Medical Assistance in Dying Committee on May 5th, 2026

[The Joint Chair, Liberal, Marcus Powlowski]

I call this meeting to order.

Welcome to meeting number seven of the Special Joint Committee on Medical Assistance in Dying.

Pursuant to the order of reference of the Senate chamber adopted on February 26, 2026, and the order of reference of the House of Commons adopted on February 13, 2026, the special joint committee is meeting to study the eligibility of medical assistance in dying for those whose sole condition is mental illness.

Today's meeting is taking place in a hybrid format, pursuant to the Standing Orders. Members are attending in person in the room and remotely using the Zoom application. I would like to confirm that the sounds tests were done successfully.

Before we continue, I will ask all in-person participants to consult the guidelines written on the cards on the table.

I would like to make a few comments for the benefit of the witnesses and members.

First, please wait until I recognize you by name before speaking. For those participating by video conference, click on the microphone icon to activate your mic, and please mute yourself when you are not speaking.

For those on Zoom, at the bottom of your screen, you can select the appropriate channel for interpretation: floor, English or French. For those in the room, you can use the earpiece and select the desired channel.

This is a reminder that all comments should be addressed through me, the chair.

For members in the room, if you wish to speak, please raise your hand. For members on Zoom, please use the “raise hand” function. The clerk and I will manage the speaking order as best we can, and we appreciate your patience and understanding in this regard.

Before we begin, I'll remind you that for the last hour today, we will meet in camera to give drafting instructions to our analysts for our report.

Now, we welcome our witnesses today. All of them are joining us all the way from Holland.

I believe you may have a World Cup team that's coming over here. Until then—until we actually oppose each other on the field—we're friends.

I would like to welcome Dr. Jim van Os, professor of psychiatry; Dr. Wilbert van Rooij, another psychiatrist; and Dr. Sisco van Veen, yet another psychiatrist. I'm sorry. That's all the information they sent us.

Try to finish your remarks within five minutes. I will hold up a piece of paper—I don't know whether you'll be able to see it—when there are about 30 seconds left.

To begin, we have Dr. van Os for five minutes, please.

[Dr. Jim van Os, Professor of Psychiatry, As an Individual]

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.

[The Joint Chair, Liberal, Marcus Powlowski]

Thank you, Dr. van Os.

Next is Dr. van Rooij.

[Dr. Wilbert van Rooij, Psychiatrist, As an Individual]

Thank you, Mr. Chair.

Honourable committee members, thank you for inviting me. I'm a Dutch psychiatrist. For nearly 30 years, I've worked with people with severe psychiatric disorders. In that time, I've seen mental health services in the Netherlands steadily erode, especially for those with the most complex conditions. This deepens despair and may contribute to a wish to die in some patients.

Since euthanasia was legalized in 2002, psychiatric euthanasia or MAID has gradually become normalized in the Netherlands. This trend has rapidly accelerated in the past decades.

In my practice, I now meet more vulnerable, often relatively young, patients who are, in principle, treatable. However, they request euthanasia because timely and adequate care for them has been eliminated for political and economic reasons. At the same time, a small group of activist physicians has adopted an increasingly permissive approach to MAID, often justified in the language of autonomy and compassion.

In 2024, with several colleagues, I raised the alarm about how broadly the legal due care criteria are being interpreted in psychiatric cases. The resulting debates revealed deep division and a lack of consensus among Dutch psychiatrists.

I speak today, out of care and responsibility, to warn of the dangers when structural shortages in mental health care and ideological convictions begin to shape decisions about life and death for some of the most vulnerable people in our society. Allow me to frame this with a story older than any of our laws.

When the Greek hero Odysseus finally sailed home, he was exhausted and wounded after years of war in Troy. On the last stretch, he faced the sirens, voices promising peace and an end to suffering. He knew that if he listened freely he would perish, so he asked his crew to bind him to the mast, not because he was weak but because he understood that the urge to escape pain can peak precisely when judgment is most vulnerable.

As a clinician, that image returns to me when I consider euthanasia for psychiatric patients. I have sat with many people who are tired in this Odyssean way, worn down by chronic depression, trauma or personality disorders. When they say to me, “I don't want to live anymore,” in most cases they are not asking to die. Often they are asking for pain to stop, for meaning to return and for someone to not give up on them.

For doctors, the central question can shift from “Is there still hope?” to “Have we followed the steps?” Suffering becomes something to be assessed, documented and, ultimately, validated by death.

Psychiatric euthanasia increasingly involves young people with conditions that fluctuate over time. These are not terminal illnesses; they are lives with uncertain trajectories. Euthanasia requires certainty, irremediable suffering. In psychiatry, that certainty is often an illusion. Moreover, vulnerability is not evenly distributed. In the Netherlands, women, young adults and people with trauma histories, autism, intellectual disability or personality disorders are overrepresented among those requesting and being granted psychiatric euthanasia. These are often people whose agency has been eroded by life experiences. To call this pure autonomy is clinically naive.

As a psychiatrist, I am trained to tolerate despair without endorsing it, to stay present and still say, “I don’t know the answer yet, but I am not done with you.” That stance is not paternalism. It's fidelity. It's what kept Odysseus alive until the voices had passed.

Canada now stands at a similar narrow strait. If you extend euthanasia to psychiatric suffering, you will not simply add an option. You will reshape the moral landscape of care.

You ask clinicians to decide not only when life can no longer be cured, but when it no longer should continue. That is a burden psychiatry was never designed to carry.

I ask you to pause to listen not only to legal arguments but to clinical experience, to those who have seen safeguards stretch, criteria soften and procedure replace presence.

Binding ourselves to the mast is not cruelty; sometimes it's the most humane act we have. Please do not ask psychiatrists and doctors to become the sirens for people who need our compassion, care and protection.

Thank you, Chair.

[The Joint Chair, Liberal, Marcus Powlowski]

Thank you, Dr. van Rooij.

Dr. van Veen, you have five minutes.

[Dr. Sisco van Veen, Psychiatrist, As an Individual]

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.

[The Joint Chair, Liberal, Marcus Powlowski]

Thank you to all the witnesses.

We'll start the first round of questioning with Ms. Jansen for five minutes.

[Tamara Jansen, Conservative, Cloverdale—Langley City, BC]

No, I think it's Mr. Cooper.

[The Joint Chair, Liberal, Marcus Powlowski]

It's Mr. Cooper. I got this totally wrong.

[Michael Cooper, Conservative, St. Albert—Sturgeon River, AB]

Thank you, Mr. Chair.

I'll start with Dr. van Os.

Professor Jocelyn Downie from Dying with Dignity Canada claimed at this committee that, if there is a delay or indefinite pause on the expansion of MAID for mental illness, people will die by suicide, impliedly asserting that MAID for mental illness will reduce suicide rates, but empirical data doesn't demonstrate that, does it?

[Dr. Jim van Os]

You are correct. At the population level, there is not a correlation or an inverse correlation between euthanasia and suicide rates in different countries with different levels of both these practices. Also, at the individual level, it's not possible to say that euthanasia is necessary to prevent suicide, because even in patients requesting euthanasia, the rate of suicide is very low. You have a number needed to treat of 10, and a number needed to harm of nine, meaning that 10 young people must undergo euthanasia to prevent one suicide, and nine die without any preventive purpose being served.

[Michael Cooper, Conservative, St. Albert—Sturgeon River, AB]

In short, such an intervention would result in far more deaths than it could possibly save.

[Dr. Jim van Os]

Yes, that is correct. I published this in the British psychiatric bulletin last month.

[Michael Cooper, Conservative, St. Albert—Sturgeon River, AB]

Looking at the experience in the Netherlands, you noted that there has been a substantial increase in MAID cases where mental illness is the sole underlying condition in recent years. I thought you had said there had been a fivefold increase. Is that right?

[Dr. Jim van Os]

It's a fivefold increase in those under 30 years of age.

Since 2020, there has been a 200% rise in psychiatric euthanasia cases compared to a 40% rise in total euthanasia cases in the Netherlands.

[Michael Cooper, Conservative, St. Albert—Sturgeon River, AB]

A disproportionate number of those cases involve women. Do I have that right?

[Dr. Jim van Os]

Yes. This is seen in many countries. Women are far more likely to request euthanasia for psychiatric reasons than men.

[Michael Cooper, Conservative, St. Albert—Sturgeon River, AB]

Despite a growing number of MAID cases, the suicide rate among women, particularly young women, has gone up, not down, in the Netherlands. Is that correct?

[Dr. Jim van Os]

That's correct, yes. There's a tendency for it to go up and not down.

[Michael Cooper, Conservative, St. Albert—Sturgeon River, AB]

Thank you.

I'll move to Dr. van Rooij.

You spoke about vulnerability not being evenly distributed, and that women, young adults and persons with trauma histories, autism and personality disorders are overrepresented among those who seek MAID where mental illness is the sole underlying condition. Can you elaborate on the experience in the Netherlands with respect to vulnerable populations?

[Dr. Wilbert van Rooij]

Yes. Thank you, honourable committee member, for this very important question.

There have been some studies by our official bodies installed by the government who are keeping statistics of the people who receive euthanasia solely on the basis of medical grounds, and a lot of patients being granted euthanasia come from certain groups, as I mentioned. The foremost is women, young women. People with autism are on the rise. There's a very big population of autistic patients asking for and being granted euthanasia in the Netherlands.

Also worrying is what came from the British research from Professor Tuffrey-Wijne in London. She revealed that, in many cases, even intellectual disability is not an exclusion criterion anymore for receiving euthanasia. That's particularly worrying, because when you read the statements the doctors gave to justify these euthanasias, they are quite worrying.

Professor Tuffrey-Wijne, who's of Dutch descent, by the way, was quite shocked when she read those reports by the body that does the supervision over the euthanasias. She said, for example, that a lot of patients receive euthanasia not based on any medical condition or something, but mainly on the basis of their social position, of situations like demoralization or a lack of social integration in society.

[The Joint Chair, Liberal, Marcus Powlowski]

Thank you, Dr. Rooij. We've run out of time for that round of questioning.

Next is Mr. Fergus for five minutes.

[Greg Fergus, Liberal, Hull—Aylmer, QC]

Thank you, Mr. Chair.

I appreciate the opportunity to speak.

Before I ask the witnesses my questions, I just want to ask you one question. Perhaps the clerk can answer it as well.

Earlier today, I received a letter that the minister of health and minister responsible for seniors and caregivers wrote to her federal counterpart. In that letter, she concludes that Quebec isn't in favour of expanding access to medical assistance in dying to persons whose sole medical condition is a mental illness. The letter reads as follows: “Finally, the report also cited concerns about the difficulty of properly diagnosing mental disorders and the worries of many health and social services professionals that the therapeutic relationship with their patients would be complicated if MAID were expanded to mental disorders alone.”

Will this letter be included in the testimonies taken into consideration by the committee?

[The Joint Chair, Liberal, Marcus Powlowski]

Perhaps the analyst can answer your question.

[The Joint Clerk of the Committee, Jean-François Lafleur]

Thank you, Mr. Chair.

We received this letter on Monday. The letter is in French. The letter will be translated according to the rules set by the committee and then distributed to each of its members. They can decide what to do with the letter.