Thank you very much, honourable committee members, for inviting me.
I am a professor of psychiatry at the Utrecht University Medical Center and a fellow of King's College in London. I advise the Dutch government on the current transition of our mental health services. In that capacity, I lead social trials of a new form of mental health care in a direction that bears directly on the question before this committee.
The Dutch experience, in my opinion, offers a warning for Canada. For 20 years, our euthanasia law left psychiatric cases largely untouched. However, over the past decade, a small group of activist physicians and organizations built a practice through sustained media campaigns. In 2024, the Dutch expertise centre for euthanasia received around 5,000 requests, with roughly 1,000 on psychiatric grounds. Among people under 30, requests rose from about 30 per year to nearly 900 in six years, and completed euthanasia rose fivefold. This pattern has been widely interpreted as a so-called suicide contagion effect, which is amplified by the institutions that should safeguard against it.
Here is a contrast that this committee should perhaps keep in mind. Under Dutch law, physicians must agree that there are no reasonable options. Euthanasia is, in principle, the very last resort. Canadian law does not work this way. In Canada, patient choice trumps the physician's professional judgment, so a doctor cannot insist that other options be tried first. That single difference will, in our assessment, drive Canadian numbers beyond ours.
In 2024, the UN Committee on the Rights of Persons with Disabilities warned that the Dutch practice was unsafe. Persons with psychosocial disabilities have a fundamental human right of protection against premature death. Euthanasia for mental suffering cannot be cleanly separated from physician-performed suicide. It is, in many cases, suicide carried out by a psychiatrist.
Our research and clinical work reveal a minefield on every side.
On autonomy, most people who request euthanasia for mental suffering are traumatized, marginalized and often living in poverty without prospects. Mental illness, by definition, compromises autonomy. Calling such a request a free expression of choice ignores the substance of the suffering.
On discrimination, the argument that refusing euthanasia for mental suffering is discriminatory equates psychiatric suffering with terminal cancer. It is a false equivalence. Cancer with a two-month prognosis is linear and progressive. Mental suffering is not. Recovery happens, often unexpectedly, through relationships, purpose, meaningful work and bonding with another person or even an animal. The patient-led recovery movement insists that recovery is possible for everyone. Plasticity is the rule.
On criteria, clinicians do not agree on irremediability, futility or competence. The result is something like a lottery. Whether you receive suicide prevention or a lethal injection depends on which clinician you meet.
On substance, recent Dutch analyses show that many who receive euthanasia are women with unaddressed trauma. Their unconscious self-destructive dynamics get enacted in the procedure. The psychiatrist becomes recruited into a deadly outcome. Tuffrey-Wijne and colleagues describe how in the Netherlands, people with autism spectrum traits increasingly receive euthanasia for what is, at its root, social suffering framed in medical language. The intervention should be social and existential, not lethal.
Psychiatry claims it can both prevent suicide in one patient and help finalize suicide in another with the same suffering. That is incoherent. It is not autonomy. It is not anti-discrimination. It is a contradiction at the heart of our profession.
My message to Canada is this: Do not expand. The evidence is not there. The UN, the International Association for Suicide Prevention and our lived experience point the same way. The social trials that we ran in the Netherlands show another path: care that builds relational continuity, hope and connectedness. That is the system worth building, not procedural pathways to death.
Thank you.