CMA President response: physician-assisted death.

Although Downar and colleagues present a very detailed examination of many of the issues involved in our growing national examination of how Canadians expect to manage their care at the end-oflife, the authors unfortunately get the cart well before the horse by focusing solely on physician-assisted death. Addressing the dire need for improved access to palliative care services, for which the late Dr. S. Lawrence Librach was an eloquent champion, and Canada’s lack of a national pain strategy would be much better places to start. Contrary to the authors’ assertion, delegates attending the Canadian Medical Association (CMA) annual meeting last August were clear that physicians needed to know more about how Canadian society viewed the full spectrum of end-of-life care before they could rush to any change in the CMA’s current policy position on physicianassisted death. This has led the CMA to conduct a national dialogue on end-of-life care, gathering input from Canadians online and at public town hall meetings in St. John’s, Newfoundland and Lab ra dor; Vancouver, British Columbia; White horse, Yukon Territory and Regina, Saskatchewan. Meetings wrap up in Mississauga, Ontario on May 27, 2014. The CMA is also conducting extensive discussions of these issues with members online and at town hall– style meetings. Although physicians may need to be prepared for the challenges of physician-assisted death, we are hearing from Canadians that there is an even greater societal need for us to ensure we can provide high-quality palliative care to everyone who would need it and provide the public with a better understanding of advance care directives.