With great caution, the Quebec College of Physicians is prepared to cross the line on the controversial debate over euthanasia and propose that it be included “as part of the appropriate care in certain particular circumstances.”

After examining the issue for three years, the College’s task force on ethics concluded that Quebec society has evolved to the point where it could tolerate euthanasia in specific circumstances. The task force’s recommendation will likely be part of a “reflection” document the College will release next fall, hoping that a public debate on the issue will pressure the federal government to eventually amend the criminal code.

“We are being very cautious in our approach,” said the College’s secretary, Yves Robert. “Avoiding the debate contributes to the general hypocrisy around this issue. To say that it doesn’t happen because it is illegal is completely stupid. … We have to stop hiding our head in the sand,” Dr. Robert said.

Anyone out there think Americans will stop hiding their heads in the sand?

It is common knowledge that physicians often have no choice but to constantly increase medication such as morphine to alleviate the pain and suffering of terminally ill patients.

Sometimes, the pain is so unbearable that the amount of painkillers or analgesics used to control it can be fatal. And this, according to the Quebec College of Physicians, can be viewed as a form of euthanasia.

“The question here is to decide whether a drop in dosage or an increase in dosage constitutes a criminal act,” Dr. Robert said. “We may go as far as to recommend that in certain cases, where the pain is unbearable, the amount of analgesic required could correspond to a form of euthanasia.”

The College wants to avoid a divisive confrontation between those who are for or against euthanasia, saying such a debate would solve nothing. Instead, the debate should be about the doctor’s role in accompanying a terminally ill patient toward the inevitability of death, offering as much dignity and medical assistance as possible. “There’s not a politician or a lawyer that can tell me what that entails,” Dr. Robert said.

Self-conscious people make decisions like this all the time. The only crime is that they are often forced to reflect upon the moment without being able to consult a doctor.