Red flag or red herring? The numbers behind assisted dying in the Netherlands

Assisted deaths among people with mental disorders in the Netherlands have surged in recent years. Some Dutch psychiatrists say that's a red flag for Canada, but not everyone agrees.

The debate surfaced during recent hearings of a federal committee tasked with advising the Canadian government on medical assistance in dying (MAID).

The Special Joint Committee of Medical Assistance in Dying is studying whether Canada is ready to allow people whose only underlying condition is a mental disorder to apply for MAID as of March 2027.

The final report is expected by June 17, the 10-year anniversary of MAID being legalized in Canada. The federal government has already delayed expanding eligibility twice, leaving many anxiously awaiting the committee's recommendations.

The Netherlands was the first country to formally legalize assisted dying in 2002, including for people with psychiatric disorders, which is why its experience is often cited in Canada's debate.

"The Dutch experience, in my opinion, offers a warning for Canada," Dr. Jim van Os, a professor of psychiatry and chair of neuroscience at Utrecht University Academic Hospital in the Netherlands, testified last month.

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Van Os and psychiatrist Dr. Wilbert van Rooij told the committee the Netherlands is seeing an alarming rise in people, particularly young people, seeking an assisted death because of mental suffering.

But while cases have risen in recent years, not everyone agrees that the situation is dire.

"All the talk about, 'it's out of control, we can't control this,' I really take distance from that because I don't think that's fair to describe the Dutch situation," Dr. Sisco van Veen, a geriatric psychiatrist who heads the End-of-Life research group at Amsterdam University Medical Center, told CBC News.

He said the Netherlands is still in a "process of adaptation" that will take some time to stabilize. While assisted dying has been available there for decades, he said, "for such a fundamental culture shift about how we die, it's not that long."

Between 2002 and 2010, the Netherlands reported one or two psychiatric-related assisted deaths each year across all ages, though officials admit the numbers were not always well tracked.

By 2024, psychiatric-related cases had risen to 219. Cases involving people under 30 rose from five in 2020 to 30 in 2024. In 2025, there were 19 cases involving people aged 29 or younger.

Van Veen said he does not want to "dismiss those cases and the suffering of those patients," but said the hard numbers remain small.

The most recent report from the Regional Euthanasia Review Committee, translated by CBC News, found a 21 per cent decrease in psychiatric assisted deaths in 2025, to 174 cases across all age groups.

That year, assisted deaths for people with psychiatric disorders made up about 1.7 per cent of all assisted death cases in the Netherlands.

Complete data on the total number of applications is not available, which concerns critics such as van Os.

One study that looked at nearly 400 completed applications over a decade by Dutch people 24 or younger found that only 12 were approved. Those approved had multiple diagnoses, had tried several medical and psychotherapeutic treatments and all had a history of suicidal thinking.

The majority of all applicants (about 73 per cent) were women.

The most commonly reported diagnoses included major depression disorder, autism spectrum disorder and eating disorder.

Van Os said he is not against assisted dying in rare and extreme psychiatric cases, but believes the recent increase is a sign the system lacks proper safeguards and that not enough is being done to help young people.

"There is a signal that you're giving to society, to people who have a life expectancy of 30-, 40-, 50-years saying, 'if you want you can die, if you don't think this life is worthwhile,'" he said.

MAID for mental illness is a heavily debated topic in Canada. Though MAID has been available for nearly a decade, people whose only underlying condition is a mental disorder have not been eligible.

If Canada moves ahead with MAID for psychiatric disorders, both van Os and van Veen said they would like to see stronger safeguards.

Van Os said Canada should consider outside, independent review of cases before approval, including someone with legal expertise to ensure the process is being followed. He said assessments should not be left to individual psychiatrists, but should involve a range of experts, including those with knowledge of existential mental suffering.

Van Veen said a "rigorous due diligence procedure" is critical. He said Canada could benefit from a committee of experts from different backgrounds who can advise on cases and possible recovery options.

"We do need some high level of certainty, but absolute certainty is impossible," he said. "But if you get all these different viewpoints in the room and if you get them to assess the case … I think you will find the right balance."

As he watches Canada's debate from afar, van Veen said he hopes that people "be kind to each other."

"This debate — it concerns real people who are in really vulnerable situations," he said.

"It's too complicated and too sensitive to go at each other's throats."