With the passing of Bill C-14, Canadians who are mentally competent adults suffering from a grievous and irremediable medical condition may now seek medical aid in dying. The policy has already resulted in ripples of controversy. For example, some large faith-based hospitals currently do not allow medical aid in dying on their premises, and a Canadian Medical Association survey of Canadian physicians found that 61% would refuse to provide this service and 14% were not sure if they would. In a linked paper, Trachtenberg and Manns explore a provocative observation that medical aid in dying will curtail, for some, the end-of-life period that is associated with intensive and costly health care … These potential cost savings, which are not trivial, should be considered in the context of the largely inadequate and haphazard delivery of palliative care across Canada. Despite some successful and exemplary palliative care programs, palliative care in Canada remains deficient; this is the reason that aggressive, institution-based and ultimately costly end-of-life care exists, and why such a large potential cost savings can be anticipated from medical aid in dying in Canada. Therefore, our response should be to transform end-of-life care.