I have reviewed the draft and the excellent comments provided by my colleagues to date. It is hard to add anything beyond their excellent opinions, especially Dr. Rebecca Genuis and Dr. Matt McIssac. In my practice I offer my patients MAIL (Medical Assistance in Living) and not MAID. I will never refer a patient for MAID as this is opposed to everything I have practiced as a physician for the last 30 plus years. I have strived to give my patients hope and compassion along their journey of life no matter what they have had to face. I will always walk with them and provide them the best possible care no matter what challenges they face. My patients know this and respect this. Conscientious objection must be paramount in any CPSA standard that is so contentious and controversial. It is also so important to recognize that not all conscientious objectors are doing so on the basis of religious conviction. Many of us object to MAID on the basis of sound medial ethics - fundamentally we are called as physicians to first of all do no harm. What is more harmful them taking a life? In the short time that Canada has allowed euthanasia, MAID is now the fifth leading cause of death in Canada and we are number two in the world in euthanasia deaths. With the possible expansion to patients with mental health illnesses, we will become number one in the world. This is not a legacy to be proud of. The slippery slope of MAID has become an avalanche. Effective referral needs to be removed from the current standard. It makes physicians like myself complicit in the death of our patients. Furthermore there has to be significant protection for conscientious objectors. Otherwise we are going to loose compassionate and caring physicians who, like me, chose not to offer euthanasia to our patients.