While Colombian justice has ruled to allow euthanasia for patients who ask for it, physicians are reticent to apply the health ministry's "vague" norms.
BOGOTÁ - While euthanasia is now legal in Colombia, when faced with individual patients doctors still hesitate on how to implement the health ministry's relevant protocol. Take the case of 79-year-old José Ovidio González. Days ago, after five years of cancer that required a range of painful treatments that have destroyed parts of his face, he wrote down on paper that he no longer wanted to live and that his family supported his decision to be put to death.
González would be the first patient to undergo euthanasia under the new protocol the health ministry issued in April to regulate assisted death. Only, 30 minutes before being carried out, his first appointment with death was cancelled earlier this week. On Thursday, the Occidente cancer clinic where he's being treated announced that the euthanasia procedure was back on schedule, though the family asked that the date and time be kept private.
The treating physician Juan Carlos Arbeláez agrees that Ovidio has an advanced illness that produces constant suffering, that he "no longer has treatment options" and his request for euthanasia is "coherent."
Yet after a scientific committee was formed to examine his case, oncologist and thanatologist Juan Paulo Cardona stated that pursuant to the ministry's own stipulations in Resolution 1216 of 2015, "which are in any case ambiguous and full of gaps," Ovidio did not meet requirements for receiving euthanasia.
Cardona defends his positions with three arguments: Firstly, he says the patient has received all palliative care that could control his pain; secondly, he says he is "very functional and the norm says he should be totally dependent" and lastly, it appears the patient's death is not imminent.
The norm he adds, "says that it has to be a patient diagnosed as about to die, though the term is very ambiguous. One could say in this case that the patient will not die soon."
These doubts led to the cancellation of the appointment already approved by the Occidente cancer clinic in Bogotá, which has prompted Ovidio González to resort to the courts to protect his right to die with dignity.
Rodrigo Uprimny, a specialist in constitutional law and head of Dejusticia, a legal research center, says that the new regulations do not specify that the patient must be lying helpless in bed or dependent on others to exercise this right. "The norms clearly state that any patient with a terminal illness and expected to die soon, can apply for euthanasia," he says.
Now, while the idea of "dying soon" has multiple interpretations, he adds, medical committees examining patients' cases "could determine whether or not the remaining time entails dignified conditions."
On the verge
Uprimny says that the ministry's regulations do not obligate patients to receive palliative treatments: "The regulation says that patients must know that the option exists, but it does not force them to receive that treatment."
The lawyer also clarifies that physicians implementing euthanasia should know that the new protocol was created to regulate two rulings of the Constitutional Court (239 of 1997 and 970 of 2014), broadly intended to defend and ensure respect for a patient's autonomy in deciding on his or her life.
"Both rulings defend the right of any person to dispose of their own life, and give centrality to a patient's free will," says Uprimny.
Juan Mendoza Vega, president of the National Academy of Medicine and head of the Foundation for the Right to Die in Dignity (Fundación Derecho a Morir Dignamente), agrees. He says "one must insist on respecting the patient's will. Besides, you must not confuse a terminally ill patient with one on the verge of death. If you are slowly dying, what is the use of euthanasia? The patient can have that if they are suffering greatly, if there are no curative treatments and if it is known the patient will die in a short time. Sometimes they come up with the silliest issues because they haven't properly read the resolutions. The health ministry's regulation is not perfect, but adequate."
Another to give his opinion is Gustavo Quintana, known in Colombia as "Doctor Death" for having carried out 200 assisted suicide procedures.
"If the Constitutional Court has clarified to us that death is a right, why do we create obstacles to a patient's autonomous decision and desire to end his or her life?" he asks.
The wish to die, he adds, "cannot be judged because it is a decision that affects one person, as an individual. As physicians we have enough elements to determine whether or not a person's request is legitimate, and every point of the resolution should be debated. While I think this is a ridiculous set of rules, I have to adapt to them and I'm sure I am not going to get myself into trouble, because every euthanasia I have carried out followed the patient's wishes and had the family's participation."