yet, a national disability rights organization, says people with disabilities are scared that what has happened in Canada could happen in America. “We’re trying to sound the alarm here,” she said.

Cameron, who has multiple disabilities, lived in Canada temporarily when she was younger and once considered moving to Canada permanently. “There’s no way in this universe, this multiverse, or the next that I will move to Canada now,” she said.

Gillmore quotes Dr Mark Komrad, a psychiatrist in Maryland. Gillmore writes:

Dr. Mark Komrad, a practising psychiatrist and medical ethicist based in Maryland, where assisted dying legislation was recently introduced, says any form of MAID represents “a profound and fundamental change in civilization in general, certainly in medical ethics.”

It contradicts a clear medical ethic: that doctors do not harm their patients, he says.

Komrad became interested in assisted dying laws worldwide in 2015 when he heard of psychiatric patients in Europe dying by MAID. Soon, he learned about Canada. He now travels internationally, sharing his concerns about MAID, which he considers to be assisted suicide.

He compares himself to Paul Revere, who warned Americans about British armies during the American Revolution. Only, Komrad warns Americans about the dangers of MAID in Canada and elsewhere.

Gillmore continues:

The two countries have very different laws, says Pope. “Canada is basically the most permissive in the world, and the United States is the most restrictive in the world,” he said, comparing the countries’ eligibility criteria. “Even though they are right next to each other, they’re about as far apart as you can get in terms of eligibility and who can access it legally.”

In the US, patients must have a terminal illness — meaning medical professionals have determined they are reasonably likely to die within six months. Canada, by contrast, has never had a time-based requirement and removed the requirement that someone’s death be “reasonably foreseeable” in 2021. This created what is known as Track 2 MAID — MAID for people who have serious illnesses, diseases or disabilities and are suffering, but whose deaths are not reasonably foreseeable.

MAID is administered differently in the countries, too. In the US, patients must self-administer lethal drugs. In Canada, most patients receive the drugs intravenously. Fewer than seven people who died by MAID in both 2021 and 2022 self-administered the drugs, according to Health Canada reports.

Gillmore quotes Komrad:

“Canada is the most compelling case study for anyone who pays attention and is interested in this,” he says. Countries that legalized MAID before Canada, such as Belgium, the Netherlands and Luxembourg, “are easy [for Americans] to dismiss” because of distance and size. Canada is closer to the US — geographically and culturally, he says.

“When you see this galloping [horse] of MAID in Canada, I think it’s a lot easier for Americans to identify that that can happen here,”

Gillmore juxtaposes Komrad with comments from Thaddeus Pope:

“Canada is, in a sense, 20 years ahead of the US on this,” he said. “Obviously, it’s informative to look at what might you authorize. You don’t have to do any of it.”

Pope supports Canada’s current laws, although some aspects of Track 2 MAID make him uncomfortable. He says there should be a way to ensure Track 2 applicants have seriously considered non-lethal options to relieve their suffering.

“I think that generally each person is the best judge for themselves of what is in their best interest,” he said. “I don’t think the right response is to completely ban that option for those people. But absolutely, I think that we should make sure that it’s carefully considered.”

The increasing number of MAID deaths in Canada “is a red flag,” he said. “But that doesn’t mean that anything bad is happening.”

Gillmore gives Komrad the last word:

Komrad disagrees. The rapid rise in deaths by MAID in Canada should cause concern, he says. “Just because something is legal, doesn’t [mean] it’s ethical,” he said.

He hopes in the future people will look back at current support for MAID and ask, ‘What were they thinking?’

“Maybe I won’t be alive to see that,” he said. “But one day we may be able to look back and say that.”

The Euthanasia Prevention Coalition is working to educate and alert people to the dangers of euthanasia.

Teaching about euthanasia for mental disorders and suicide prevention.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

The Canadian Medical Education Journal has published an editorial by Marcel F D’Eon, Mark S Komrad, Jeremy Bannon called: Teaching suicide prevention: a Canadian medical education conundrum. The article focuses on the medical education curriculum and the tension around suicide prevention and Medical Assistance in Dying (MAiD) also known as euthanasia, for patients with mental disorders. The editorial asks the question:

What are we educators to do when we find ourselves needing to teach about MAiD for mentally ill patients alongside suicide prevention and what we might consider for MAiD in general?

The editor writes:

At White Coat Warm (the) Art (International Congress on Academic Medicine, 2024), I was struck by the artwork and accompanying text by Nicole Graziano (University of Alberta) published in this issue of the CMEJ. Nicole’s art poignantly depicts what she called “the torment, grief, and freedom of suicide.” The white noose portrayed over a backdrop of light and dark sheds small white flowers filling the space. Her enigmatic set of words on its own caused me to pause. For me, her art juxtaposed the tragedy of suicide, liberation, and the expansion of MAiD, especially for those with psychiatric disorders. How does one help students and residents grasp the need to prevent suicide while offering MAiD to the psychiatrically ill?

The editor then examines the word suicide in relation to MAiD. He quotes Dr John Maher who stated:

Dr. John Maher, editor of the Journal of Ethics in Mental Health, has also pointed this out. How are educators then, supposed to teach students to provide suicide prevention to some patients who exhibit “self-directed behaviour with an intent to die” and simultaneously assist patients who request MAiD thus also demonstrating “self-directed behaviour with an intent to die”? Learners will notice this incongruence and have questions. We need to help them find some resolution.

The editor points out that there are a wide range of views concerning the issue of MAiD and how it may apply to people with psychiatric conditions. The editor then writes:

For a broad discussion of this topic, we could also explain the history of human rights in Canada and around the world where Canada was considered a pioneer and model for other countries. But here too there are controversy and opposition: the United Nations’ Special Rapporteur on the rights of persons with disabilities; Independent Expert on the enjoyment of all human rights by older persons; and Special Rapporteur on extreme poverty and human rights declared that MAID in Canada was not consistent with human rights. We need to acknowledge this wide range of local and international opinions on MAiD, including relevant rulings by the Supreme Court of Canada, and allow our learners to discuss these openly and transparently without repercussions.

The editor then deals with the question of autonomy:

First, that there are no choices that are completely and wholly autonomous. We all live in a context with intertwining relationships and limitations where our decisions are made, at least in part, after consideration of what is possible and desirable within our unique situations. Our teaching about the social determinants of health affirms this perspective. Patients with mental disorders face longer waits for care, have less access to state-of-the-art expertise in certain conditions, and are generally far less economically resourced then people with other illnesses. How could these circumstance not shape the  MAiD decision?

Second, autonomy is an instrumental value. Autonomy helps us lead a fuller, better life, one of our choosing. Self Determination Theory posits that autonomy supports two other major motivators in our lives. Namely, it helps us make a world of our choosing and to enhance our sense of both accomplishment and belonging. Looking back, we reflect and learn from what we ourselves have chosen, good and not so good. But the exercise of autonomy in the MAiD decision does not lead to a fuller life, and we do not get to live with an enhanced sense of accomplishment or belonging. For those who chose MAiD, they cannot ever say of their MAiD choice, the one facilitated by medical professionals, “I’m proud of what I’ve done” and hence their exercise of autonomy was for naught.

The editor completes the article by stating that there is a diversity of thought on these issues. One of the concerns in the Canadian culture is an attitude that "shuts down the debate" and imposes a point of view on the culture.

Marcel D'eon - professor Emeritus, University of Saskatchewan, Canada; Dr Mark Komrad - Faculty of Psychiatry, Johns Hopkins and University of Maryland, USA; and Jeremy Bannon - Assistant Clinical Professor (Adjunct), Michael G. DeGroote School of Medicine, McMaster University, Ontario, Canada. Correspondence to: Marcel D’Eon, email: marcel.deon@usask.ca