This article is written by Kim Carlson and Paul Magennis from the MAiD in Canada substack.
The following post is part of a structured, multi-week, simultaneously published exchange between Kim Carlson and Paul Magennis, authors of MAiD in Canada, and Gordon Friesen, President of the Euthanasia Prevention Coalition. These alternating messages will explore deeply divergent views on Medical Assistance in Dying (MAiD), and no mutual endorsement is implied.
Previously published exchanges between Friesen and MAiD in Canada have been:
Gordon Friesen, Monday, January 12, 2026.
Maid in Canada (MIC) January 19, 2026.
Gordon Friesen January 26, 2026.
The False Ally Fallacy:
Why Friesen’s references do not support his claims
It is disappointing that Mr. Friesen devoted so much time to matters unrelated to MAiD in cases where eligibility is based on mental illness and the central question is decision-making capacity. By our count, less than half of his latest submission addressed the topic we explicitly agreed to discuss. In addition to being red herrings,[1] this appears to be an attempt to introduce so many diversions that responding to them would distract us from addressing his central—and unsupported—claim.
For now, we simply ask Friesen how characterizing MAiD providers as “homicide-friendly professionals” reflects anything that could reasonably be described as “neutral,”[2] or even respectful, within the terms of this exchange?
Back to the topic
Friesen has not engaged with our previous arguments. Since he has not challenged the fact that people living with mental illness can possess decision-making capacity, we take this point as conceded.
What remains, then, is an argument from uncertainty: that there is no way to distinguish between a desire to die arising from acute symptoms of mental illness, and a reasoned and capable response to long-term, treatment-resistant suffering. Uncertainty is not justification for categorical exclusion, and arguments of this kind have already been considered and rejected by the Supreme Court of Canada.[3]
Denying the rights of an entire group demands substantial justification from those advocating for that denial.[4] Because Friesen’s purported justifications are unsupported—even by his own references—he has not met that burden.
The Canadian Psychiatric Association (CPA)
Friesen notes that the CPA “has not taken a position on whether MAiD should be available” on the basis of mental illness and then treats that as evidence of opposition. It is not. Declining to take a position is not the same as taking a position against, particularly in a complex and contested domain.
More importantly, the CPA’s statement contains no suggestion that decision-making capacity cannot be assessed in this context.[5] Instead, it acknowledges a lack of consensus within Canadian psychiatry—a point made explicit in the preceding sentence that Friesen omitted from his quote:
“Within Canadian psychiatry there are divergent opinions with respect to the provision of MAID, as well as whether access to MAID should be permitted on the basis of mental disorder.”
The CPA declined to take a position because of the complexity of the issue and because its members genuinely disagree—not because they believe decision-making capacity cannot be assessed. For those psychiatrists who believe MAiD might be appropriate in some cases, that view necessarily presupposes that capacity can be determined—further undermining Friesen’s claim.
Canadian Association for Suicide Prevention (CASP) & American Association of Suicidology (AAS)
Friesen again appeals to the CASP and AAS to suggest that MAiD and suicide are indistinguishable. CASP explicitly disagrees with that claim, and AAS doesn’t even make it.
CASP stated that MAiD for those without a terminal illness constitutes a form of suicide.[6] However, CASP does not argue that MAiD and suicide are clinically or ethically indistinguishable, nor that it is impossible to differentiate the two. In fact, in an earlier statement, CASP explicitly affirmed that “MAiD and suicide can, at least in principle, be distinguished,” even while acknowledging possible overlap.[7]
Claims that CASP regards MAiD and suicide as indistinguishable are not just unsupported—they directly contradict CASP’s published statements.
Friesen makes a similar error with the AAS, who retired a prior statement recognizing a distinction between MAiD and suicide[8] [9]—a standard process for aging position statements.[10] [11] But the removal of that statement does not imply the adoption of the opposite position. Friesen’s conclusion here relies on an inference his source does not support.
The American Psychiatric Association (APA)
Friesen’s reference to the APA follows the same pattern. While the APA opposes MAiD based on mental illness, the objection does not rest on an inability to assess capacity.[12] On the contrary, in the reference Friesen provides the APA explicitly states that:
- psychiatrists may be asked to assess capacity where psychiatric symptoms may impair decision-making;
- some mental conditions involve temporary alterations in preferences that reflect the underlying disorder; and
- in jurisdictions where MAiD is legal, it is ethically permissible for psychiatrists to assess capacity in this context.
There is no suggestion here that capacity cannot be determined. Indeed, there is an explicit acknowledgment that psychiatrists can assess capacity for MAiD in the setting of mental illness.
The APA’s objection is instead tied to concerns about hope and incurability, stating that “labelling a mental illness as…irremediable is inconsistent with present treatment approaches in psychiatry.” That is a complex and contested claim, particularly given the growing discussion of palliative psychiatry[13]—but incurability is not the subject of our exchange with Friesen.
Conclusion
This exchange now turns on a narrow question: whether the acknowledged difficulty, in some cases, of assessing decision-making capacity justifies denying assessment to an entire group. Neither clinical practice nor legal principle supports that move. Friesen has not shown why it should.
[7] CASP statement on the Expansion of Medical Assistance in Dying to those without a Reasonably Foreseeable Death
[9] Statement of the American Association of Suicidology: “SUICIDE” is not the same as “Physician Aid in Dying”
1 comment:
Translation from Friesen's critics: we do what we want, so shut up.
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