Bogota, Colombia (PanAm) – A new ruling by Colombia’s Constitutional Court means that public health institutions, and all the doctors who work in them, will be unable to refuse a patient’s request for assisted suicide — forcing them to carry out the procedure, or transfer the patient to an institution that will.
Medical euthanasia has long been a grey area in Colombia, even after decriminalization in 1997. The decision to end the life of a patient asking for the procedure has hitherto rested on the doctor’s personal preference. But a lack of regulation, and the absence of reliable figures for those dying through such means, has seen three failed congressional debates attempt to reform the law in nearly 20 years.
The controversy re-emerged in early 2015, after the Constitutional Court analyzed the request of a woman suffering from an advanced stage of cancer to die in a “dignified way.” The court then ordered the Health Ministry to make it mandatory for all public doctors and hospitals to provide their patients with access to legal euthanasia, giving it 30 days to present a legislative blueprint.
The judicial order was immediately criticized by the ministry. Some doctors and institutions have defended it, while others are against it, both in principle and on the finer points of the new protocol. The Catholic Church, of course, has firmly opposed the issue.
What remains is the Constitutional Court’s ruling that “to condemn a person to prolong his existence for a short time, against his will and suffering from profound illness, is equivalent not only to cruel and inhumane treatment, but the cancellation of his dignity,” and as such, Colombia should guarantee patients’ the right to die.
Juan Mendoza: you can’t force someone who is suffering in an intolerable and incurable manner to continue living . . . this is torture.
Neurosurgeon Juan Mendoza Vega, the current president of the National Academy of Medicine, is one of those in favor of euthanasia. According to him, “you can’t force someone who is suffering in an intolerable and incurable manner to continue living … this is torture.”
Mendoza is also president of the Foundation for the Right to Die with Dignity, which has been working in Colombia for 35 years.
For surgeon Jorge Merchán Price, who heads the Médicos Azules movement against assisted dying, such statements are shameful.
“As doctors we exist to defend the value of life and restore our patients to health; we don’t treat people because they have the right to life or not; we treat them because they’re alive,” says Merchán, the author of Medical Ethics: Abuses and Conflicts.
Others have criticized the attack on doctor’s autonomy and their freedom of conscience.
“The Constitutional Court is completely ignorant about the doctor’s vocation, and in an unprecedented reductionism it assumes that he’s a simple ‘technical worker’ at the service of the law and not life,” Merchán argues.
Before the court’s ruling, a doctor or institution could refuse to offer euthanasia to its patients. Now, once requested by the patient and confirmed by a committee of health professionals, the termination of life will have to be delivered by the hospital, or arranged to take place with another institution, within 15 days.
The new legal document establishes interdisciplinary medical committees that are tasked with analyzing each case. The committees will be made up of one doctor who specializes in the relevant illness, a lawyer, and a psychiatrist or clinical psychologist, all of whom will be designated by the hospital.
Money is no object. Health providers (entididades promotoras de salud) must “guarantee the right to a dignified death for everyone who asks it, and help them to receive this service without obstacles.” As a result, not only doctors but also institutions as a whole will be prevented from making an objection to providing access to assisted dying on grounds of conscience.
The resolution insists that prior to providing euthanasia, it must be verified that the patient has received all palliative care. In fact, if the patient changes his mind, the hospital must guarantee him every assistance in cancelling the process.
Nubia Posada: When the patient asks for euthanasia, you need to establish if there has been negligence on the part of health professionals.
The Court’s ruling further establishes that the same doctors must provide the information, deal with any concerns, and administer the lethal procedure — something which has further raised the alarm among its critics.
With regard to this, Merchán argues that “the mere fact of giving information to the patient automatically makes the doctor far from the ideal person to kill him.”
“A person who really wants euthanasia can freely deny any treatment and simply die through inaction: it’s safe, it’s efficient, it’s painless, and in genuinely terminal conditions and with careful sedation, the process should only last a few days. We don’t need to abusively force third parties to kill,” he wrote in an article for Medellín’s Bolivarian Pontifical University.
A Human Problem
For Nubia Posada, director of the Colombian Foundation for Ethics and Bioethics, the fact that a patient requests euthanasia has more to do with a lack of support from their family and doctors than a genuine wish to die.
“When the patient asks for euthanasia, you need to find out who to report to, and who can establish if there has been negligence on the part of health professionals. You also need to make the family see that they have to love and spend time with that person … I’m a nurse, and my direct experience with terminal patients is that if you care for them and encourage them to share with others, they die happy, despite their discomfort,” she says.
Posada further argues that patient shouldn’t have to go to the extreme of asking for euthanasia as a means of ending pain, as, according to her, this can be controlled almost 100 percent with modern medicine.
“They say that patients have the right to take their life when they’re suffering from uncontrollable pain, but in these very rare cases where you can’t dull the pain, you can sedate the patient with their consent.”
In this sense, Posada believes that the state would be better off concerning itself with regulating the law concerning palliative care, which was written long before the euthanasia debate emerged. “They’re taking the easy way out with this false argument of respect for the patient’s autonomy or the right to destroy themselves, when what they ought to do is regulate the existing law.”
Posada is also worried about how even countries like Holland and Belgium, which supposedly possess advanced legislation on the topic, “haven’t managed to control euthanasia in the intimacy of people’s homes nor during lonely night shifts.”
“The doctors say that in over 50 percent of cases, they wouldn’t want to follow the protocol demanded by the state to develop this practice, It’s striking that [the court] wants to imitate in Colombia a model that brings negative effects that they know can’t be controlled.”