CHICAGO (McClatchy) — For more than 20 years the nation’s most prominent doctors’ group has opposed physician-assisted suicide, but there are signs the American Medical Association may be wavering on that position.

An AMA council spent two years reviewing the group’s opposition to the practice, and recommended in a report that its stance stay the same. The AMA’s House of Delegates, however, narrowly voted Monday at the group’s annual meeting in Chicago not to accept that report, instead sending it back to the council for further review. About 56 percent of the delegates voted for further review.

The American Medical Association’s current opinion says, “Permitting physicians to engage in assisted suicide would ultimately cause more harm than good.”

The debate comes as the majority of Americans support the practice. About 72 percent of people surveyed as part of a recent Gallup poll said they believe doctors should be legally allowed to end a terminally ill patient’s life using painless means. That support, however, drops to 65 percent when people were asked if doctors should be allowed to “assist the patient to commit suicide” if a person has an incurable disease and is in severe pain.

The vote also followed much debate over the matter at the meeting this past weekend. On Monday, some delegates said they felt it was important for the AMA to support physicians who choose to help patients die in states where the practice is already legal.

“There’s a conflict there that’s very worrisome,” said Dr. Theodore Mazer, president of the California Medical Association and a member of the House of Delegates, said in an interview. “It puts physicians at risk of being in conflict with the (AMA’s) code of medical ethics.”

Physician-assisted suicide is legal in Montana, Oregon, Vermont, Colorado, Washington and the District of Columbia, and it will become legal in Hawaii in 2019. It also was legalized in California, though it’s prohibited there while courts review the manner in which California’s law was passed.

Though only individual states can legalize the practice, the AMA’s position has been influential in informing those decisions.

Other delegates said the AMA’s opposition is as valid now as it was more than 20 years ago when it was adopted. Reversing that position would go against thousands of years of medicine, dating back to the Hippocratic Oath, said Dr. Thomas Sullivan, Massachusetts Medical Society president, in an interview.

“It’s the antithesis of why you want to become a doctor or a healer,” said Sullivan, who is also a member of the AMA’s House of Delegates. He’d instead like to see more palliative and hospice care and psychological support for patients.

The council’s report cited concerns from some critics that physician-assisted suicide might be used for more than just competent, terminally ill adults, such as for children, people with psychiatric disorders or people with socioeconomic challenges. They pointed to studies out of Belgium and the Netherlands, where the practice is legal, that they said show some who chose to end their lives “reported only psychological suffering.”

The report, which was two years in the making, also recommended the group continue using the phrase “physician assisted suicide” rather than the terms “aid in dying” or “death with dignity” as some advocates of the practice would prefer.

“(The AMA’s Council on Ethical and Judicial Affairs) believes ethical deliberation and debate is best served by using plainly descriptive language,” the report’s authors wrote. “In the council’s view, despite its negative connotations, the term ‘physician assisted suicide’ describes the practice with the greatest precision.”

The terminology may also be re-examined as the council takes another look at the report.