CMA President response: physician-assisted death/Of carts and horses ... [the authors respond]

We agree with [Louis Hugo Francescutti MD PhD]'s1 goal of improving access to palliative care, but there is no reason to think that this is a prerequisite for discussing physicianassisted death. Legalization of physicianassisted death need not hinder efforts to develop palliative care, and our article2 made this clear. Palliative care and advance-care planning improved considerably in Oregon after legalization, and Oregon is now a leader in the United States in a variety of palliative metrics.3 But even the best palliative care may not be sufficient for some patients, since 90% of Oregonians who received assisted death were enrolled in a hospice program. 4We have not put the cart before the horse. Francescutti should not overlook the main point of the article: the yes/no debate about assisted death could become practically obsolete in the very near future. While physicians are arguing about the relative positions of the cart and the horse, many Canadians have completed the journey on foot. Physicians do not need to lead or even agree with efforts to change Canadian law, but they have a professional responsibility to develop a Plan B at the very least. We need to begin the process of developing policies, protocols and guidelines, because we may need them in the near future.