Canada's leading newspaper calls for lethal injection for the mentally ill

The Canadian newspaper Globe and Mail published a column by Dr Jean Marmoreo calling for medical assistance in dying to be extended to people with mental illness. Mark Carney's government announced it will block that extension, and the debate pits those who invoke patient autonomy against those who warn that psychological suffering is not irreversible.

Medical assistance in dying has been expanding in Canada for years. First it was for terminal illnesses, then for chronic conditions and disabilities. The next step was to be mental health, and that is where the consensus has broken down. Justice Minister **Sean Fraser** announced that **Mark Carney**'s government plans to ban euthanasia for those suffering solely from mental disorders. The reaction was swift.

## A Globe and Mail column and two psychiatrists in the New York Times

**Jean Marmoreo**, a physician who has performed euthanasia for more than a decade, published an article in the **Globe and Mail** titled "Rejecting medical assistance in dying for mental disorders will have a terrible cost." In it, she argues that denying access to these people is "an act of cowardice with political motivations." Marmoreo is co-author of *The Last Doctor: Lessons for Life from the Front Line of Medical Assistance in Dying*, and she opens her piece by recalling that she has stood beside more dying people than most politicians could imagine in a lifetime.

Her central argument is that the suffering of a person with a mental illness can be as unbearable as that of someone with cancer. And that the same standards applied to other conditions should apply to psychiatric disorders. "Canadians cannot afford to have their legislators choose this path when it comes to people with mental illness," she writes.

The response came from another newspaper. Two psychiatrists from the **University of Toronto**, one of whom has performed euthanasia on patients, published an opinion piece in the **New York Times** warning that Canada has gone too far and that euthanasia is being performed on people who should not be allowed to receive it.

## The debate over consent and irreversibility

Psychiatrist **John Maher**, who specialises in cases considered hopeless, argues that mental illnesses are not incurable and that other options exist. This is the underlying clinical objection: severe depression, schizophrenia or borderline personality disorder respond to treatment in a far from negligible percentage of cases, even if those treatments are slow, expensive and hard to access.

Critics say Marmoreo presents a false dilemma. Nobody compares the suffering of a 25-year-old with depression to that of someone in the terminal stage of incurable cancer. The real question is different: whether the consent of someone whose mind is ill can be equated with that of someone whose body is ill. Millions of Canadians know someone who had suicidal thoughts and is now in good health. Millions know people who endured unbearable suffering and are now grateful to be alive.

Marmoreo invokes bodily autonomy and choice. Her detractors reply that choice presupposes a will capable of choosing, and that in many mental disorders that capacity is precisely what is impaired. This is no minor debate: it goes to the very definition of what it means to consent.

## The suicide figures in Canada

The numbers handled by the Canadian health system are stark. Roughly **one in five Canadians** suffers from a mental health problem or illness, and that figure rises to nearly **50%** by age 40. Access to psychiatric care is extremely difficult: the **Canadian Mental Health Association** estimates the funding shortfall exceeds **one billion dollars**.

In **2024**, the number of suicide attempts in Canada was estimated at **100,000**. Not counting euthanasia, there were **4,394** deaths by suicide. The question hanging over the debate is what happens when a state officially recognises suicidal ideation in people with brain disorders and decides they may opt for state-funded suicide.

Marmoreo argues that the terrible costs of not extending euthanasia are patients whose condition worsened and who took their own lives when they could have benefited from assisted dying. Her critics point out that she never once mentions the many Canadians who had suicidal thoughts or attempted suicide and survived. Many people do not kill themselves out of antiestéticar or concern for their loved ones. The medicalisation of suicide would change that calculation.

Carney's government has decided to put the brakes on. It remains to be seen whether Parliament backs it or whether the pressure from those who have been performing these deaths for a decade manages to reverse the decision. This is a matter of public health and law, and healthcare and legal professionals should be consulted before drawing conclusions about specific cases.