WINNIPEG, Manitoba -- As the end of his life drew near, Pope Pius XII began addressing complex medical questions that were personal, theological, practical and scientific, all at the same time. For example, how far could doctors go to relieve a dying patient's pain?

Months before his death in 1958, the pope wrote: "Is the suppression of pain and consciousness by means of narcotics (when it is demanded by a medical indication) permitted, by religion and morality, to the patient and the doctor (even at the approach of death and when one foresees that the administration of narcotics will shorten life)?" His answer was "yes," if that was what it took to truly relieve suffering.

Pius XII also knew that doctors were pondering ways to apply ancient truths to issues raised by new technologies, said Ian Dowbiggin, author of "Life, Death, God and Medicine: A Concise History of Euthanasia." The historian from the University of Prince Edward Island spoke to media professionals gathered at this week's G8 "World Religions Summit" at the University of Winnipeg.

Many of these puzzles remain, which is why ethicists still study another 1957 address by Pius XII to the International Congress of Anesthesiologists, in which he asked when it was necessary to make extraordinary efforts to resuscitate patients.

The pope concluded that if it "appears that the attempt at resuscitation constitutes ... such a burden for the family that one cannot in all conscience impose it upon them, they can lawfully insist that the doctor should discontinue these attempts, and the doctor can lawfully comply. There is not involved here a case of direct disposal of the life of the patient, nor of euthanasia in any way: this would never be licit. Even when it causes the arrest of circulation, the interruption of attempts at resuscitation is never more than an indirect cause of the cessation of life."

Dowbiggin stressed that Pius XII was already engaging complex issues that continue to impact debates -- in Canada, the United States and elsewhere -- about legalizing physician-assisted suicide. While this decade has seen a "perfect storm" of conflicts about a "right to die," it is essential that citizens, clergy and public officials study the history of euthanasia before making policy decisions that will touch millions of lives in the future, he said.

"There are deep moral and religious issues at stake in debates about physician-assisted suicide, which is why religious believers have always been involved," said Dowbiggin. "But what we are hearing today are prominent voices that say that religious people must keep their ideas to themselves, because religion is a private thing -- period -- and must not affect public life. If that idea is accepted, that's a major step toward the acceptance of physician-assisted suicide."

The word "euthanasia" comes from two Greek words that simply mean "good death," noted the historian. For centuries, Catholics and others have argued that a "good death" is one that is as pain-free and dignified as possible. Thus, religious groups have been at the forefront of efforts to offer in-home hospice care.

However, several trends have aided efforts to legalize physician-assisted suicide, especially scientific advances that have increased the "graying of America," said Dowbiggin. Thus, people are living longer lives, which also means they are more likely to face lengthy battles with cancer and neurological conditions such as Alzheimer's and Parkinson's disease.

Rising health-care costs have also affected "quality of life" debates. After all, as President Barack Obama told the New York Times, the "chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health care bill out here." The stakes are rising.

Meanwhile, the Hemlock Society has evolved into End of Life Choices, an organization that merged with Compassion in Dying to form Compassion & Choices. Physician-assisted suicide became the "right to die" which has now evolved into calls for a legal "self deliverance" option.

If religious leaders want to keep taking part in these policy discussions, said Dowbiggin, "they must have something positive to say. It is not enough to just keep saying 'no.' ... They need a vision of what the 'good death' looks like. They need to say that this is the goal of all end-of-life care -- people making informed moral decisions about hospice and other forms of care that are right for themselves and for their families."