Medically assisted suicide in Colombia: challenges after decriminalization – Courts – Justice

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The ruling made Colombia the first country in Latin America to legalize this mechanism as one of the possibilities to access medically assisted death.

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Some of these countries, like Colombia since 1997, have also decriminalized euthanasia and in others, like Switzerland, there is only endorsement for physician-assisted suicide. The difference between one procedure and the other lies in the fact that in euthanasia, the final action is carried out by a doctor, and in the SMA, it is done by the patient. From now on, according to the ruling, it will not be a crime to help a patient who wants to take his own life under the following strict requirements:

That it is a person who suffers from intense physical or mental suffering due to bodily injury or serious and incurable disease duly diagnosed and who presents a free, conscious and informed consent, which may be prior to the diagnosis or after it. And as long as the conduct is performed by a doctor.

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It is not about an apology for suicide, but about not criminalizing the doctor who attends a patient who has intense suffering due to a diagnosis of incurable disease, that meets the same requirements by which today he could also access euthanasia, but in which the decision of the person is to end his existence himself.

There are still preventable suicides, it is important to continue working on prevention. We must recognize that they are different discussions, that we are not promoting people to take their own lives

In the official statement on the decision, the Constitutional Court explained this same matter when it stated that materializing the right to die with dignity “is predictable in these circumstances with respect to the doctor, since he is the one who has the best technical, scientific and ethical tools to try to guarantee safeguarding human dignity in the procedure”.

Therefore, for the expert, one of the first challenges is that the conversation is maintained in the informed contexts. Added to this is the naturalization, as has been done in the last 25 years with euthanasia, of the concept of the SMA. Lucas Correa, from the Laboratory of Economic, Social and Cultural Rights (DescLAB), assures that even the conversation should be about the concept of medically assisted death, which includes both procedures, due to the social and moral burdens that include the words “euthanasia” and “suicide”.

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“It’s not about avoiding debate, but about finding a common language,” he says. And Giraldo adds that one cannot fail to recognize that suicide that is not related to these cases continues to be a public health problem.

“There are still preventable suicides, it is important to continue working on prevention campaigns. We must recognize that they are different discussions, that we are not promoting people to take their own lives, but rather that we are doing it in the context of a dignified death,” added the expert.

Antonio José Lizarazo, president of the Constitutional Court, explained that compliance with guardianships will be prioritized, so urgent measures will be taken.

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Courtesy Constitutional Court

With a presentation by the magistrateor Antonio Jose Lizarazothe Court said that the “criminalization of the conduct of the doctor who helps someone who suffers from illness and suffering of such intensity that they prevent a dignified life, is disproportionate and exceeds the limit of minimum criminal intervention.”

The ruling does not deal with the inducement to suicide, which continues to be a crime, but referred exclusively to aid in the aforementioned conditions, by protecting the right to a dignified death and to personal autonomy and the free development of the personality, to make it clear that the SMA is a “means to carry out a dignified death”.

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And, as it has done since 1997 and for the eighth time, The Constitutional Court called on Congress to “advance in the protection of the right to die with dignitywith a view to eliminating the barriers that still exist for effective access to said right”.

Are we going to think of MAS like in European countries and the United States, where the procedure can be done at home with oral medications?

According to the experts consulted, the route to be used could be the same one in force for euthanasia, which started in 2015, in which, after the request, the health system is activated with the Interdisciplinary Scientific Committee for Dignified Death, which must review the case to, in ten days, give an answer.

What there is not is a protocol on medications. “Are we going to think of MAS like in European countries and in the United States, where the procedure can be done at home with oral medications? And, if so, how are we going to guarantee the chain of custody so that they fulfill their ultimate goal?” asks Mónica Giraldo.

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Now, whether in this or the next government, the regulations must maintain the current line that allows the doctor object conscientiously in case you consider that doing the accompaniment is not compatible with your deepest convictions. What is not possible is that an entire healthcare center object conscientiously, since institutional objection is not allowed.

And another issue that will have to be dealt with in depth is the scope of the medical assistance, to determine if it includes psychosocial work with the family, whether it is limited to the provision and dispensing of medicines or not, among others.

This point is key because it had been the subject of a technical concept that the Ministry of Health sent to the Constitutional Court in the middle of the debate in which it warned that “bringing the SMA to the provision of services requires a service provision structure, primarily access to medicines and a network for dispensing, surveillance and control, different from the one used in euthanasia”.

And in which he assured that a “contextual definition” and “differentiated operational reviews” would also be needed, so in his opinion this matter should be subject to regulation by Congress and not by judicial means. He even assured that the right to die with dignity “does not contain infinite alternatives” and that it was a mistake to equate the SMA with euthanasia as it had obvious “conceptual, procedural and care differences”.

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Medically assisted death in the world.

Medically assisted death in the world.

Full Chamber Constitutional Court

Full Chamber Constitutional Court

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Constitutional court

Judge Cristina Pardo said that the same intense suffering of the person “difficult the freedom of consent” that he can give to seek to end his own life. And he pointed out that dignity in these conditions implies that the person may have the effective right to restore health, mitigate pain and even give up palliative care, but not until the end of life because this is, in his opinion, “ an attack on dignity”.

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Judge Paola Meneses said that “the suicide’s consent does not exist to the extent that he is not autonomous in the decision and execution to consummate his death.” “In no way does the condition associated with an activity such as medicine validate and make, in accordance with the principles and values ​​defended by the Constitution, the induction, help or effective support to encourage, materialize or promote death, an effect that ends up deriving from the sense of judgment adopted,” he said.

And Judge Jorge Ibáñez stated that the right to die with dignity does not exist because to recognize it, it would be necessary to include it in the Constitution through a reform. “The right that does exist is the fundamental right to life. This right, in harmony with the principle of human dignity, qualifies as a right to live in decent conditions, in which any form of inhuman, cruel and degrading treatment is avoided”, he pointed out.

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It is unfortunate the growing moral inconsistency of those doctors who lend themselves to it and who proudly maintain that killing is a compassionate and correct medical act.

There is no way to legitimize or harmonize the act of killing with the universal values ​​that define a medical act and the doctor who deviates from those values, protected by a wrong and distorted conception of compassion,” said Merchán, criticizing the Constitutional Court and assuring that it would have exceeded its functions.

“The growing moral inconsistency of those doctors who lend themselves to it and who proudly maintain that killing is a compassionate and correct medical act is unfortunate. It’s not!” she said.

Congresswoman María del Rosario Guerra, from the Democratic Center, pointed out that the Court usurped the functions of Congress “which is the only one” called to “create rights and modify rights.”

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“The Court has created a new right, to die with dignity, which does not exist in the Constitution. There is no international agreement that speaks of this. What exists is the right to life and that is why I have to reject the decision. What the Court is encouraging is the culture of death,” he said.

and hehe Episcopal Conference of Colombia also pointed out that “based on the principle of human dignity, there is no ‘fundamental right to a dignified death’ but the right to life”, for which he called on people to “reject the temptation, sometimes induced by legislative changes, to use medicine to cause death”.

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