This week, the Quebec College of Physicians and Surgeons tentatively approved euthanasia. That means it's essential that we look, specifically, at the impact that euthanasia would have on physicians and the profession of medicine, in order to understand why this approval is a very bad idea.

In mainstream media, and therefore in the general public forum, the euthanasia debate has been focused, almost entirely, on the impact that legalizing euthanasia (a term I use in this article to include physician-assisted suicide) would have at the individual level. But we must also consider the impact legalizing it would have at institutional, governmental, and societal levels. We need to explore not only the practical realities, such as the possibilities for abuse, that allowing euthanasia would open up, but also, the effect that doing so would have on important values and symbols that make up the intangible fabric that constitutes our society.

For example, what would be its likely impact on major societal institutions, such as medicine and law, which help to establish those values and carry the message of the need to respect them?

Legalizing euthanasia would damage the foundational societal value of respect for human life. If euthanasia is involved, how we die cannot be just a private matter of self-determination and personal beliefs, because, as American philosopher Daniel Callahan says, "Euthanasia is an act that requires two people to make it possible and a complicit society to make it acceptable." The British House of Lords, likewise, rejects euthanasia because of the harm it would cause to societal values and institutions: "The prohibition on intentionally killing is the cornerstone of law and human relationships, emphasizing our basic equality."

One important reason to protect health-care institutions is that they are value-creating, value-carrying, and consensus-forming for society as a whole.

In a secular, pluralistic society, medicine and law are the principal institutions that maintain the value of respect for human life in society as a whole.

Changing the law to allow physicians to carry out euthanasia – making an exception to the norm that we must not kill each other – would seriously damage these institutions' capacity to carry that value.

In short, we need to be concerned about the impact that legalizing euthanasia would have on the institution of medicine, not only in the interests of protecting it for its own sake, but also because of the harm to society that damage to the profession would cause. And what might be the impact of the legalization of euthanasia, internally, on the profession of medicine and its practitioners?

As the Canadian Medical Association wrote in a letter distributed to all members of Parliament just before the first debate on Bill C-384, "CMA's policy on this matter is clear: 'Canadian physicians should not participate in euthanasia or assisted suicide.’" And surveys consistently show that physicians in various countries are more opposed to euthanasia than the general public. For instance, a 2009 survey by the British Royal College of Physicians showed 73 per cent of its members opposed euthanasia, whereas up to 82 per cent of the British general public approved of it. Important insights could be gained by pondering the causes of such disparities.

Euthanasia takes physicians and medicine beyond their fundamental roles of caring, healing, and curing, whenever possible. It involves them, no matter how compassionate their motives, in the infliction of death on those for whom they provide care and treatment. It can be described, as the London-based Institute of Medical Ethics does in its report, "Working Party on the Ethics of Prolonging Life and Assisting Death," as "a merciful act of clinical care," or, as the Quebec College of Physicians and Surgeons characterizes it, "part of appropriate care in certain particular circumstances" and, therefore, it may seem appropriate for physicians to administer. But the same act is also accurately described as "killing." This means, as American psychiatrist and ethicist Willard Gaylin put it, that euthanasia places "the very soul of medicine on trial."

There are very few institutions in today's secular societies, if any, with which everyone identifies except for those – such as medicine – that make up the health-care system. These, therefore, are of unusual importance when it comes to carrying values, creating them, and forming consensus around them. We must take great care not to harm their capacities in this regard and, consequently, must ask whether legalizing euthanasia would run a high risk of causing this type of harm.

The kinds of questions we need to ask include: How would legalizing euthanasia affect medical and nursing education? What impact would physician role models carrying out euthanasia have on medical students and young physicians? Would we devote time to teaching students how to administer death through lethal injection? (There has been a medical malpractice case in The Netherlands for "botched" euthanasia – the patient didn't die.) Would they be brutalized or ethically desensitized? (And we cannot afford to underestimate the desensitization and brutalization from carrying out euthanasia.) Do we adequately teach pain-relief treatment at present? Would euthanasia be a required procedure, that is, a student must perform it competently, in order to graduate? Can we even imagine teaching medical students how to kill their patients?