The Canadian Medical Association, which has a long-standing policy saying doctors should not participate in euthanasia or assisted suicide, is substantially softening its stance.

Delegates to the organization's general council decided Tuesday that the CMA now "supports the right of all physicians, within the bounds of existing legislation, to follow their conscience when deciding whether to provide medical aid in dying."

The carefully crafted position is an acknowledgment that, while assisting death is still a crime in Canada, the attitudes of Canadians, including those of physicians, are changing quickly, and so is the law.

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While the group's official policy has not changed, "it's only a matter of time," said Louis Francescutti, outgoing president of the CMA. Dr. Francescutti said the "conscience" resolution, which was adopted by an overwhelming 91 per cent of delegates, means that the CMA supports a doctor's right to refuse to hasten the death of a terminally ill patient, but it will also support a doctor's right to hasten death if the law allows.

In June, Quebec became the first province to adopt right-to-die legislation; it will take effect later this year. In October, the Supreme Court of Canada will hear the case of Kay Carter and Gloria Taylor, in which the B.C. Supreme Court declared the law banning assisted death to be unconstitutional.

A poll of Canada's doctors showed that 44.8 per cent think physician-assisted death should be legalized, while 41.7 per cent think it should remain illegal. The balance, 13.5 per cent, were undecided. (By contrast, polls show that about 70 per cent of Canadians support the legalization of physician-assisted death.)

More than one-quarter of physicians, 26.7 per cent, said they would likely agree to a patient's request to end their life, while 55.4 per cent said they were unlikely to take on that role.

The subject of euthanasia has, in the past, caused deep divisions and sparked emotional debate among Canada's doctors. But, in the last year, the CMA has made the issue a priority and conducted a series of town halls to get input from physicians and the general public.

At the CMA's general council meeting Tuesday in Ottawa, a sea change was evident. "Canada's doctors engaged in a reasoned, honest, empathetic discussion on end-of-life care," Dr. Francescutti said in explaining the attitudinal shift. "This in the new CMA."

The debate was nonetheless emotional at times.

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"There are conditions where no level of oxygen, morphine or supportive counselling will provide relief," said Sarah Bates, a family physician from Calgary, after relating that both her mother and sister were diagnosed with early onset dementia in their 40s. "There is no physician who would not offer a patient death without first offering them life," Dr. Bates said, adding that "as a caregiver and future patient," she believes both choices should be available to the terminally ill.

Eric van Wijilck, a senior policy adviser with the Royal Dutch Medical Association, also related the experience from the Netherlands, where physician-assisted death has been legal since 1973. He said, among the 140,000 annual deaths in The Netherlands, fewer than 3,800 are physician-assisted deaths, out of 14,000 requests. "Euthanasia is a tiny minority," Mr. van Wijilck said.

Angela Genge, director of the clinical research institute at the Montreal Neurological Institute, said what she has learned from her patients, who tend to have incurable neurological conditions, is that physicians have to be open to talk about end-of-life issues and respect their wishes.

"Every patient has the right to ask for control over their end-of-life," Dr. Genge said. "My job is to make sure they don't suffer."

In fact, most of the discussion among CMA members was about the lamentable state of palliative care in Canada.

"To the question, 'Do patients have access to adequate palliative care?' the answer is an unequivocal 'No,'" said John Haggie, a physician from Gander, Nfld.

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Fewer than 30 per cent of Canadians have access to palliative care, though there are pockets of excellence around the country.

Scott Wooder, president of the Ontario Medical Association, said what is probably most important is for physicians, and Canadians in general, to discuss end-of-life issues openly. In particular, Dr. Wooder said every patient should have an advanced care plan to ensure that their end-of-life wishes are clear to their family members and care providers.

Dr. Francescutti, the CMA president, said the take-home message is that regardless of how things play out in the courts, or how public opinion changes, "Canadian physicians will always be there for their patients at this most difficult time, at the end of life."