We need to make well-funded, comprehensive palliative care services available to all and advance care directives need to be better crafted and promoted: These messages were delivered repeatedly at the most recent Canadian Medical Association (CMA) town hall meeting on end-of-life care held in Regina.

As for the hot-button topic of euthanasia or physician-assisted dying, audience members expressed diverse views on whether it should be legalized in Canada.

This fourth of five scheduled meetings in the national dialogue hosted by the CMA and Maclean’s magazine attracted about 100 people for an informed and thoughtful discussion. The stage had been set for the Regina meeting by a lengthy interview with CMA President Dr. Louis Hugo Francescutti published the morning of the meeting in the Regina Leader-Post newspaper.

“Doctors grappling with public calls for euthanasia and assisted suicide are seeking a second opinion – yours,” wrote Pamela Cowan in explaining the rationale for the initiative. “This is an issue that physicians are directly involved in and it’s an issue that Canadians want to talk about,” said Francescutti.

Francescutti referenced the excellent palliative care received by his mother at the West Island Palliative Care Residence in Montreal. Coincidentally, the same day as the Regina meeting, a commentary by Teresa Dellar, executive director of that centre appeared in The Montreal Gazette calling for Canadians to have ready access to quality palliative care services.

The Regina meeting was moderated by Ken MacQueen, Vancouver bureau chief of Maclean’s and featuring a panel consisting of Dr. Jeff Blackmer, the CMA’s director of ethics, Dr. Ken Stakiw, co-medical director of palliative care services for the Saskatoon Health Region and Claire Bélanger-Parker, a palliative care volunteer.

Following the same format as all the town halls, discussion focused on three main areas: advance care directives, palliative care services, and euthanasia and physician-assisted dying.

“We all have an obligation to prepare our exit strategy,” Bélanger-Parker said, discussing the importance of advance care directives and giving examples from her own personal experiences. “We need to leave our family well prepared for our departure.”

Clarity and communication is the key to such planning, Stakiw confirmed, while acknowledging that the lack of standardization for advance care directives can create challenges.

Stakiw also reiterated comments made by palliative care experts at other town halls that while multidisciplinary palliative care services in urban centres are excellent, this “falls apart” even a few miles outside of major centres. “Shocking” was how Bélanger-Parker described the lack of palliative care services in First Nations reserves.

“Anybody who can get palliative care … their troubles are over,” a 96-year-old audience member commented.

A report on the public town hall meetings – which will conclude in Mississauga May 27 – will be released in June and will provide background information for the CMA’s General Council meeting in August where it is anticipated delegates will debate the euthanasia issue.

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