Thank you for inviting me.
I'm Sisco van Veen. I am a psychiatrist from the Netherlands who is experienced in assessing psychiatric MAID requests.
As an empirical ethicist, I have been studying MAID for psychiatric suffering for 10 years now, and I am currently the head of the end-of-life psychiatry research group at the Amsterdam University Medical Center. I also have a research appointment at our national suicide prevention centre, and I’m the chair of the committee tasked by the Dutch Psychiatric Association with updating the clinical guidelines for psychiatric MAID.
I have been following the debate in Canada closely over the past years, but as a disclaimer, I would like to state that I've learned that when it comes to this topic it is virtually impossible to maintain a detailed understanding of another country's legal, cultural and ethical context, because it's continuously shifting. For the remainder of my time I'll focus on the Dutch situation and what universal lessons can be drawn from that.
MAID for psychiatric suffering has been legal in the Netherlands for decades, first, on the basis of jurisprudence, which was codified into law in 2002. Our first guideline for psychiatric MAID stems from 1998 and describes a rigorous assessment procedure. However, in clinical practice, it remains extremely rare. Only zero to five cases were reported annually, and it was barely a topic for patients and clinicians alike.
This changed around 2010 when the possibility to request MAID for psychiatric suffering became more salient. A few years later, the Expert Centre on Euthanasia, ECE, was formed, which quickly became the centre where most patients with psychiatric MAID requests were referred to.
With this, the cases started to increase over the years, about 8% annually until 2024. This is a significant raise, but it's also important to mention that psychiatric MAID to this day remains relatively rare at around 2% of all MAID cases.
The increase in cases eventually led to long waiting lists at the ECE, which in turn was reason for a small group of pro-MAID psychiatrists to seek publicity and call on their colleagues to perform psychiatric MAID more often.
In my view, this mainly caused a strong resistance among Dutch mental health care professionals, which in turn was fertile soil for a fierce and equally public counter-reaction, deepening the polarization further. This dynamic has soured the debate and may have contributed to the 21% drop in psychiatric MAID cases we saw in 2025, which in itself, of course, cannot be seen as a bad thing.
Together with different stakeholder groups, including the Dutch Psychiatric Association and the Dutch Patients’ Federation, we are currently working on getting the discourse back on track in the Netherlands to a more nuanced and constructive conversation. This is important for there are still many clinical and ethical challenges that require our continuous attention, which I’m happy to discuss further if asked.
Let me continue with my more universal, moral view on psychiatric MAID. Drawing on a decade of clinical and research experience, I've come to the following view. Although respecting autonomy is, of course, a fundamental justification for MAID, mercy is even more important. Because of this, I think it's hard to justify excluding patients with psychiatric disorders whose suffering can be immense or, in other words, unbearable.
I do think that MAID for terminal suffering is fundamentally different from MAID for chronic suffering. MAID for terminal illness is a way to prevent a terrible death, and MAID for chronic illness can be seen as a way to end a terrible life. Both situations require different due diligence approaches, and I think your two-track system reflects this better than our Dutch system, which does not make this distinction.
I also think MAID should be accessible for people suffering from chronic illness, because, by definition, death will not end a suffering that is not terminal. Although I see a lot of differences between chronic physical and psychiatric suffering, I do not think these differences are sufficient to justify a complete ban of psychiatric patients. Uncertainty about irremediability is a big challenge in almost all cases regarding psychiatric suffering, but it can also be an issue in some forms of chronic physical suffering.
I would also argue that adopting a retrospective view on irremediability is more suited for patients with psychiatric and chronic physical illness. This means that a physician isn’t asked to judge whether a patient will never recover, but that the physician is asked to judge, together with the patient, if they have suffered enough.
Finally, I have a short word on media dynamics.
It is my experience that media and social media play a profound, polarizing role in debates surrounding psychiatric MAID. This worries me a great deal. For large groups in both our countries, this is not a mere theoretical, ethical problem. It's a debate with real-life concerns of real people who are in vulnerable positions. These people deserve that we remain curious about each other's viewpoints and commit ourselves to a respectful, responsible and constructive debate.
Thank you for your invitation to contribute to this conversation.
I'm happy to answer all your questions.