Ontario report: Euthanasia approvals for patients refusing treatment.

Psychological concerns were also paramount.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Ontario’s MAID Death Review Committee (MDRC) released it's fifth report on August 25, 2025. The MDRC is a body of the Ontario Coroner's Office that is composed of 16 people who are charged with examining Ontario euthanasia reports that may have concerns.

The reports from the MDRC committee concern people who have already died by euthanasia.

Meagan Gillmore wrote an article that was published by Canadian Affairs on August 27 examining the most recent report concerning euthanasia deaths on patients who had refused treatment, or had psychological concerns.

Gillmore begins her article with the story of Mr. C:

A widowed, elderly man with a body tremor was approved for medical assistance in dying (MAID) despite loneliness and poor self-esteem motivating his application, a new report from Ontario’s chief coroner’s office says.

The man, called Mr. C in the report, had an essential tremor, which causes uncontrollable shaking, often of the hands. Tremors are incurable neurological conditions, but not fatal.

Mr. C’s tremors had made it difficult for him to participate in hobbies and social activities. A widower in his 70s, he “did not perceive that he had much to offer in a new relationship” because of the tremor, the report says.

Mr. C said he “experienced profound hopelessness and loneliness” and could not find meaningful relationships or fulfillment after his spouse’s death. His MAID provider noted he applied because of bereavement and emotional suffering.

He was approved for Track 2 MAID, which is MAID for people whose deaths are not reasonably foreseeable.

Mr. C is one of three individuals profiled in a new report by Ontario’s MAID Death Review Committee, which examines how MAID assessors interpret the legal eligibility criteria for MAID.

Gillmore explains that:

Guidance released by Health Canada in 2023 says a patient and doctor must together decide if a patient’s condition is incurable, after considering available treatments and the patient’s overall health and values. Patients are not required to try treatments, but must be informed of means to relieve their suffering.

The guidance says a person cannot make themselves eligible for MAID by refusing all or most available treatments.

The most recent report from the MDRC raises concerns that people are being approved even when it is unclear why they refused all treatments. Gillmore then writes about Mrs A:

In one case, a woman in her 60s was approved for MAID after declining every treatment offered to treat her obesity and related chronic conditions, including type 2 diabetes and depression.

The woman, called Mrs. A, was approved for Track 1 MAID, which is MAID for people whose natural death is reasonably foreseeable.

In the years before her death, Mrs. A refused offers of health care and stopped taking her medications because she “no longer had the will to live,” the report says.

Her MAID assessors believed she would improve with proper health and home care. They offered her weight loss surgery, medication and disability supports. She declined everything, saying they would not help her.

The MDRC committee were divided on Mrs A. Gillmore reports:

Some committee members said Mrs. A should not have been eligible for MAID because she declined all treatments. Some also said it was not clear whether the MAID assessors had determined why she refused treatments.

“MAID legislation requires more than a respect for autonomy, it also mandates the application of clinical expertise to ensure that reasonable care options are considered,” they said.

Other members said Mrs. A’s MAID assessors respected her autonomy and that refusing treatment is a personal decision.

Gillmore states that the report uncovers "ableist concerns" concerning the term "irreversible decline in capability:

Health Canada’s guidance helps MAID assessors determine if a patient has an “irreversible decline in capability.”

According to the guidance, the decline in capability does not need to be related to symptoms of an illness or disability. It can include decreased job opportunities or ability to participate in meaningful activities.

Gillmore then reports on the case of Mr B.

The report tells the story of a man in his 60s, known as Mr. B, who had cerebral palsy and had lived in long-term care for several years.

Mr. B “expressed profound psychological suffering and loneliness,” the report says, which increased when he moved to long-term care.

He used a wheelchair, but was able to push it, transfer out of his chair and toilet himself. He was scared that he would lose those abilities as he aged.

Six to eight weeks before his MAID death, Mr. B voluntarily stopped eating and drinking. The report does not say why or whether MAID assessors tried to determine his reasons for doing so.

In approving him for Track 1 MAID, his assessors said Mr. B’s death was reasonably foreseeable because he had stopped eating and drinking and had signs of kidney failure. His dependency on others showed he was in an “irreversible state of functional decline,” the assessors said.

In other words, Mr. B. stopped eating and drinking to be approved for Track 1 MAiD. Track 1 MAiD is for people who have a terminal condition. There is no waiting period for Track 1 MAiD.

The MDRC committee were divided on Mr B. Gillmore reports:

A few members did not think Mr. B’s dependency and need for long-term care fulfilled that criteria. Needing help is part of many disabilities, including cerebral palsy, they said.

“Framing such dependency as evidence of an irreversible decline in capability potentially risks introducing an ableist perspective, wherein inherent disability-related needs are mischaracterized as functional decline that is aligned with an irreversible trajectory, rather than a person’s basic care needs,” these members said.

The report also raised concerns about unmet psychological needs influencing MAID requests. Gillmore explains:

Currently, the law prohibits eligibility for MAID on the basis of a mental health condition alone.

Gillmore comments on the reports findings concerning psychological suffering.

Yet, Mr. B’s MAID assessors noted his suffering was “primarily psychosocial and existential.” Several committee members said he should have had a psychiatric assessment to determine whether he was suicidal.

Members also said a psychiatric assessment would have helped determine Mrs. A’s MAID eligibility. If she had declined, the MAID practitioner would have had to say that her eligibility could not be determined.

The Ontario’s ministry of the solicitor general told Gillmore:

MAID requests have become more complex since 2021 when the federal government removed the requirement that someone’s death be reasonably foreseeable to qualify for MAID.

“The interpretation of illness and function of decline are more challenging for MAID assessors and providers to evaluate,” the statement says.

The MDRC committee were divided MAiD for psychological reasons. Gillmore reports:

A few members of the committee said current MAID practices need to be re-evaluated.

They said clarity is needed about whether a person’s refusal of routine treatments or food and water qualifies them as being in an irreversible state of decline.

These members also said further guidance is needed about how to assess a decline in capability when a person’s disability means they always depend on others for some care.

Gillmore ended the article by stating:

There were 4,958 MAID deaths in Ontario in 2024; coroners’ investigations were started in 299 — or six per cent — of these cases, the office of the solicitor general said in its statement. Five investigations are ongoing.

Previous article: Canada euthanasia reports: Rushing to Death (Link).

Lessons from the Netherlands 2024 euthanasia report.

"once legal euthanasia and assisted suicide will expand in both numbers and reasons for approving and providing death."

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

On March 26, 2025 I published an article concerning the 2024 Dutch euthanasia report. My article was based on an article by Bruno Waterfield who reported for The Times on March 24 that there were 9958 reported euthanasia deaths in 2024 in the Netherlands which was up by 10% from 9068 in 2023. According to the report, Netherlands euthanasia deaths have increased by 88% since 2014.

Waterfield also reported that there were 219 psychiatric euthanasia deaths in 2024 which was up from 138 in 2023 and 115 in 2022. Euthanasia for psychiatric reasons has increased by 59% since 2023 and nearly 250% since 2020.

The growth of euthanasia and the acceptance of euthanasia for psychiatric reasons in the Netherlands is concerning. The Netherlands experience indicates that euthanasia must never be extended to psychiatric reasons. 

Canada is scheduled to expand euthanasia to psychiatric reasons alone on March 17, 2027. The United Nations Committee on the Rights of Persons with Disabilities (the CRPD Committee) recently condemned Canada's intention to expand euthanasia to psychiatric reasons alone. 

Canada needs to heed the United Nations Committee on the Right of Persons with Disabilities warning and acknowledge the experience with euthanasia for psychiatric reasons in the Netherlands.

But there is more.

Professor Theo Boer

On April 8, 2025 I published an article by Theo Boer who is a professor of health ethics at the University of Groningen and a former member of a Netherlands government euthanasia oversight committee. 

Boer wrote a profound article that was published by Le Monde on April 8, 2025 urging France to learn from the Dutch and not legalize euthanasia. (The text was google translated).

In his article Boer explains the euthanasia trends in the Netherlands. Concerning the growth of euthanasia Boer points out that the trend will likely continue. He wrote:

...the (Netherlands government euthanasia oversight) committee's chairman, Jeroen Recourt, predicts that the curve will continue to rise in the years to come. This is no longer a fluctuation: it is a structural trend.

Boer explains that even though the number of total deaths in the Netherlands is increasing that the percentage of euthanasia deaths is also increasing:

from 5.4% of deaths in 2023 to 5.8% in 2024. In 2017, in some regions, this percentage had already reached 15%, and it is expected to have increased since then. Euthanasia is no longer exceptional: in many cases, it is becoming just another end-of-life option.

Concerning the phenomenon of couple euthanasia Boer writes:

The emergence of "euthanasia for two," which allows couples or siblings to die together, is one such trend. In one year, the number of these planned deaths in tandem has jumped by 64%, reaching 108 deaths in 2024.

Boer also comments on the growth of euthanasia for psychiatric reasons:

Above all, euthanasia for psychiatric disorders has increased by 59%, affecting people who are sometimes very young. Patients who are physically healthy, but plunged into mental suffering that medicine struggles to alleviate, are now asking to die – and are succeeding. The number of cases related to dementia is also increasing rapidly.

Boer completes his concerns by stating:

With increasing "normality," healthcare workers are asking themselves: "How far will we go? At what point will this stop being an act of compassion and become an automatic response to patients who refuse to accept a refusal?"

Boer states that the government has launched an investigation into the reasons for this increase and comments on the fact that the government is investigating the reasons for the increase in euthanasia deaths while they are also considering future expansions of the law to include:

assisted suicide to anyone over the age of 74, even in the absence of serious illness. The sole criterion would be age.

Based on the Netherlands euthanasia data and the warnings from Professor Boer, it is wrong to suggest that the euthanasia "slippery slope" is a fallacy. 

Boer also points out that it is wrong to suggest that the same won't happen in other countries. As Boer states:

all countries where euthanasia or assisted suicide have been legalized, we observe a continuous growth in the number of cases. This is not a Dutch exception. This is a dynamic at work everywhere medically induced death becomes an option.

Canada needs to  heed the Netherlands warning. In Canada euthanasia has grown and expanded significantly. Euthanasia for psychiatric reasons alone remains prohibited until March 17, 2027. When examining the Netherlands euthanasia data it is clear that no country should follow their path.

Countries that are currently debating the legalization of euthanasia or assisted suicide must change their direction. Caring is always good and necessary killing is dangerous.

Based on the Netherlands, Belgium, Canadian, Oregon and California data, it is clear that once legal euthanasia and assisted suicide will expand in both numbers and reasons for approving and providing death.

Let's be clear. There is another way. Legalizing euthanasia or assisted suicide is not necessary for providing care and comfort in difficult cases. Further to that, no one is required to accept medical treatment to prolong their life, especially when the treatment has questionable benefits or has onerous outcomes.

Killing is not compassionate, but rather it is abandonment. Killing is not a solution. Once killing is approved that the acceptance and promotion of killing expands.

Maclean's Magazine: Canada's New Home for Death Porn?

This article was published by Kelsi Sheren on April 8, 2025

Kelsi Sheren

By Kelsi Sheren

Yes, Yes they are.

Maclean's recent article advocating for the inclusion of individuals with mental disorders in Canada's Medical Assistance in Dying (MAID) program isn't just controversial—it's dangerously unethical, manipulative, fundamentally dark and sinister.

Maclean’s is very quickly gaining a reputation for promoting death porn and suggesting that those suffering mental illnesses should have access to assisted dying. They are once again choosing to send a chilling message to it’s readers, which at this point I doubt are many. They implicitly suggests that lives affected by mental health conditions are less valuable, less deserving of intensive care, treatment, or societal compassion.

In the most recent article promoting and manipulating it’s readers is their attempt to frame suicide as a legitimate option for those struggling with mental health, when all this really shows is Maclean's constant attempt at devaluing the lives of the mentally ill, effectively promoting hopelessness rather than hope.

Imagine the devastating effect on a vulnerable individual reading that their life is considered disposable or irrecoverable by society. This undermines decades of work aimed at destigmatizing mental illness and reinforces dangerous stereotypes about mental health struggles being inherently hopeless. While reading there most recent article I couldn’t help but notice the add for “war amps” on their site, which makes me laugh a bit because people who aren’t perfect are exactly what this magazine is attempting to suggest are disposable.

This magazine continues to frame the argument that people with mental illness are “irremediable”. In the Maclean’s article the concept of "irremediable" mental illness is a wild one. This position is scientifically and ethically unsound. Mental illness, unlike terminal physical illness, is complex, dynamic, and subject to significant change and improvement over time.

Mental illnesses such as depression, PTSD, bipolar disorder, or schizophrenia can indeed be severe and debilitating. But the nature of these illnesses is often fluctuating, with many sufferers experiencing meaningful recovery after proper care, therapy, medication, lifestyle changes, and even innovative treatments like psychedelics.

To label someone’s mental condition as "irremediable" is both wildly misleading and irresponsible, but this magazine seems to have no soul and seems quite alright with removing the very hope necessary for recovery and invalidates the lived experiences of countless individual’s who have successfully recovered from severe mental health episodes.

As someone who has personally overcome suicidal thoughts and severe mental health struggles, I can affirm that recovery and healing are possible. At my lowest point, it felt impossible to see a way forward, but with appropriate support, therapy, community, plant medicine and determination, I found a path out of that darkness. But according to this article Maclean’s wrote, I would have been considered “irremediable” and If I had seen this story over the 10 years of struggling with my mental health, then I'm sure I would have lost hope too. They are contributing to the idea that there is nothing left to live for so why the fuck should we even try mentality.

The thing is my story isn't unique; countless others have walked similar journeys, reclaiming their lives and thriving beyond their struggles.

To advocate for MAID as an option for mental health conditions fundamentally denies stories like mine and many others, wrongly presenting death as an inevitable or acceptable outcome rather than encouraging genuine healing and recovery.

Expanding MAID to mental illness sets a dangerous and dark cliff people will easily jump off of once we remove the responsibility of being the person to take our own life. A lot of the reason people stop before they attempt suicide is the FEAR or pain and what death will feel like. MAID and the “Dr’s” that do this dangle the carrot like a prize, removing the burden from the person and offering an easy way out.

Initially positioned as compassion, this policy change quickly risks becoming a tool of coercion, especially for marginalized and economically vulnerable groups, something we are continuously seeing in Canada and will continue to see as our healthcare system and country crumble to the ground.

Individuals suffering from severe mental health issues also face compounded struggles—economic hardship, isolation, lack of family support, or chronic homelessness. Offering MAID to these individuals coerces vulnerable people into viewing suicide as a reasonable escape from systemic failures and insufficient social support.

This has never once been about compassionate care. It’s darker than that more sinister and the reality is, is that it’s an abandonment of society’s moral responsibility to provide robust and holistic support systems. MAID has becomes not a tool of autonomy but a grim solution offered by a liberal government who is unwilling to invest adequately in mental health care but will send hundreds of millions of dollars overseas, to support ANYONE BUT it’s citizen’s.

The role of psychiatrists and mental health practitioners is to preserve life, treat illness, and support recovery. Maclean’s advocacy fundamentally conflicts with these professional ethics. Asking mental health professionals to facilitate MAID turn’s healer’s into facilitators of death and we are essentially making all healthcare practitioners EXECUTIONERS. Trained killers, guns for hire and instead of using a gun which would be more humane in my opinion. We are giving them government funded-non FDA approved drugs to inject into the veins of the vulnerable victims of people that have been convinced that death is the only option by people DWD and Macleans.

This ethical dilemma isn't abstract. It poses real-world risks of eroding trust in mental health services. People are hesitating to seek help, fearing their mental health struggles might qualify them for assisted dying rather than compassionate treatment, and we are seeing this time and time again. This scenario undermines the very fabric of mental health care, turning hospitals and therapists’ offices from sanctuaries of healing into environments potentially perceived as threats.

Beneath the surface, this debate is marred by an alarming economic incentive. Promoting MAID as an acceptable choice for mental illness is conveniently become a cost-saving measure for overwhelmed healthcare systems and governmental budgets by the liberal government.

Providing comprehensive mental health support, including therapy, long-term care, psychiatric assistance, and social programs, requires substantial investment, an investment the Canadian government is unwilling to make. Although they seem to have no issue making that investment on illegal immigrants who don’t pay taxes, lining the CBC’s pockets, and helping any country besides it own. MAID, by contrast, is inexpensive and expedient. Allowing individuals struggling with mental illness to access MAID has become a financially attractive alternative to addressing underlying systemic and societal shortcomings.

This hidden economic agenda is morally reprehensible, sacrificing human dignity and life at the altar of fiscal expediency, but at this point no one is surprised.

The language used in Maclean’s and similar articles often subtly manipulates public opinion, masking a morally and ethically complex issue behind words like "compassion," "dignity," and "choice." But true compassion would emphasize support, care, and recovery—not present suicide as a rational option.

Macleans is no longer rational journalism and frankly hasn’t been for some time. It’s now bought and paid for suicide porn for the sick, unwell and sad.

Nearly 10,000 Netherlands euthanasia deaths. psychiatric euthanasia's increase by 60%.

Alex Schadenberg
Executive Director,
Euthanasia Prevention Coalition

Bruno Waterfield reported for The Times on March 24 that:

The number of young people in psychological distress being offered lethal injections has caused growing controversy in the Netherlands.

The 2024 euthanasia statistics that were recently released indicated that there were 9958 reported euthanasia deaths in the Netherlands which was up by 10% from 9068 in 2023.

It is concerning that there were 219 psychiatric euthanasia deaths in 2024 which was up from 138 in 2023 and 115 in 2022. That represents an almost 60% increase in psychiatric euthanasia deaths in 2024 and a greater than 90% increase since 2022.

Waterfield reported:

There is concern that growing numbers of suicidal people, especially young people, are asking for help to die. Last year, there were 219 reports of euthanasia after psychological suffering, up by almost 60 per cent from 138 the previous year. In 2020 there were just 88.

Of the cases last year, 30 people were under 30 when they died. In 2020, that number was five.

Waterfield reported that Jeroen Recourt, the president of the RTE, a body comprising five euthanasia oversight committee's stated:

“Are we still doing this right?”

“I welcome social debate on euthanasia due to mental suffering in young people.”

Waterfield reported on one of the young people who died by euthanasia based on psychological suffering:

“The young man described his life as ‘luckless’. He felt very lonely, was deeply unhappy and did not enjoy anything. He could not connect with peers and society, and felt misunderstood,” said the committee, noting a previous suicide attempt. The boy’s parents were consulted in the euthanasia process, although “his relatives and care had tried for a long time to change his mind, without success”.

“The doctor was convinced that the young man’s suffering was hopeless. He did not expect current and any future treatments would improve the quality of life. The young man’s death wish was expected to continue, with a high probability that he would make another suicide attempt if his euthanasia wish was not honoured.”

The euthanasia report indicated that there were 6 concerning cases. Waterfield reported:

Only six cases referred by oversight committees as in breach of rules, mostly involving bungled lethal injections, with too long a gap between the induction of a coma and the deadly drug that stops the patient’s breathing.

One case involved an elderly woman suffering from a mental disorder that made her see faeces everywhere and cause her to clean obsessively who was not referred to an independent psychiatrist. Another elderly woman, in this case with with Parkinson’s disease, “may no longer have felt free to still abandon her choice of euthanasia”. 

I am concerned about the subtle coercion with euthanasia. I know of a Netherlands euthanasia death of an elderly couple where one of the partners was dying and the other was encouraged to die with the partner. 

How is it free consent when there is subtle coercion involved?

More articles:

• Britain must learn from the Netherlands experience with assisted dying (Link). 
• Netherlands euthanasia (homicide) death of 22-year-old averted at the last minute (Link). 
• Netherlands euthanasia death of 17-year-old criticized (Link) 
• Landmark study: Assisted suicide deaths for eating disorders (Link).
• Netherlands assisted suicide group leader found guilty of distributing suicide drugs (Link). 
• Why are the Dutch euthanizing young healthy women? (Link). 
• Netherlands 2023 euthanasia report. A 20% increase in euthanasia for mental illness. (Link).

Why are Dutch doctors euthanising healthy young women?

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Kevin Yuill

Kevin Yuill, who is an emeritus professor of history at the University of Sunderland and CEO of Humanists Against Assisted Suicide and Euthanasia (HAASE) was published in Spiked on April 18, 2024 is asking the question: Why are Dutch doctors euthanising healthy young women?

Yuill begins his article by telling the stories of Yolanda Fun and Zoraya ter Beek:

Jolanda Fun is scheduled to die next week on her 34th birthday. As such, she has been able to prepare the funeral invites in advance. ‘Born from love, let go in love’, reads the card. ‘After a hard-fought life, she chose the peace she so longed for.’

Fun, who lives in North Brabant in the Netherlands, explained why she wants to die in an interview with The Sunday Times last week. Though she is physically healthy, she feels constantly ‘sad, down, gloomy’. At age 22, she was diagnosed with a litany of mental-health problems and has since run the gamut of therapies. Consequently, she has never been able to hold down a job. When a counsellor told her two years ago that she could be euthanised, she decided this was the only option left for her. ‘I want to step out of life’, she explains. 

Fun has no doubt had a difficult life. She suffers from an eating disorder, recurrent depression, autism and mild learning difficulties. But to suggest suicide as a cure to these problems is as good as giving up on her.

Shockingly, Fun’s case is not all that unique in the Netherlands. Earlier this month, it was reported that another young, physically healthy Dutch woman is seeking euthanasia on mental-health grounds. The 28-year-old Zoraya ter Beek is scheduled to die in May on account of her depression and autism.

Yuill then explains how euthanasia for psychiatric reasons has expanded.

Most cases of assisted suicide or euthanasia (ASE) in the Netherlands – the first country to legalise the practice in 2002 – involve people with terminal illnesses. But ASE for psychiatric reasons is on the rise. In 2010, only two people sought euthanasia on the grounds of mental health. That increased to 68 in 2019 and to 138 last year.

Psychiatric euthanasia remains divisive in the Netherlands. Many Dutch people who were initially in favour of ASE are reconsidering their positions because of it. Boudewijn Chabot is one such critic, a psychiatrist who actually received a suspended sentence for carrying out the first reported case of euthanasia for psychiatric reasons in the 1990s. Now Chabot worries that the legalisation of ASE has gone too far. ‘I am not against euthanasia in psychiatry or severe dementia’, he writes. ‘[But] I am extremely concerned that doctors are trying to solve social misery due to lack of treatment and care, by opening the gate to the end.’

Yuill continues:

There is no doubt that the Netherlands’ laws on euthanasia have harmed the most vulnerable. In 2023, a study found 39 cases of ASE in the Netherlands involved people with either learning disabilities or autism, or both. Of these, nearly half were under 50. Although many of these patients also suffered from physical co-morbidities that led to them seeking out ASE, 21 per cent of them did so primarily for psychiatric reasons. They cited characteristics associated with their conditions, such as anxiety, loneliness, difficulty in making friends and connections, and not feeling they had a place in society.

A growing number of people with dementia are also seeking euthanasia in the Netherlands. In fact, 42 per cent of Dutch GPs reported requests for euthanasia from people with dementia. Of those, patients cited feeling like an emotional burden as the most frequent reason. Disturbingly, just under 43 per cent of these patients said they felt pressured by relatives.

Yuill then warns countries that are debating euthanasia to consider the grim reality:

In Scotland, where the government is currently considering a bill to allow assisted suicide, support for legalisation has consistently dropped since 2019. Perhaps this has something to do with the neverending stream of horrific stories emerging from countries where ASE is legal. In Canada, people seek out euthanasia to solve poverty, homelessness and lack of medical care. In the Netherlands, therapists seem to have given up on treating the mentally unwell, recommending euthanasia instead. 

Yuill ends his article by explaining 

The brutality of encouraging those like Jolanda Fun to die destroys the argument that ASE is about compassionately relieving end-of-life suffering. Fun herself is unsure whether or not things could have been different for her, had she received the right treatment. ‘They say you are born like this’, she says, ‘but I really think the services should have listened a bit better’.

This is where treating death as a form of medicine has led to. Medical professionals should be telling suicidal people that life can get better, not encouraging them to give up. Allowing euthanasia on psychiatric grounds tells those suffering with a mental illness that their lives are not worth living. This is not compassionate or dignified. It is evil. 

More articles on this topic:

• Autistic 28-year-old Dutch woman is scheduled to die by euthanasia (Link).
• Netherlands 2023 euthanasia report - A 20% increase in euthanasia for mental illness (Link).

Irish Psychiatrist issues warning as physically healthy Dutch and Canadian autistic women are approved for death by euthanasia.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

As Ireland debates legalizing euthanasia, a leading psychiatrist issued a warning that the recent case of a physically healthy 28-year-old autistic woman in the Netherlands, and a healthy 27-year-old autistic woman in Canada who have been approved for euthanasia could also become a reality in Ireland if euthanasia is legalized.

Maria Maynes was published by RIPT on April 9, 2024 concerning the debate to legalize euthanasia in Ireland. Maynes interviewed Consultant psychiatrist, Professor Patricia Casey, a specialist in Adult Psychiatry. Maynes reportes:

recent cases unfolding worldwide involving physically healthy young people should provide evidence to Irish lawmakers that “the slippery slope exists,” as she expressed particular concern about those with autism choosing assisted suicide or euthanasia.

Last month, this publication also reported on the Canadian case of an unnamed 27-year-old woman, who was also autistic, and had chosen to die by physician assisted suicide. While the father of the unnamed woman tried to intervene through court action, arguing that she did not have the ability to consent to the death under Canada’s MAiD programme, his intervention was unsuccessful.

There have also been cases in Belgium, where Asperger’s (now subsumed under the autistic spectrum) is among the most common conditions for which Belgians seek euthanasia on mental health grounds, alongside personality disorders and depression.

Maynes quoted Casey as stating:

“There is a danger that when young, autistic people see a problem that they will look for what they see is a simple solution, or a trendy solution,” she said.

Casey also stated:

“I was struck by the photograph of 28-year-old Zoraya ter Beek in the Netherlands, who was pictured surreally embraced in the arms of her boyfriend while announcing that she was due to die on May 28th. This photograph conceals the turmoil and nihilism behind her decision and may well be used in the future to promote assisted dying as a calming answer to one’s problems.”

Professor Casey compares the issue to the romanticizing of suicide that was successfully countered by national campaigns. Professor Casey fears that the same type of romanticizing of death by euthanasia will also occur.

Professor Anne Doherty examined the issue of suicide rates in jurisdictions that have legalized euthanasia and assisted suicide. Professor Casey referred to her research and stated:

“Prof Doherty found that the rate of non-assisted suicide increased after assisted suicide was legalised, and I fear we will see exactly the same pattern. I also think it is very nihilistic to say to people, ‘There is no help. Why don’t you go for assisted suicide?’ I mean, it is such a dark thing to say to anybody. I think it should be absolutely taboo, but instead of that, it is now becoming glamorised.”

Professor also commented on the "bracket creep" in countries that have legalized euthanasia and stated:

“This is what has happened in a range of countries. The Netherlands, for instance, didn’t start with euthanasia for young people with mental illness. It legislated initially for those with terminal illness. Similarly in Canada and in Belgium. Now all of those countries are allowing assisted suicide for young people, or for people with mental illness – or a combination of both.”

As for the concern that people with Autism are more susceptible to requesting euthanasia, Casey stated:

“One of the reasons a young person with autism may be more susceptible is due to the fact that a lot of those with autism have unusual interests and hobbies. For example, some would have an interest in the afterlife, or the occult, or similar. We also know that some individuals who are on the autistic spectrum have very fixed beliefs about things, and so can be quite suggestible.”

“Once something has been suggested, the person can fixate on that. I think the interest in unusual things, something we often see in those with ASD, and some of the things that are outside the norm, along with their tendency to fixate on things, would make that person particularly vulnerable. For instance, people with rigid thinking, such as many of those with ASD, find it difficult to consider alternative solutions to problems. And this may render them more than willing to choose this particular pathway to death.”

Professor Casey also commented on the Social Contagion that is likely to happen with euthanasia:

“There will be a social contagion aspect, because as we know, teenagers and young adults are always online now. One person engaging in, or planning, an assisted suicide, will be in touch with others in their group and that contagion effect is very toxic.”

“We must not forget that suicide clusters existed in the recent past, because of social contagion. And it is difficult to escape that prospect in relation to assisted suicide, also.”

Ireland is currently debating the legalization of euthanasia. A recent parliamentary report was released which advocated that euthanasia be legalized for a person diagnosed with a disease, illness or medical condition that is both incurable and irreversible; advanced, progressive, and will likely cause death within six months (or within 12 months in the case of someone with a neuro-degenerative disease, illness or condition; and suffering in a manner that the person “cannot be relieved in a manner that the person finds tolerable.”

The Irish report obviously decided to push for the legalization of euthanasia in a fairly wide open manner.

For further reading, Gordon Friesen, the President of the Euthanasia Prevention Coalition issued a warning to Ireland in his article: If euthanasia is legalized as a cure for suffering, then suffering people will be "cured" with euthanasia!

Netherlands 2023 euthanasia report. A 20% increase in euthanasia for mental illness.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

The 2023 Netherlands euthanasia report, that was recently released, indicates that the number of euthanasia deaths increased and the number of euthanasia deaths based on mental illness increased by 20%.

The Netherlands Times reported that there were 9,068 reported euthanasia deaths in 2023 which was up from 8,720 in 2022. There was also a 20% increase in euthanasia for psychological reasons in 2023 with 138 reported deaths.

The Netherlands Times refers to reported euthanasia deaths because studies indicate that approximately 20% of the euthanasia deaths are not reported.

Link to my article on the 2022 Netherlands euthanasia report (Link).

50% of the euthanasia deaths for psychological reasons are carried out by the Euthanasia Expertise Center (EE) euthanasia clinic. The (EE) received were more requests for euthanasia for psychological reasons from young people and approved more deaths for this age group. The Netherlands Times reported:

EE saw a significant increase in requests last year from young people with psychiatric issues. The center received 322 requests from people aged 18 to 30, which is over 50 percent more than last year. The RTE numbers showed that 40 requests for assisted suicide were granted to people 30 years old or younger.

The NL Times stated that euthanasia for psychological reasons accounted for 1.5% of all euthanasia deaths in the Netherlands in 2023.

When I was Anorexic I would have "chosen" assisted suicide.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Chelsea Roff

An excellent article was written by Chelsea Roff and published by Newsweek on February 23, 2024 concerning the false diagnosis of terminal anorexia and its connection to assisted suicide. Roff explains:

Nineteen years ago, I was hospitalized for severe anorexia. I was in dire shape: My skin was yellow from liver failure. I was unable to stand up, walk, or bathe myself. At 5'6" tall, I weighed 58 pounds.

Had I been hospitalized today, physicians might have debated whether I met the criteria for a new, controversial condition—terminal anorexia. Not yet an official diagnosis, the term appeared in the Journal of Eating Disorders, in an article describing the deaths of three patients with "severe and enduring anorexia."

According to the authors, their prognosis was grim, but treatment was "medically futile." Instead of forcing hospitalization, the consulting physician felt the most compassionate response was to allow them to die.

They were offered palliative care, and two patients received prescriptions for Medical Aid and Dying (MAiD). One patient died after ingesting a lethal dose, the other of malnutrition before she could take the medication.

The article sparked an outcry, igniting a debate about whether right-to-die laws allow patients with anorexia to end their own lives. MAiD is now legal in eleven states, but its use for a psychiatric disorder is a legal gray area.

Roff explains that in most states where assisted suicide is legal, the law requires that the person have a six month prognosis for death in order to qualify for assisted suicide. "Terminal Anorexia" may become a legal pathway to assisted suicide. Roff continues:

But it is especially complex in anorexia, a disorder in which patients appear rational in all ways except their ability to do the one thing that could save their lives—eat.

Even at the height of my illness, I was a convincing narrator of my mental capacity. I was remarkably lucid, yet could not comprehend the risk that starvation posed to my life.

One of the most striking neurological effects of starvation is how it distorts your emotional perception of risk and reward.

I felt comfort when I was hungry, but apathetic about my failing organs. If I had not been forcibly hospitalized, I would have continued starving.

Roff explains that many of her doctors had little hope for her recovery. They tried multiple treatments and therapies but she was obstinate, stubborn and appeared treatment resistant. She felt like a burden on her family and she states:

If the option for assisted dying had been available, I would have taken it.

She states that she was state mandated for 16 months in a treatment program which resulted in her recovery and today she runs a non-profit for people with eating disorders. She continues:

For years, I believed I had a chronic and likely terminal disease. I was told by well-meaning medical professionals that relapse was inevitable. I met people who had cycled in and out of treatment for decades—they said anorexia never goes away.

These ideas are unscientific and misleading, eroding the sense of agency and self-efficacy you need to recover.

The notion that anorexia is a terminal disorder has no place in medicine. Anorexia is difficult to recover from, but it is a treatable condition. Even with a paucity of evidence-based treatments, most people will recover.

Roff explains that Anorexia has the highest mortality rate of any psychiatric disorder but 72% of patients can make a partial recovery and almost 50% will make a complete recovery. She then states that:

Assisted dying laws require physicians to deem with "reasonable medical certainty" that the patient will die within six months.

But in mental illness, there are no standardized tests to determine disease progression like there are in physical illnesses like cancer. Physicians' assessments of who is terminal are almost entirely subjective, carrying life-or-death consequences.

A diagnostic term is powerful, and especially for those with psychiatric disorders, a terminal one can become a self-fulfilling prophecy. Calling treatment "futile" and death "inevitable" can itself diminish a person's capacity to make sound judgments about whether to continue living.

The creation of "terminal anorexia" will inevitably sow feelings of cynicism and hopelessness in people with a real shot at recovery.

Roff explains that a diagnosis of terminal anorexia leads to a life-threatening disadvantage. When a patient fails to get better and relapses for years they will often be steered towards palliative care or pushed towards assisted suicide leaving the system to continuing churning out subpar care.

Roff concludes:

Instead of a new diagnosis of terminal anorexia, we need enforceable standards of treatment and more funding for eating disorder research. Most importantly, we must not abandon or lose hope in those who have been struggling to get better in a flawed system the longest.

We can respect a person's autonomy without colluding with their most despairing thoughts—the feeling their life is not valuable. I am alive today thanks to those who never gave up on me, and for that, I will always be grateful.

Chelsea Roff is the executive director of Eat Breathe Thrive, a nonprofit that helps people recover from eating disorders. A yoga therapist, educator, and researcher, she has spent over a decade working to develop, deliver, and conduct scientific studies on yoga programs for people with eating disorders.

More articles on this topic:

• Anorexia does not justify Aid in Dying (Link).
• Anorexia is not a death sentence. I am living proof of this (Link).
• Assisted suicide for anorexia expands assisted suicide to chronic conditions (Link).

Canadians need Medical Assistance in Living not Medical Assistance in Dying

The following is the speech by Dr Paul Saba at the EPC Press Conference on February 27 at the Parliamentary Press Gallery.

Dr Paul Saba speaking at the EPC Press Conference

Starting March 17, 2024, Canadians with mental health problems will be able to access euthanasia. (If the Senate doesn't pass Bill C-62)

In Canada, euthanasia is called “medical assistance in dying.” This must not happen. 

It is not medical assistance in dying that people need, but rather medical assistance in living. 

Around one in five people will have a mental illness in their lifetime. Less than half will seek professional help. 

The recent pandemic has worsened mental health problems especially for marginalized women. young adults, indigenous people, the poor, and people with pre-existing mental disorders. 

More than 50% of people receive mental health care from their family doctor, often without help from other providers. 

Our health and social care system is failing for people with mental health problems.

According to the Angus Reid Institute poll, most Canadians do not support medical assistance in dying (MAID) for mental illnesses and want improved mental health care. 

In Quebec, the average waiting time between consultation with a psychiatrist and treatment is approximately five months. However, the new law requires a three-month waiting period before euthanasia is administered. In other words, the person who wants to see a psychiatrist will be long dead before they get an appointment with the psychiatrist. 

There is always a reason to live, but as caregivers we must find that reason for the person to want to live. 

Nobody wants to die. Instead, people want to escape their emotional distress. We must help them in their distress. 

Most psychiatrists do not support legalizing euthanasia for the mentally ill due to increased risks for certain groups such as women, young adults, the poor and other marginalized groups. 

Additionally, psychiatrists often disagree which patient is irremediable. 

From a legal point of view, the request for medical assistance in dying for the mentally ill does not meet the condition of free and informed consent. The longer a person lives with a mental illness, the less able they are to give free and informed consent. 

As a society we have a responsibility to improve our health care system for people with mental health problems. Rapid access to psychiatrists, psychologists and social workers must be ensured. Access to a wide variety of treatments, including art, music, dance, animals, recreation and other therapies, must be ensured. We must also guarantee free medicine, affordable housing, and food security. 

As a society we must provide the best care to people with mental health problems. We must treat them and not kill them through euthanasia or assisted suicide.

The Euthanasia Prevention Coalition held a Press Conference on February 27 at the Parliamentary Press Gallery with the Hon Ed Fast (MP), Dr Paul Saba, Lia Milousis, and Alex Schadenberg.

Canada, there’s still time to rethink this risky expansion of euthanasia

The following editorial was published by the Washington Post on January 27, 2024.

Few topics cause more impassioned debate than euthanasia. Ill people with no other options, suffering beyond a point they wish to bear, make a strong case that they should be allowed help to end their lives. On the other hand, establishing clear, consistent, ethical rules to govern where, when and how physicians might be involved in ending lives, rather than saving them, is inherently difficult. People of good will can disagree as to what compassion requires.

In recent years, a handful of countries have authorized medically assisted dying in the form of lethal injections or other interventions administered actively by physicians. In the United States, assisted dying still takes only the comparatively passive form of “physician-assisted suicide,” in which doctors prescribe a lethal dose of medications for self-administration. The practice is lawful in 10 states and in D.C. We have supported limited assisted dying programs of this kind.

The expansion of euthanasia Canada is currently contemplating, however, goes too far. The country already has one of the world’s most permissive euthanasia regimes, which empowers patients to seek “Medical Assistance in Dying” (MAID) — a practitioner-administered lethal injection — for physical conditions they deem unbearable, whether terminal or not.

And on March 17, barring a last-minute change in government policy, Canada will authorize MAID upon the request of patients whose only illness is a psychiatric one, such as depression or schizophrenia.

Advocates frame this as an advancement for patient autonomy and equal rights for the mentally ill. In fact, it would risk the lives of vulnerable people who, by definition, might have trouble assessing reality and whose symptoms and conditions are notoriously difficult even for experts to specify. There might, indeed, be mentally ill patients suffering from symptoms so debilitating and intractable that their options are uniformly dismal. But designing a system to distinguish them reliably from others in mental distress, who would benefit from treatment, is at least extremely hard, if not impossible.

Certainly, Canada’s system is not up to the task. Its MAID regulations are looser than those of Belgium and the Netherlands, where psychiatric euthanasia has been lawful since 2002 — and where serious concerns have arisen about that practice. Since Canada legalized euthanasia in 2016, some 44,958 Canadians have been granted permission to receive MAID for terminal or “grievous and irremediable” medical conditions.

Most of these cases have occurred in the past three years, with each year seeing an increase of 30 percent or more. Authorities rejected only 3.5 percent of written requests for euthanasia in 2022. Last year, Quebec’s top end-of-life care regulator decried rampant noncompliance with the rules in that province. If a medical provider rejects a request, nothing prevents Canadians from shopping around for another who will say yes.

Mental suffering can indeed be as real and, to those in the grip of it, as subjectively unbearable as the pain of other types of disease. However, empowering a mentally ill person to invoke a physician’s aid in ending his or her suffering — by ending life itself — inverts the most basic goal of psychiatry, which is to prevent suicide rather than to facilitate it. Many in the grips of psychiatric distress view, temporarily, suicide as their only way out, only to later be grateful they did not kill themselves in the depths of their suffering.

The American Psychiatric Association’s official policy is that psychiatrists “should not prescribe or administer any intervention to a non-terminally ill person for the purpose of causing death.” Two other English-speaking countries that allow assisted death, Australia and New Zealand, exclude purely psychiatric cases. Many Canadian mental health professionals have argued offering MAID to those with psychiatric illness is especially unwise in a country whose mental health system struggles to provide treatment to all who need it. The Canadian Association for Suicide Prevention opposes it.

Last month, Canadian Justice Minister Arif Virani said the government of Prime Minister Justin Trudeau has the “option” to delay implementation further, pending a report on the issue from a parliamentary commission due Jan. 31. This was a welcome sign of second thoughts, however belated.

No doubt Canadian advocates mean to enhance individual freedom and equality as between those with physical and mental illness. Perhaps they have high confidence in the procedures they’ve developed to control psychiatric euthanasia. They need to remember that no procedural protections are perfect — and building them for psychiatric euthanasia is a profound challenge.

Good intentions tend to have unintended consequences. In the United States, Americans need to keep a close eye on their neighbor’s experience, and learn from it’

More articles on this topic:

• Canada's euthanasia law. We've already gone too far. (Link). 
• Canada has revealed the horror of assisted dying (Link). 
• Canada must put the brakes on euthanasia for mental illness (Link).
• Don't abandon people to death by euthanasia (MAiD) (Link)