With 76,475 dead, Canada appears to find its line on euthanasia
A parliamentary committee recommends against expanding it to psychiatric patients.
Charles Lane is a nonresident senior fellow at the American Enterprise Institute.
In the decade since Canada legalized euthanasia, known there as medical assistance in dying, or MAID, its physician-assisted death regime has developed into one of the most permissive in the world. Between 2016 and 2024, 76,475 Canadians received lethal doses from doctors or nurse practitioners. The 16,499 cases in 2024 accounted for 1 out of 20 deaths in Canada. In some regions of Quebec, the rate is 13 out of 100.
Now, however, Canada might finally be maxing out on MAID. On June 17, a special parliamentary committee recommended that the government “indefinitely exclude” patients whose only medical condition is a psychiatric one such as depression or schizophrenia. Pro-euthanasia activists had urged that MAID eligibility be expanded to include them, but “safe and equitable implementation” of MAID in such cases is simply not possible, the committee said.
Prime Minister Mark Carney’s government has yet to say what it will do about putting the recommendation into effect, which would require legislation. Advocates of psychiatric euthanasia are pursuing litigation. The unequivocal nature of the report, and the fact that it was endorsed by members of Carney’s own Liberal Party, will make it difficult to contravene, however.
“It’s literally the first time we’ve seen in the last 10 years that the government expresses any reservations about further expansion,” Trudo Lemmens, a law professor at the University of Toronto and critic of MAID who testified before the committee, told me. “It’s a significant moment.”
What happened? In 2021, Canada expanded MAID eligibility to include not just people whose death from, say, cancer is “reasonably foreseeable,” but also anyone with a “grievous and irremediable” disability or illness — such as paralysis — who wants to die rather than go on suffering from it. Such “Track 2” cases now number in the hundreds each year and are growing faster than terminal illness cases, which still constitute the vast majority.
The law had left open the possibility of further expansion to psychiatric euthanasia, which “death with dignity” advocates argued was necessary to prevent “discrimination” against people with mental illness. But polls showed deep public ambivalence about the idea, and Ottawa repeatedly postponed it for further study. The latest postponement expires next March.
Based on the committee’s report, and members’ comments to the media, it appears that the panel simply bowed to common sense — all the obvious moral and practical concerns that had prompted previous delays in implementation combined, no doubt, with the public’s mixed feelings.
In mental health, a patient’s prospects for recovery are notoriously variable and difficult to forecast; it’s even harder to figure out whether his or her death wish is rational and autonomous, or a symptom of the illness itself.
To embrace physician-administered death for psychological suffering is to undermine suicide prevention. And it could be especially dangerous to offer MAID without first assuring an adequate system of mental health care — a perennial concern in Canada.
“I do not think we as a society should ever accept killing someone in order to alleviate a burden of suffering imposed, at least in part, by controllable societal factors,” the committee’s co-chair, Marcus Powlowski, who is both a Liberal member of Parliament and a physician, wrote in an addendum to the report. “Factors like the availability of housing, social support, access to mental health services — factors that to some extent are under the control of the government. A government offering death as an alternative to addressing these issues is not a humane and compassionate government — it is the opposite.”
What’s more, Powlowski wrote, during its deliberations the committee had “heard stories of doctors with a seemingly cavalier attitude towards ending a life.”
Canadian news organizations — formerly boosterish toward MAID — have increasingly focused on such cases. The most recent scandal involved an Ontario man with inflammatory bowel disease and a history of substance abuse whose MAID eligibility assessment took place outside a Tim Hortons coffee shop, after which the doctor drove him to a facility where funeral homes store cadavers and administered the lethal injection.
The committee also took the testimony of doctors from the Netherlands, one of two countries (Belgium is the other) where psychiatric euthanasia has long been allowed as part of a broader MAID regime — and where it has recently gone from rare exception to troublingly frequent occurrence. Nearly 850 people have received lethal injections for psychiatric suffering there since 2020, including teenagers as young as 16.
In fact, at roughly the same time as the Canadian commission issued its report, the Dutch themselves were tapping the brakes on psychiatric euthanasia. The Netherlands’ main professional organization for psychiatrists has issued new guidelines requiring stricter prior scrutiny for euthanasia requests.
This raises an agonizing question: How many people in the Netherlands were put to death under the old rules but might have gone on living under the new ones?
“It is heartbreaking that some euthanasia procedures might not have been carried out if this protocol had been established earlier,” Theo Boer, a leading Dutch bioethicist, told the Nederlands Dagblad newspaper.
Of course, countries that don’t authorize psychiatric euthanasia in the first place never have to face that awful realization. Canada is still such a country. Thanks to the committee report, there’s a chance it always will be.
What readers are saying
The conversation explores the complex and emotionally charged topic of medically assisted death (MAID), with participants expressing a range of perspectives. Many commenters share personal experiences and advocate for the option of MAID, emphasizing the importance of dignity,... Show more
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