dutch doctors euthanized an autistic teen. why some say that should be a 'wake-up call' for canada
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four-and-a-half years after he was diagnosed with autism spectrum disorder, a dutch teen was euthanized at his request.
the boy, aged between 16 and 18, had described his life as “joyless.” he’d struggled with anxiety and mood-related problems, and where he fit in, in the world. oversensitive to stimuli, “every day was an ordeal he had to get through,” according to the latest annual report from the netherlands’ regional euthanasia death review committees. “in the final weeks before his death, he lay in bed the whole time.”
despite his young age, his doctor had “no doubts whatsoever” that the youth had the mental capacity to appreciate what he was seeking, and that there was no prospect of improvement, according to the case report.
his death, part of a dramatic increase in psychiatric euthanasia in the netherlands in recent years, should serve as a warning to canada as a special parliamentary committee reconvenes to assess the country’s readiness to permit maid on the sole basis of mental suffering, a prominent canadian psychiatrist says.
the dutch experience “should be taken as a wake-up call,” said dr. sonu gaind, a professor of medicine at the university of toronto and a past president of the canadian psychiatric association.
“the threshold (for assisted death) in canada is actually lower than the netherlands,” gaind said. “if maid for sole mental illness is opened up in canada, the numbers would significantly exceed what you see in the netherlands.”
proponents of maid for mental suffering have long held the netherlands out as a model — “no slippery slope there” — arguing that psychiatric euthanasia in canada, like the netherlands, would remain extremely rare.
however, the dutch situation suggests a more appropriate metaphor for the risks of medically assisted suicide for mental illness “is not a slippery slope but a runaway train,” as charles lane reported last week in the atlantic.
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maid for psychiatric suffering has been legal in the netherlands since 2002. once “virtually nonexistent,” with only one or two cases per year between 2002 and 2010, the number of psychiatric euthanasia cases has risen sharply, “with a disproportionate increase among young adults and, more recently, minors,” dutch doctors reported this month in the psychiatric times.
“the dutch model, once presented internationally as careful and balanced, is now attracting attention for a different reason: growing uncertainty about whether psychiatry has crossed a boundary it cannot coherently justify,” the authors wrote.
while most euthanasia deaths in the netherlands involve people with medical conditions such as cancer, 219 people whose suffering was largely due to one or more psychiatric illnesses died an assisted death in 2024, up from 88 in 2020.
of the 2024 deaths, 111 involved people aged 30 to 60, 78 involved people 60 and over, and 30 deaths were among people aged 18 to 30.
in 2023, two psychiatric euthanasia deaths involved a minor between the ages of 12 and 18. the teen with autism was one of them.
not only are more young people requesting assisted death for autism, depression, personality disorders, eating disorders and other mental conditions, those who died by maid were disproportionately female with a history of suicidality. of 397 people younger than 24 who applied for maid for mental illness between 2012 and 2021, 259 were female.
“once you normalize that death is an acceptable solution for the problem that some people are having — people who are not otherwise dying — then people see it as a solution, instead of other things that might help,” gaind said.
in a brief submitted to canada’s special joint parliamentary committee on maid three years ago, psychiatrist and bioethicist scott kim, a senior investigator with the u.s. national institutes of health, estimated canada could see 2,500 to 5,000 requests for maid for mental illness annually, and “not what the expansion advocates have suggested, which is that, ‘oh, it’ll just be a handful,'” gaind said. “there is no evidence supporting it will just be a handful.”
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in the netherlands, maid can only be a last resort. a doctor must conclude that the person’s suffering is unbearable, and the doctor and patient together must be satisfied that there are no reasonable alternatives.
canada currently has no similar “due care” requirement, gaind said. people need to be informed of the means available to reduce their suffering. but they can refuse treatments they don’t find acceptable. in 2023, the joint committee recommended that “incurability” can’t be established if people haven’t tried multiple attempts at a cure. however, the panel said it’s impossible to set “fixed rules” on how many attempts, what kinds of treatments and over what period.
in addition to lower rejection rates for maid requests, canada’s law also states that intolerable suffering is subjective and personal. it’s what the person says it is and, unlike the netherlands, a doctor doesn’t have to agree.
groups such as mental health research canada have warned youth mental health is in serious decline, with a “generation at risk” of rising rates of depression, anxiety and suicidal thinking, and major gaps in care.
given those factors, the approval rate for requests for maid for mental illness in canada could be 50 per cent or higher, kim estimated.
the increase in dutch youth seeking maid is particularly alarming, gaind said. “these are people who are not even 30 years old.”
“these people are still in the developmental stages of their lives, biologically, socially and psychologically, struggling to find their place in the world, dealing with other issues that are stressing them out, including a mental illness,” he said.
“and somehow, in that state, we’re thinking that their wish to have their life ended by the state is potentially ok, even when it’s somebody who is too young to buy alcohol, or marijuana?” in most provinces, the minimum age to drink alcohol or possess pot is 19. anyone over the age of 18 is eligible for maid in canada.
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even among psychiatrists, opinions are deeply divided over whether mental illness is ever incurable — terminal. those who oppose any further delays have been labelled ideological expansion activists; those pushing for an indefinite pause have been accused of over-stating the effectiveness of current treatments.
“we can’t make predictions about whether a person’s mental illness will or won’t improve,” gaind said. “we’re terrible at making those predictions.
“to say, ‘this is now a terminal psychiatric condition’ has no scientific basis. the whole concept is nebulous.”
“in many cases what people are seeking death for is not suffering that will never get better,” gaind said. suffering is broader and often fuelled by isolation and social distress, he said.
the canadian psychiatric association hasn’t taken a position on whether maid should be available to people whose sole underlying condition is a mental disorder. “there are compelling, legal, clinical, ethical, moral and philosophical questions that make this issue particularly challenging,” according to the group’s backgrounder on maid.
in 2024, the federal government passed a bill pausing the expansion of maid for mental illness to march 2027 after concluding the health system wasn’t prepared for the expansion.
“the bulk of evidence that we’ve gotten since that time actually leans to say we cannot implement maid for sole mental illness responsibly, in an honest way,” gaind said.
unlike the dutch law, which grants euthanasia to people 16 and older, canada has not opened maid to minors, however the committee suggested in 2023 that mature minors with incurable medical conditions should have access to assisted death.
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