Joint chairs, dear members, my name is Trudo Lemmens. I have been a professor of health law and bioethics for over 25 years and have an extensive research record related to MAID, including MAID for mental illness. I am a member of the Ontario MAID death review committee, but I speak in my own name. Thank you for inviting me.
Let me be blunt: There are myriad reasons not to introduce MAID for the sole reason of mental illness, and they are clearer than ever. First, it is not constitutionally required. Second, evidence from Canada, Belgium and the Netherlands shows it would create significant additional risks of premature death for many Canadians with mental illness.
On constitutionality, I will be brief. Submissions to AMAD by constitutional scholars and a letter signed by more than 30 scholars, including leading constitutional and human rights experts, support this. The committee can also consult a co-authored analysis in the Manitoba Law Journal, and I'm sure they will hear from other constitutional colleagues.
Second, it is wrong to claim that denying MAID for mental illness alone is discriminatory simply because people with concurrent physical conditions have access, as is sometimes stated. This reverses the burden of justification. Instead we must ask what current MAID problems tell us about the risk in expanding access.
Troubling evidence is accumulating. The Ontario MAID death review committee reports cited by the UN Committee on the Rights of Persons with Disabilities in support of its request not to introduce MAID for mental illness and to withdraw track 2 MAID contain case summaries that reveal at times sloppy, impressionistic and minimalistic assessments. These reports include cases in which unaddressed suicidality, psychosis, substance use issues, pressure from caregiver burnout and cognitive impairments did not stop MAID providers from ending people's lives. Some cases involved only cursory reviews of mental health history.
Judicial interventions, other reports and media reports reveal similar concerns elsewhere. Examples include a woman seeking suicide prevention in B.C. being informed about MAID and a man who was involuntarily hospitalized for suicidality receiving MAID while on a day pass.
Current practice provides a critical insight: Some MAID providers already function as a pole of attraction for suicidal people. In Canada, and in Belgium and the Netherlands, which permit psychiatric euthanasia, a small number of permissive clinicians drive controversial cases. People shop for assessors who are willing to say yes, even when care teams are working toward recovery. Such providers become a predictable pathway, much like a suicide-prone bridge, drawing people toward a guaranteed death.
We know that when a known pathway is removed, many people who otherwise would die by suicide will be saved. MAID for mental illness does the opposite of what we otherwise do—namely, installing special guardrails on such bridges. It institutionalizes a medicalized method of death for mental illnesses in which hopelessness is often a key symptom.
Gender concerns are key too. Women attempt suicide at about twice the rate of men, and in jurisdictions allowing psychiatric euthanasia, many more women than men receive it. Of 30 youth aged 17 to 30 who received psychiatric euthanasia in the Netherlands in 2024, an overwhelming majority were women.
Reassurances that the practice will remain rare and limited to cases of years of treatment failure are speculative and unfounded. MDRC reports already indicate that MAID has been provided despite unaddressed mental health and substance use issues, minimal exploration of palliative, disability or community supports, and track shifting from track 2 to track 1.
We will further see many more cases than in Belgium or the Netherlands, where psychiatric euthanasia, particularly in the Netherlands, is on the rise. Some psychiatrists there already use non-existing clinical concepts, such as “mentally terminal”, to approve patients for euthanasia. Unlike in Canada, Belgian and Dutch law still at least requires a clinician provider to agree that no other treatment options remain. Canada's MAID law and policy emphasize access over protection.
Several Canadian provinces face worse problems with access to timely and quality mental health care, as 10% of people wait for six months or more for mental health care and 50% wait for a month.
The question before Parliament is very concrete: Knowing that people with intersecting disabilities already face risk of death in our MAID regime, will the law strengthen guardrails and prioritize suicide prevention or do the opposite?
Thank you.