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In June 1997 the BMJ published an article (1) stating that Colombia
was confused about the decision to legalize euthanasia. At the time, the
main arguments against this practice stressed the inviolability of the
right to life, set forth in article 11 of the Political Constitution (2)
and the poor offer of palliative care by the Colombian Health System.
Those in favor argued the right to a dignified death. Finally, Colombia
was the second country in the world to legalize euthanasia. In order to
regulate this practice the Constitutional Court held in its decision C-239
-97 defines patients likely to be the object of euthanasia as follows:
“Patients who in fact are suffering from a terminal disease or injury
certified in their medical records by two specialist physicians,
experiencing intense, ongoing pain, which cannot be alleviated by modern
medical science, and with no hope for a cure or relief”. Has this
confusion been cleared ten years after the ruling of the Court?
The development of palliative care in Colombia has undergone no
significant change since 1997. Legally, the Health System in Colombia is
regulated by Law 100, put into effect in 1993, and 4 years later, only 58%
of the population was affiliated to it. Fourteen years after its
implementation, the expression palliative care is not even mentioned, and
the only concept more or less closely related to it is a form of
precarious and very limited domiciliary care provided by people with no
specialized training. The minimal dissemination through the media has led
the public to be misinformed, and health professionals count on only two
academic centers in the country for their training in this specialty,
after which, they work exclusively in large cities. As compared with 1997,
the number of deaths by cancer in 2002 increased by 27%(3). In the same
period, chronic obstructive pulmonary disease increased by 53%. In
parallel, the consumption of morphine was reduced by 25%(4) between 1997
and 2001. Besides, investment in health as part of the GDP was also
reduced by 19%(5). We can therefore state that for most of Colombian
population there is no palliative care, although this type of care was a
prerequisite for the legalization of the compassionate termination of
life. Now the society as a whole is exposed to it. In order to regulate a
“dignified death” the court demanded the state, in its commitment to life,
to "…offer the terminally ill who are enduring excruciating suffering, all
the possibilities to continue to live. It is therefore in the obligation
to provide palliative care to relieve their pain(6)". Has there been
progress within these 10 years? This reality leads to a reflection on the
number of people who would be likely to receive or who would be eligible
for euthanasia since 1997, with no palliative solution. In the 10 years
euthanasia has been legalized, the most recent and meaningful event was
the urgency of the Colombian Congress to regulate it. In spite of the
intense publicity surrounding the law project, it was not approved. This
process did not take into consideration valid public and professional
opinions. It is clear that the legalization of euthanasia has not done
anything to improve the quality of care at the end of life. Unfortunately,
Colombia is still confused, unable to provide good care to the terminally
ill. It proposes alternatives that make it possible to end life, without
offering options that contribute to a good death.
References
1. Ogilvie AD. (1997) Colombia is confused over legalization of
euthanasia. British Medical Journal, 314:1849.
2. Article 11. Political Constitution of Colombia 1991
3. Statistics from the World Health Organization. www.who.int
4. Statistics from the International Narcotics Control Board. www.incb.org
5. Statistics from the Pan American Health Organization. www.paho.org
6. Sentence C-239-97. Legalization of the Compassionate termination
of life
Competing interests:
None declared
Competing interests:
No competing interests
18 January 2008
Jairo R. Moyano
President
Sofía C. Zambrano
Colombian Association of Palliative Care- Av 9 #116-20 Bogotá / Colombia
Ten years later, Colombia is still confused about euthanasia
In June 1997 the BMJ published an article (1) stating that Colombia
was confused about the decision to legalize euthanasia. At the time, the
main arguments against this practice stressed the inviolability of the
right to life, set forth in article 11 of the Political Constitution (2)
and the poor offer of palliative care by the Colombian Health System.
Those in favor argued the right to a dignified death. Finally, Colombia
was the second country in the world to legalize euthanasia. In order to
regulate this practice the Constitutional Court held in its decision C-239
-97 defines patients likely to be the object of euthanasia as follows:
“Patients who in fact are suffering from a terminal disease or injury
certified in their medical records by two specialist physicians,
experiencing intense, ongoing pain, which cannot be alleviated by modern
medical science, and with no hope for a cure or relief”. Has this
confusion been cleared ten years after the ruling of the Court?
The development of palliative care in Colombia has undergone no
significant change since 1997. Legally, the Health System in Colombia is
regulated by Law 100, put into effect in 1993, and 4 years later, only 58%
of the population was affiliated to it. Fourteen years after its
implementation, the expression palliative care is not even mentioned, and
the only concept more or less closely related to it is a form of
precarious and very limited domiciliary care provided by people with no
specialized training. The minimal dissemination through the media has led
the public to be misinformed, and health professionals count on only two
academic centers in the country for their training in this specialty,
after which, they work exclusively in large cities. As compared with 1997,
the number of deaths by cancer in 2002 increased by 27%(3). In the same
period, chronic obstructive pulmonary disease increased by 53%. In
parallel, the consumption of morphine was reduced by 25%(4) between 1997
and 2001. Besides, investment in health as part of the GDP was also
reduced by 19%(5). We can therefore state that for most of Colombian
population there is no palliative care, although this type of care was a
prerequisite for the legalization of the compassionate termination of
life. Now the society as a whole is exposed to it. In order to regulate a
“dignified death” the court demanded the state, in its commitment to life,
to "…offer the terminally ill who are enduring excruciating suffering, all
the possibilities to continue to live. It is therefore in the obligation
to provide palliative care to relieve their pain(6)". Has there been
progress within these 10 years? This reality leads to a reflection on the
number of people who would be likely to receive or who would be eligible
for euthanasia since 1997, with no palliative solution. In the 10 years
euthanasia has been legalized, the most recent and meaningful event was
the urgency of the Colombian Congress to regulate it. In spite of the
intense publicity surrounding the law project, it was not approved. This
process did not take into consideration valid public and professional
opinions. It is clear that the legalization of euthanasia has not done
anything to improve the quality of care at the end of life. Unfortunately,
Colombia is still confused, unable to provide good care to the terminally
ill. It proposes alternatives that make it possible to end life, without
offering options that contribute to a good death.
References
1. Ogilvie AD. (1997) Colombia is confused over legalization of
euthanasia. British Medical Journal, 314:1849.
2. Article 11. Political Constitution of Colombia 1991
3. Statistics from the World Health Organization. www.who.int
4. Statistics from the International Narcotics Control Board.
www.incb.org
5. Statistics from the Pan American Health Organization.
www.paho.org
6. Sentence C-239-97. Legalization of the Compassionate termination
of life
Competing interests:
None declared
Competing interests: No competing interests