The World Medical Association (WMA) has gathered at the heart of the Catholic Church to debate its policy on end-of-life care.
The choice of location sends a clear message about the organisation's position on the controversial issue of euthanasia, according to Jeff Blackmer, the vice president of the Medical Association in Canada.
"It's like having a human rights discussion in North Korea," said Blackmer, whose home nation allows terminally ill patients to legally receive medical help to die. "It's not a neutral environment."
Euthanasia, practised by a doctor, and assisted suicide, performed by a patient, are deemed unethical by the organisation, which counts more than 100 national medical organisations among its members.
The standards-setting body encourages doctors worldwide to refrain from supporting the procedures -- even if they are legal in their country.
But medical associations in Canada and the Netherlands, where assisted dying is also legal in limited cases, are calling for a change in attitude within the WMA.
Littooji says a patient experiencing unbearable suffering who requests an assisted death is monitored over a long period by a team of doctors.
"It's a road we walk together over time, the end can be euthanasia but far more often it's a natural death," adds Littooji.
President of the German Medical Association, Frank Ulrich Montgomery, quoted the 2,400-year-old Hippocratic Oath to the conference: "... neither will I administer a poison to anybody when asked to do so, nor will I suggest such a course."
While he highlighted surveys from some industrialised nations which show majority support for terminally ill people legally ending their own lives with doctors' help, he questioned whether it is "compassionate" to kill your patient.
"In liberal societies people want to have choice and options right up to the very end of their life," he added.
"Are our ethics, our deepest beliefs, dependent on polls?"
But Dutch Royal Medical Association chairman Rene Heman told the conference that euthanasia "can be accepted".
In the Netherlands, a patient must be experiencing unbearable suffering with no prospect of improvement to qualify for one of the life-ending procedures.
"It will never feel good for a doctor," he accepted.
"The possibility of euthanasia does not undermine the trust between patient and doctor. The patient knows he can rely on this physician."
A letter from the Pope was read to the conference, reiterating the Catholic Church's unwavering opposition to both acts.
During a coffee break, delegates were also offered books with titles such as "Post-Abortion Trauma" or "The Risk of Eugenics" by the Vatican's Pontifical Academy for Life.
By Catherine Marciano