Evidence of meeting #7 for Medical Assistance in Dying in the 45th Parliament, 1st session. (The original version is on Parliament’s site, as are the minutes.) The winning word was euthanasia.
A recording is available from Parliament.
Liberal
Greg Fergus Liberal Hull—Aylmer, QC
I would like to know whether this letter will be included in the testimonies that we received or in the documents that we can quote when drafting the report.
The Joint Clerk Jean-François Lafleur
This letter was received in response to Mrs. Jansen's motion, which was passed and which ordered the production of documents. This letter was received in response to that order. Again, the letter will be translated. If the committee sees fit to include this letter, it can do so, obviously.
Liberal
Greg Fergus Liberal Hull—Aylmer, QC
Okay. Thank you.
Thank you to our witnesses today. I have a couple of questions.
Dr. van Os, you made some very strong statements, one of which is that the question that is before us is the equivalence of “suicide carried out” by psychiatrists. I'm wondering if you could, given your experience in the Netherlands, please explain why you would consider that to be a fair comment to make, or is it an exaggeration?
Professor of Psychiatry, As an Individual
This is not a strong statement. This is, in fact, a well-known framing of the problem. It is often virtually impossible in clinical practice to distinguish between the symptom of suicide and the death wish expressed in the form of a euthanasia request.
The International Association for Suicide Prevention has attempted to come up with a statement trying to guide clinicians to distinguish between a death wish as a symptom of mental illness and a death wish as a rational expression of euthanasia. In theory they may exist, but in clinical practice they are very difficult to distinguish from each other.
Therefore, what often happens is that individuals indeed suffer and express a death wish as a result of their mental suffering which results from a mental disorder. They are granted euthanasia, so the doctor performs the suicide. This is not a strong statement. This is an internationally accepted framing of the question before us.
Liberal
Greg Fergus Liberal Hull—Aylmer, QC
I have very little time left.
Dr. Rooij, you had pointed out a case in the Netherlands, which has had this available for about 30 years. You said that mental health services were not equally distributed and that would therefore affect whether or not you were able to make the case for irremediability.
Could you talk a little more about that from a Dutch experience?
Psychiatrist, As an Individual
Thank you for that very important question. In essence, it's a more political question than a medical question.
What I witnessed in the last 30 years is that psychiatric care, especially for the people most severely affected by mental suffering—like the population I mentioned earlier, the people with autism, personality disorders and traumatic histories—has been selectively reduced in the Netherlands.
Our health care system, which is a commercial system, is run by health care insurance companies. For health care insurance companies, providing care for the most severely psychotic ill patients is not very profitable.
In the last 15 years, this care in the Netherlands has been reduced quite significantly. The patients I could treat 20 years ago quite adequately and effectively are now perishing on long waiting lists. These waiting lists are getting longer and longer in the Netherlands. Many patients come to me, or sometimes even their parents or family members, saying, “If this system can't provide proper care to my loved one, I at least ask you, as a doctor working in that system, to be able to provide euthanasia to this person, to this family member, because you can't provide any care anymore.”
That's causing a lot of moral stress in Dutch psychiatrists, as you can understand. This has made quite an impact on many psychiatrists I speak to on a daily basis. They are very reluctant and very wary about what's happening now in our country.
We have to be quite clear that people die now, who could have been treated 10 to 20 years ago quite effectively. I've done it myself. It's actually a real shame.
Liberal
The Joint Chair Liberal Marcus Powlowski
Mrs. DeBellefeuille, it's your turn now. I see that you're sitting on the other side of the table this evening. Have you changed parties?
Bloc
Bloc
Claude DeBellefeuille Bloc Beauharnois—Salaberry—Soulanges—Huntingdon, QC
Thank you, Mr. Chair.
I'll make a comment.
I appreciated our witnesses' testimonies. However, I find it odd that we could meet with psychiatrists from the Netherlands, whereas we couldn't meet with representatives of the Canadian Psychiatric Association to ask them questions. I'm not a permanent member of the committee. Frankly, I find it hard to understand why we're speaking with people from the Netherlands when we can't consult our own psychiatrists, who have an opinion. I wonder whether the representatives of the chair or the clerks are responsible for the fact that we haven't heard from them, given that the study ends this evening. Mr. Chair, I must say that I find this unacceptable.
Conservative
Tamara Jansen Conservative Cloverdale—Langley City, BC
On a point of order, I want to make sure we recognize that we've heard from many psychiatrists and psychiatrist associations.
Bloc
Claude DeBellefeuille Bloc Beauharnois—Salaberry—Soulanges—Huntingdon, QC
Are you giving me the floor, Mr. Chair?
Bloc
Claude DeBellefeuille Bloc Beauharnois—Salaberry—Soulanges—Huntingdon, QC
Just because we've heard from 10,000 psychiatrists doesn't mean we shouldn't hear from the Canadian Psychiatric Association. I honestly find this completely unacceptable.
I would now like to ask Dr. van Veen a question.
I strongly believe in a person's right to decide for themselves the level of suffering that they want to endure. We know that people are treated and medicated but forced to suffer for their entire lives because psychiatry and community support won't take away their suffering. If, this evening, we were to decide to take away the ability of people with a mental illness to request medical assistance in dying, we would be engaging in discrimination. We would be excluding some people who have rights. In the absence of a clinical consensus, we would be determining that they don't have the same rights as people who have a chronic incurable disease or as people who are suffering from a disease such as Alzheimer's and who make their advance requests in Quebec. I find that somewhat unacceptable, Mr. Chair.
On that note, I appreciated Dr. van Veen's testimony. I gather that he thinks that taking away this right wouldn't be the best idea because some people with a mental illness have the right to decide for themselves and the capacity to do so. Dr. van Veen, I understand that currently some people are forced to suffer for their entire lives and to receive psychiatric palliative care at the end of their lives. It seems that, in 2026, we have a duty to give these people an option. They have the right to decide that they have suffered enough and to make the decision that concerns them.
Do you agree, Dr. van Veen, with my hypothesis that we'll never be able to take away some people's suffering?
Psychiatrist, As an Individual
Thank you for your comments and question.
I do agree that psychiatric MAID should be available for a small group of patients. I do think there are differences between psychiatric and physical suffering, but I do not think they are fundamental enough and that there is absolutely no overlap that it would justify a total ban of psychiatric MAID.
I do think we need different due diligence criteria, but I've seen some documents from Canada that give me confidence that you are preparing for that.
Bloc
Claude DeBellefeuille Bloc Beauharnois—Salaberry—Soulanges—Huntingdon, QC
I'll give you an example, Dr. van Veen.
In their report, the experts say that people under the age of 30 wouldn't be allowed to request medical assistance in dying. Just because you make the request doesn't mean that you're eligible. In Quebec, for example, medical assistance in dying isn't available to anyone diagnosed with an intellectual disability. Limits and criteria are used. I sincerely believe that we'll never get all psychiatrists to agree. However, we're talking here about preserving the right to self‑determination.
Do you agree that members of the scientific community could settle on fairly tight criteria in order to support a schizophrenic person, for example, who, after 25 years of suffering and treatment, ultimately wants to avoid dying in what they consider completely unacceptable conditions, and that this person has the right to decide for themselves?
Can we find criteria that would help these types of people get what they want?
Psychiatrist, As an Individual
Yes, I think so. I think the criteria in the Canadian and the Dutch law can apply to the kind of patient you described.
I do think there's consensus. There are studies being performed that show a relatively high acceptance of psychiatric MAID in the Netherlands and also abroad. I also think that, because of the polarized debate in the Netherlands, we have a silent majority which, in essence, is supportive of a restrictive option of psychiatric MAID.
I agree with most of your statements. I would argue that mercy is more important than the right to self-determination in the current Dutch system. Self-determination autonomy is necessary, but insufficient as a criterion. It's especially important in psychiatry, for psychiatric suffering, to also maintain the criteria of irremediability and unbearableness.
Liberal
The Joint Chair Liberal Marcus Powlowski
Thank you, Mrs. DeBellefeuille.
Senator Dalphond, you have the floor for three minutes.
Pierre Dalphond Senator, Quebec (De Lorimier), PSG
Thank you, Mr. Chair.
Thank you to the members of the panel.
Dr. van Veen, you were appointed, I think in 2024, chair of a committee of the Dutch Psychiatric Association to revise the guidelines applicable to mental illness. Where are you in your review of the guidelines?
Psychiatrist, As an Individual
Currently, we have shifted from a total renewal of the guidelines to a more gradual renewal of guidelines, a modular renewal. We recently finished renewing the modules addressing second opinions. There are two second opinions in the Dutch due diligence procedure. We recently renewed them. We will publish them shortly.
We've just started the next cycle, which we will publish in the spring of 2027, addressing special patient groups, for instance, young patients or patients with autism and some other groups.
Senator, Quebec (De Lorimier), PSG
I understand that your work is not to propose to deny access but to make stricter guidelines applicable to psychiatrists before they can agree to provide MAID to people suffering from mental illness.
Psychiatrist, As an Individual
Because we haven't published the guidelines yet, I can't comment too much on the substance. I'm sorry. I can say, however, that I don't think we're going to make it more strict or more lenient. It's just that we're making different access in the due diligence procedures, at different points in time, where the goal is always to find balance between safety and accessibility.
Senator, Quebec (De Lorimier), PSG
Is there an age at which it will be excluded for youth, such as 25 or 30?
Psychiatrist, As an Individual
This is currently under discussion. We are currently examining that module. I cannot tell the outcome of that discussion.