The debate surrounding assisted dying, particularly in relation to mental health disorders, is a complex and emotionally charged issue that has sparked intense discussions across the globe. In this article, we delve into the numbers and narratives from the Netherlands, a country that has pioneered assisted dying legislation, to explore the implications for Canada and beyond.
The Dutch Experience: A Cautionary Tale?
The Netherlands, a pioneer in assisted dying, has seen a notable surge in assisted deaths among individuals with mental disorders, especially among the youth. This trend has sparked concern among some Dutch psychiatrists, who view it as a red flag for countries like Canada considering similar expansions to their medical assistance in dying (MAID) policies.
However, the situation is not as straightforward as it may seem. While cases have indeed risen, not everyone agrees that the situation is dire or uncontrollable. Dr. Sisco van Veen, a geriatric psychiatrist, emphasizes that the Netherlands is still adapting to this fundamental cultural shift and that the numbers, although rising, remain relatively small.
The Numbers Behind the Headlines
Between 2002 and 2010, the Netherlands reported only one or two psychiatric-related assisted deaths per year across all age groups. However, by 2024, this number had risen to 219 cases, with a notable increase among individuals under 30. In 2025, there were 19 cases involving people aged 29 or younger.
Despite this rise, the most recent report from the Regional Euthanasia Review Committee showed a 21% decrease in psychiatric assisted deaths in 2025, with these cases making up only 1.7% of all assisted death cases in the Netherlands that year. Complete data on the total number of applications is not available, which has raised concerns among critics.
Interpreting the Data
One study analyzed nearly 400 completed applications over a decade by Dutch individuals aged 24 or younger, finding that only 12 were approved. Those approved had multiple diagnoses, had undergone various treatments, and had a history of suicidal thinking. The majority of applicants were women, with common diagnoses including major depression disorder, autism spectrum disorder, and eating disorders.
Dr. Jim van Os, a Dutch psychiatrist, believes that while assisted dying may be appropriate in rare and extreme psychiatric cases, the recent increase suggests a lack of proper safeguards and insufficient support for young people. He argues that the system's signal to society, particularly to those with a long life expectancy, is concerning and may contribute to the rise in applications.
Learning from the Dutch Experience
As Canada debates whether to expand MAID eligibility to include mental disorders, both van Os and van Veen emphasize the need for stronger safeguards. They suggest independent reviews, legal expertise, and assessments by a range of experts, including those specializing in existential mental suffering.
Van Veen proposes a rigorous due diligence procedure, advocating for a committee of experts from diverse backgrounds to advise on cases and recovery options. He believes that while absolute certainty is impossible, a balanced approach can be achieved through diverse perspectives.
A Broader Perspective
The debate surrounding assisted dying for mental illness is not just about numbers and policies; it's about the very essence of life, suffering, and the role of society in supporting its most vulnerable members. As van Veen poignantly notes, "This debate concerns real people in vulnerable situations. It's too sensitive to go at each other's throats."
As we navigate these complex ethical and moral dilemmas, it's crucial to approach the issue with empathy, understanding, and a commitment to finding solutions that prioritize the well-being and dignity of all individuals involved.
