Webcast archive: Council of Canadian Academies MAID expansion – mental illness

This week, we continue to review the  Council of Canadian Academies proposal to extend euthanasia to people with psychiatric conditions.

In this episode of Euthanasia & Disability, Amy Hasbrouck, Christian Debray, and Taylor Hyatt discuss:

  • Council of Canadian Academies MAID expansion: mental illness
  • Assisted suicide suggested to mother of disabled woman in Newfoundland

Please note that this text is only a script and that our webcast contains additional commentary.


  • This is the second part of our series on the three areas of assisted suicide expansion being studied by the Council of Canadian Academies. Today, we’re discussing mental illness as the main reason for assisted suicide eligibility.
  • The first and most obvious problem with allowing assisted suicide and euthanasia for people with psychiatric disabilities is that their wish to die is usually a symptom of the disability – as is the case with depression. The only way to know if the person is receiving the treatment that is best suited to their needs and most effective – and the person responds to treatment – will be a lessening of their wish to die.
  • The link between mental illness and the wish to die also calls into question a person’s ability to make a free and informed decision to end their life.  In a Dutch study of assisted suicides, in 24% of cases, there was disagreement among the doctors who approved the euthanasia about whether the person was competent, and whether all possible treatment options had been tried.
  • While 74% of people who asked for AS/E in one study had depression, many had other conditions that complicated matters, including substance abuse, intellectual disability or being on the autism spectrum.  About half the people had personality disorders, which increases the chances that their desire for assisted suicide would not be consistent and settled.
  • In addition, the ratio of women to men asking for assisted suicide was over 2:1.  This lines up with statistics showing that women are much more likely to attempt suicide (as a “cry for help”) than men, but men are three times more likely to complete suicide.  Thus, many “cries for help” from women will result in death in places where assisted suicide and euthanasia are legalized for psychiatric conditions.
  • More than a quarter of the people in the Dutch study asked for death from a doctor they didn’t already know – most at a specialized euthanasia clinic.  It’s hard to imagine that a family doctor or a clinic specializing in euthanasia would be able to correctly decide whether a person’s psychiatric disability interfered with their judgment, whether they were getting the best possible treatment, and if they had exhausted all treatment options.
  • Another concern is whether legalizing assisted suicide for psychiatric disabilities would lead mental health professionals to believe it is acceptable to give up on treating people with mental disorders.  Would that, in turn, cause people with psychiatric disabilities to lose hope about getting treatment or feeling better?
  • Allowing assisted suicide solely for mental health reasons is a form of legalized discrimination against people with psychiatric disabilities.  This discrimination already exists in our society’s very different approaches to physical and mental health care. Physical illnesses are considered uncontrollable, whereas mental illness is thought to be a moral failing.  Physical health is therefore seen as a priority, while mental health services have less funding and are unavailable to many who need them.  Only 1 in 5 young people who need mental health treatment get it; 2/3 of adults who need help don’t seek it out, either because it’s not available or because of the stigma associated with mental illness.
  • Mental health treatment has also changed drastically over the past few decades. Instead of interactive therapies, doctors are prescribing drugs. Talk therapy is often not covered.  If someone’s needs do not respond to pills, “the system” may claim it is unable to help them.
  • Reports from the Netherlands and Belgium have shown that many people who are euthanized because of psychiatric disabilities were physically and sexually abused. One example is the case of “Ann G.”, who sought treatment for anorexia.  However rather than being helped, Ann G. was sexually abused by her therapist.  After publicly accusing the therapist – who admitted what he had done, but was not punished – she was approved for euthanasia by another mental health professional.  Thus death became a second form of victimization.
  • In fact, people with psychiatric disabilities – who are often stigmatized as being dangerous – have the highest rates of abuse, poverty, homelessness, and lack of adequate health care.
  • Statistics also show many people asking for euthanasia are socially isolated and lonely.  Rather than providing psychosocial supports to these people, the mental health system “gives up on” them by euthanizing them.
  • Research shows that mental health professionals often harbour negative feelings toward suicidal patients. “Countertransference” describes a therapist’s reaction to their patient based on his or her own psychological issues or background.  If a therapist is having a negative reaction to a suicidal client, this can contribute to a “negative outcome”; in other words, the client’s death.


  • Last November, a 25-year-old woman named Candice Lewis was hospitalized in Newfoundland. Ms. Lewis has cerebral palsy and spina bifida, as well as a seizure disorder. A doctor suggested to Ms. Lewis’ mother, Sheila Elson, that she should be helped to die. When Ms. Elson refused to consent on her daughter’s behalf, the doctor called her “selfish.”  Ms. Lewis has since recovered.
  • When news outlets were reporting on it a few months ago, only Ms. Elson was quoted – even though Ms. Lewis was the target of the comment, and was also upset by the incident.
  • This incident confirms the fears of many people with disabilities: our voices are unheard and our lives are not valued. The belief that it’s better to be dead than disabled inspires many requests for assisted suicide, and the whole ‘death with dignity’ movement.
  • People with disabilities already face discrimination in healthcare. As an example, they are often pressured to sign “do not resuscitate” (DNR) orders; we’ll talk about this in more detail next week.