To Suffer or To Live: The Dilemma of Euthanasia – CONNECTAS – Connectas

By Carlos Gutierrez*

Most attendees will never forget that football match. It was Saturday, September 10, and Deportivo Independiente Medellin (DIM) and Santa Fe were facing each other. It was memorable, not because of what happened on the pitch, but for what was going on in the bleachers. Sebastian Pamplona, a young man with a terminal illness, went to the stadium to fulfill his last wish: watching the DIM (his favorite team) play before being euthanized. Thousands of fans and players chanted his name in deeply poignant moments.

Colombia is a pioneer in decriminalizing euthanasia in Latin America. The law authorized it, back in 2015, for patients with terminal illnesses. Physicians must undertake the procedure with prior authorization of the respective Interdisciplinary-Scientific Committee to Die with Dignity.

Aside from Sebastians story, the debate to decriminalize and regulate euthanasia is back in the news in Latin America. In early February, the Constitutional Court of Ecuador decriminalized euthanasia in its active form, after a woman, 42, Paola Roldan, made a plea on social media to request the legalization of assisted death, in August 2023.

Three years ago, Paola was diagnosed with amyotrophic lateral sclerosis and she has been immobilized for more than six months, without chances to improve. Those being her circumstances, she recruited a team of lawyers to demand her right to die with dignity to the Court. Along the process, she became a symbol of the fight to decriminalize euthanasia not only in Ecuador but in Latin America.

Although etymologically euthanasia meansgood death, it refers to ending the life of a person with an incurable or irreversible disease. It implies administering painless means to avoid the continuation of grave physical suffering. Oftentimes, it takes place in clinical contexts in which a third party, usually a doctor or group of doctors, is in charge of performing the procedure. The third party sets in motion a chain of events leading to the final outcome, controlling the result at all times, explains Carlos Molina-Ricaurte, of Universidad Cooperativa de Colombia, in a chapter of the book Las identidades analizadas a traves de las segregaciones historico-culturales.

Globally, a mere nine nations have decriminalized and legalized the intervention. The Netherlands walked that path first, in April 2002. A month later, Belgium followed, and so did Luxembourg in 2009. In 2016, Canada joined them, and New Zealand in 2020. Spain legislated on it in July 2021, and Portugal in 2023. And In Australia, euthanasia is allowed only in the state of New South Wales, which authorized it in 2022.

In the United States, from 1997 to 2017, ten states legislated on assisted suicide for people over 18 who had a life prognosis shorter than six months. Unlike euthanasia, assisted suicide requires no intervention by a third party. It is defined as the action of a person suffering an irreversible disease to terminate his or her life. To do so, he or she has to have the support of practitioners that provide knowledge and means. Since 2020, it is not prosecuted in Germany and in Italy, where it is admitted in very special cases. Austria and Switzerland consider it only if the motive is not against the law.

In 2022, Colombia decriminalized assisted suicide for people with grave or incurable diseases. That same year, Victor Escobar, a 60-year-old driver, was the first Colombian to be euthanized without having an illness in the terminal stage. He had had cerebrovascular accidents, as well as obstructive pulmonary disease and hypertension. His battle opened doors for patients behind me who wish to die with dignity, Victor said in a farewell video published by the newspaper El Tiempo.

In Cuba, last December, the National Assembly of Peoples Power passed a new law by which it admits the right of people to die with dignity by arranging the decisions for the end of their lives, which may include the limitation of therapy, continuous or palliative care and valid conducts that put an end to their lives. The law, however, will only become effective when the legislature passes the regulation for its application.

Eneyda Suer, Mexican professor at Instituto Tecnologico y de Estudios Superiores de Occidente (ITESO), thinks that euthanasia should be legal and not just decriminalized, because that would open the door to serious, strict and dutiful protocols. Otherwise, it will continue taking place surreptitiously, carelessly and without adequate protocol. In his text, Molina-Ricaurte admits that in the case of Colombia, neither euthanasia nor assisted suicide have been sufficiently regulated. It is a fair demand to legislate on the matter.

Mexicos General Health Law forbids euthanasia, assisted suicide and mercy killing. However, there is the option of anticipated will, a legal figure through which someone with a terminal disease, or a forecast of one, may plan treatment and care for the end of life. One of the purposes of this resource is to respect the patients will, as well as guaranteeing a natural death in dignified conditions, says the Mexican Health Secretariat.

One of the arguments in favor of legalization is the right to make choices pertaining to our own lives. Neither assisted suicide nor euthanasia harm the rights of third parties. And we all know, as the popular adage says: my rights end where yours begin, states Marina Arias, lawyer of the Ministry of Public Defense of Paraguay.

Discussions around euthanasia are full of complexities and myths. Topics that have to do with morality are usually taboo. Theres abortion, euthanasia, surrogacy, homosexuality Suer says. From her point of view, euthanasia should be legislated because it is about coexisting. And in coexisting, we must admit that there are some facts that, albeit unpleasant, occur. So, why not legalize and create protocols to effectively respect a person?

Some studies address the influence of religion. It is clear that religiousness is negatively associated with accepting euthanasia or assisted suicude. As explained by Norma Ordoez and a team of researchers at Universidad Nacional Autonoma de Mexico (UNAM), in the article entitled Exploracion del discurso de los enfermos cronicos sobre la legalizacion de la muerte asistida.

But this brings upon controversy. Miguel Pastorino, PhD in philosophy and director of Centro Core at Universidad Catolica de Uruguay, considers it a myth to argue that the main stance against euthanasia is religiously driven. If you read documents by Catholic bishops, and I just read the one written by the bishops of Ecuador, their arguments appeal to human rights instead of to religion. The question is: Is it a human right to demand induced death? Or, as it is almost everywhere thus far, is it a human rights violation to end someones life even though he or she asked for it? In other words, what we have are two conflicting points of view on human rights, he underscores.

Lawyer Arias claims that at the moment of legalizing, the right that would prevail the most would be the right of autonomy. So, to what extent are we allowed to make decisions about ourselves? she wonders. She alleges that the existence of laws that criminalize euthanasia and assisted suicide means that the State is meddling on when a person can decide over his or her body. She also supports that mental illnesses should be taken into account when legalizing euthanasia.

Pastorino adds that it is a myth to confuse euthanasia with palliative or terminal sedation. It is not an undercover form of euthanasia, as many people think, he says. It is about inducing a coma for the personal to die naturally, but unconsciously. It simply makes death less atrocious, it makes it peaceful. That is ethically correct. It is legal, he explains.

For Pastorino, the law in favor of euthanasia allows physicians to kill patients. The problem is that it has been sweetened and romanticized. He believes the only argument for it is compassion towards the patients suffering, but that can be alleviated with proper palliative care. He highlights that, in that regard, there is a problem of social injustice that is frequently overlooked, since many people dont even have access to palliative care.

In an interview with the Uruguayan radio show En perspectiva, Spanish oncologist and palliative care physician Enric Benito talked about his experience with Fernando Sureda, former manager of the Uruguayan Football Association. In 2018, after being diagnosed with amyotrophic lateral sclerosis, he requested an euthanasia to the Uruguayan legal system, to no avail. Due to the pandemic, Benito virtually accompanied Sureda in his last days.

The documentary Hay una puerta ahi is a compilation of videos of those meetings, and it shows Sureda reconsidered the possibility of euthanasia. Based on this experience, the persons real intention is to put an end to suffering. And it is more elegant, more professional, and more humane, to put an end to suffering instead of ending a life.

Gerardo Perez-Mendoza, researcher of Laboratorio de Genetica at Universidad Autonoma de Yucatan, proposes considering the opinion of physicians. He thinks that many resist doing it because it is against their professional principles. Their oath dictates that they must seek to save or alleviate the patient.

In 2020, the Medical Association of Uruguay conducted a poll that revealed doctors in that country had a very favorable attitude towards the approval of legislation to enable euthanasia in its active form. In 62% of the cases, they responded in favor with total certainty.

In any case, the role of doctors would have to be closely monitored to avoid the likelihood of malpractice. In a text published in Prudencia Uruguay. En defensa de la dignidad humana, Carlos Maria Schroeder, honorary professor of Universidad de la Republica, refers to an official report of the Canadian Medical Association in which 120 Belgian nurses admitted to having performed euthanasia without the patients request. He states that in countries where it has been approved, the practice of palliative care has truly decreased: the medical community has been strongly deterred from pursuing that type of care, in the face of mounting unruly, and oftentimes, unjustified cases of euthanasia.

Most experts interviewed for this article agree that many of the controversies on the matter are among healthy people and at theoretical level. There arent many studies with people living with diseases in the terminal stage. People who really wish to be euthanized are not in conditions to manifest their intentions or to sign documents. Normally, they realize they wish for it when they are in a terminal stage and in a lot of pain, Suer says.

The stance of sick patients on this topic is relevant to have enough elements aimed at a prospective regulation, from the bioethics, medical and legal perspectives, UNAM researchers expound.

The topic requires serious analyses and dialogue between professionals from different disciplines. In the meantime, Pastorino recommends moving forward on better palliative care, on laws of anticipated will, on health care, on providing support to patients in pain and their families. For this expert, whose thesis in bioethics was on euthanasia, the discussions tend to be in black and white, in heated defenses for or against. And, well, this is not a football match.

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*Member of the editorial board at CONNECTAS

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To Suffer or To Live: The Dilemma of Euthanasia - CONNECTAS - Connectas