Commentary
Societies occasionally reach a threshold so significant that it demands direct attention, regardless of legal or bureaucratic framing. Canada’s current approach to assisted suicide, especially in cases involving mental illness, represents such a threshold. Recent federal data indicate that more than 16,000 assisted suicide cases are approved annually in Canada, with an increasing proportion involving individuals with mental health challenges. This trend highlights the urgent need for policy reassessment and underscores the critical importance of addressing this issue.
The recent approval of medical assistance in dying (MAiD) for Kiano Vafaeian, a 26-year-old Ontario man suffering from major depression, is not only a tragedy, but represents a profound ethical failure. This case reflects a system that has conflated compassion with capitulation, autonomy with abandonment, and the practice of medicine with actions that undermine its foundational principles.
This individual did not die from cancer, amyotrophic lateral sclerosis (ALS), an untreatable neurodegenerative disease, or catastrophic trauma. He died because the medical system, supported by state authority, determined that his psychological suffering warranted the termination of his life. At 26.
It is essential to clarify that this discussion does not concern terminal illness. Terminal illness is defined as a disease expected to result in death regardless of treatment, typically within a specified time frame.
In contrast, irremediable conditions, central to these debates, are those considered incurable despite treatment efforts. Recent explorations within the field have shown an evolving understanding of “irremediable” as outlined by changes in the Diagnostic and Statistical Manual of Mental Disorders (DSM), where criteria for remission and recurrence of psychiatric disorders like depression indicate potential for recovery that can often be overlooked. Psychiatric suffering, such as depression, significantly impairs quality of life but is often treatable with appropriate interventions. The central question is whether society should permit physicians to end the lives of young adults whose primary diagnosis is depression—a condition that inherently distorts perception, diminishes hope, and leads individuals to believe their future is irreversibly closed.
If this does not alarm us, nothing will.
Depression Is Not a Death Sentence
As physicians, psychiatrists, and mental health professionals know well, major depressive disorder is a serious illness, but it is also one of the most treatable conditions in medicine. Treatment may not be simple, linear, or quick. It often requires time, trust, medication trials, psychotherapy, social support, and sometimes years of adjustment. But people recover. They return to meaningful lives. They fall in love. They build careers. They become parents. They rediscover joy.
Take, for instance, the journey of Sarah, a composite of many patients who have overcome depression. At one point, Sarah felt trapped in an endless cycle of despair. Through a combination of therapy, medications, and unwavering support from her community, she began to see small improvements. Over time, Sarah found solace in painting, began volunteering, and eventually landed a job she loves. Her story is a testament to the fact that between 70 and 90 percent of individuals respond positively to combined therapies, such as medication and psychotherapy. This promising statistic reinforces the potential for remission and the importance of hope in treatment outcomes.
Labeling depression as “irremediable” in a 26-year-old is not a medical determination; it represents a philosophical concession.
Every suicide note written by a depressed person shares a common thread: the conviction that suffering is permanent and escape is impossible. That belief is not insight—it is a symptom of the disease itself. When the medical system validates that distorted belief by offering death as a solution, it does not respect autonomy; it collaborates with pathology. I met a survivor of severe depression, who reflected, ‘I once believed there was no light at the end of the tunnel, but with support and treatment, I found hope and a future I never imagined.’ Her testimony to me underscores the need to differentiate between temporary despair and a genuine wish to end one’s life.
In no other area of medicine do we allow a disease to define its own prognosis in this way.
Patients with delirium are not asked to consent to irreversible surgery. Similarly, requests from individuals experiencing psychosis for amputation, or from those with anorexia for assistance in starvation, are not honored. Medical intervention occurs in these cases precisely because judgment is impaired.
Canada’s Medical Assistance in Dying (MAID) framework increasingly emphasizes concepts such as choice, autonomy, and dignity. While these principles are significant, they can be misapplied. In contrast, countries such as the Netherlands and Belgium have established psychiatric MAID protocols with international safeguards that maintain necessary boundaries while respecting autonomy. These protocols require comprehensive evaluation processes, including multiple psychiatric assessments and mandatory waiting periods, to prevent impulsive decisions. A vivid contrast is the Dutch requirement for a second psychiatric opinion, which exemplifies a concrete safeguard that starkly reveals the policy gap.
Examining these differences highlights where Canada’s approach diverges and how it risks blurring the distinction between genuine choice and vulnerability.
Autonomy is not an absolute principle. In medical ethics, autonomy is balanced with beneficence, non-maleficence, and professional responsibility. Physicians are not obligated to fulfill every patient request; their ethical duty is to discern, advise, protect, and, when necessary, refuse specific interventions.
Yet in Canada, MAID assessments have increasingly become procedural eligibility checklists rather than opportunities for substantive moral deliberation. The prevailing question has shifted from “How can we help this person live?” to “Do they meet the criteria for assisted death?” and is devastating. Acknowledging the complex role clinicians face in balancing patient autonomy with the imperative to prevent harm is crucial. How can we better equip assessors to make informed, compassionate decisions that prioritize life-affirming solutions?
In this instance, a young man was reportedly approved for MAID following a defined assessment period, despite having a psychiatric condition characterized by fluctuation, responsiveness to treatment, and significant influence from environmental and social factors. The system did not require comprehensive mental health intervention, ensure access to advanced therapies, or implement a multidisciplinary support strategy.
It approved death.
Such actions do not reflect compassion; instead, they represent institutionalized despair.
A Failure of Medical Ethics
For centuries, medicine has been grounded in a simple moral framework: do not kill. This principle predates modern religion, modern law, and modern politics. It is the reason patients trust physicians with their lives. As articulated in the Hippocratic Oath, a classical cornerstone of medical ethics, physicians pledge to “do no harm” and protect life. By embedding these timeless commitments into the fabric of medical practice, we underscore the deep-rooted trust patients place in their doctors to preserve life.
Permitting, or even encouraging, physicians to end the lives of patients who are not terminally ill fundamentally undermines the core principles of medical ethics.
Proponents of MAID frequently contend that physician-assisted death is an extension of patient care. However, this rationale is insufficient when applied to psychiatric illness. Mental illness not only causes suffering but also alters cognition, motivation, hope, and self-worth. Treating a request for death arising from depression as a rational, stable, and autonomous decision reflects a fundamental misunderstanding of the illness.
There is no blood test for hopelessness. No imaging study for meaning. No objective measure of when despair becomes permanent. While current science has yet to validate definitive biomarkers for suicidality, emerging research suggests the possibility of such markers. Acknowledging this empirical uncertainty invites ongoing inquiry and exploration.
Nevertheless, Canada currently permits physicians to make such determinations, resulting in irreversible consequences.
The Age Factor Cannot Be Ignored
Twenty-six years old. This cannot be emphasized enough. At 26, the human brain has only recently completed its full neurodevelopment. Emotional regulation, long-term planning, and resilience continue to mature well into the late twenties. Life trajectories at that age are fluid, not fixed.
A system that authorizes assisted death for a 26-year-old with depression implicitly asserts that certain lives are not worth supporting. Such an implication should be deeply concerning.
If a society believes that a 26-year-old’s future can be definitively judged as hopeless, what does that imply for adolescents? For young adults with trauma? For people struggling economically? For those with disabilities? For the socially isolated?
Historical precedent shows that when death is reframed as a solution, eligibility boundaries tend to expand over time.
When the State Replaces Care With Death
One of the most uncomfortable truths in this debate is also the most important: Assisted suicide is cheaper than long-term care. Comprehensive mental health treatment is expensive. It requires therapists, psychiatrists, social workers, inpatient beds, outpatient programs, community support, housing stability, and time. Canada—like many countries—has struggled to fund these services adequately.
In contrast, MAID is a comparatively efficient intervention.
This efficiency should prompt significant ethical concern.
When a healthcare system characterized by long wait lists, limited psychiatric access, and fragmented social support offers assisted death as an option, it establishes a perverse incentive structure. Vulnerable individuals, including those facing significant systemic inequities related to housing instability, unemployment, or belonging to marginalized groups such as Indigenous communities, may internalize the explicit or implicit message that their continued existence constitutes a burden.
This scenario is not hypothetical. Disabled Canadians, veterans, and individuals with chronic illnesses have reported being offered MAID in place of support services. The case of the young man with depression exemplifies a troubling pattern rather than an isolated incident.
The Family’s Voice Matters
Behind every MAID approval is not just a patient, but a family. In this case, a mother has spoken out, grieving not only her son’s death but the knowledge that the system failed him. She laments, “He was not in his right state of mind and needed time and support, not the option to end his life.”
Families often understand the cyclical nature of mental illness better than any clinician. They have seen relapses and recoveries, and they recognize when despair is speaking louder than truth. Her words remind us that the family’s perspective is a crucial component of ethical deliberation.
However, family objections are increasingly disregarded in MAID assessments under the principle of patient autonomy. While such exclusion may be appropriate in specific end-of-life scenarios, particularly when family members are abusive or unable to act in the patient’s best interest, it is highly inappropriate in cases involving psychiatric illness in young adults. When family members have shown understanding and support, dismissing their concerns simplifies the decision-making process. A system that excludes family input while facilitating assisted death demonstrates a significant ethical lapse.
A Slippery Slope, Now Made of Ice
For years, critics cautioned that expanding assisted suicide beyond terminal illness would result in cases such as this. These warnings were often dismissed as alarmist. Now the fears are a reality. Minors have been targeted as eligible.
Canada has already announced plans to expand MAID eligibility further, including mental illness as a sole qualifying condition. Each delay has been framed as caution; each expansion as progress. But progress toward what?
A society that medicalizes despair and normalizes assisted death risks becoming desensitized to suffering rather than addressing it constructively.
What Must Change—Now
First, psychiatric illness alone should never serve as justification for assisted suicide, particularly in young adults.
Second, any MAID request related to mental health must initiate mandatory, extended, and well-funded therapeutic intervention, rather than a progression toward death.
Third, independent psychiatric review processes should be rigorous, adversarial, and conservative, with the burden of proof firmly in favor of life. Fourth, governments must make substantial investments in mental health infrastructure before considering end-of-life options for psychiatric suffering. Finally, physicians must reaffirm their ethical role as advocates for life, hope, and healing, even when outcomes are uncertain and the work is challenging.
Policy Proposals:
—Amend the law to prohibit psychiatric illness as a sole qualifier for assisted suicide, particularly for individuals under 50.
—Mandate that every MAID application related to mental health includes a compulsory therapeutic period that ensures access to advanced psychiatric care and comprehensive mental health services.
—Establish an independent oversight committee to enforce strict psychiatric evaluations, emphasizing life-affirming solutions before considering assisted death.
—Allocate sufficient funding to mental health services, ensuring accessibility to cutting-edge treatments and support systems.
Policy must reinforce the role of physicians as custodians of life, emphasizing ethical responsibilities over mere compliance with patient requests. Clinicians must be encouraged to pledge specific actions that uphold these ethical principles. For example, physicians could commit to refusing MAID requests when there is no documented treatment failure, thereby ensuring that the ethical appeal is actionable. By taking this stand, physicians can transform ethical reflection into concrete practice.
Conclusion: A Line Must Be Drawn
The approval of assisted suicide for a 26-year-old man with depression does not represent progress, compassion, or dignity. Instead, it constitutes a failure of medicine, ethics, and society. If Canada aspires to be a nation that values human life in both principle and practice, it must avoid conflating despair with destiny and death with care. A future in which Canada leads globally through a robust and compassionate mental health system is possible. By investing in mental health advancements and ensuring universal access to support and care, the narrative of despair can be transformed into one of hope and resilience.
One can imagine a 26-year-old, once grappling with severe depression, now thriving after receiving intensive care. With the support of a dedicated community of health professionals, access to cutting-edge therapies, and comprehensive social support, this individual embarks on a transformative journey. They rediscover their passions and forge new paths in life, contributing value to society. Their story becomes a powerful testament to the potential of a system that prioritizes compassion and healing over despair.
This vision of hope underscores the imperative of creating a future where every individual has the opportunity to experience the fullness of life.
Views expressed in this article are the opinions of the author and do not necessarily reflect the views of The Epoch Times.
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