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Colombia allows euthanasia of two people with non-terminal illness

BMJ 2022; 376 doi: https://doi.org/10.1136/bmj.o67 (Published 11 January 2022) Cite this as: BMJ 2022;376:o67
  1. Owen Dyer
  1. Montreal

Two people who had serious diseases but not terminal prognoses have ended their lives legally in Colombia with the assistance of doctors. The country’s new policy makes it the fourth in the world, after Belgium, Canada, and the Netherlands, to permit voluntary euthanasia to end suffering in people who may not otherwise be likely to die soon.

Victor Escobar, 60, who had chronic obstructive pulmonary disease, ended his life in Cali on the evening of 7 January, becoming the first person in Latin America to die legally and voluntarily without a diagnosis of terminal illness.

The next day, Martha Sepúlveda, 51, who had fought a long legal battle for the right to die, was euthanised at her request in Medellín. She suffered from progressive amyotrophic lateral sclerosis, also known as Lou Gehrig’s disease.

Sepúlveda’s death had been scheduled for October 2021, following a July decision from Colombia’s constitutional court, which ruled that death with dignity should be accessible not only to people in their final days but to all experiencing “intense physical or mental suffering from bodily injury or serious and incurable disease.”

But on the eve of her planned death, the health provider that had agreed to carry out the procedure, the Colombian Institute of Pain, notified her that a committee had reviewed her condition and found improvement in her symptoms since the court ruling, making her ineligible. Sepúlveda, who had not been told of the review, accused the health provider of backing down to political and church pressure.

Much of the debate in the Catholic country has been couched in theological terms. Leaders of the National Bishops’ Conference have called euthanasia a “serious offence” to the dignity of human life and publicly urged Sepúlveda to “calmly reflect” on her decision.

Sepúlveda, who described herself as a devout Catholic, told Caracol News, “I know that God is the owner of life. But God doesn’t want to see me suffer.”

In 1997 Colombia became one of the first countries to legalise medically assisted dying when its highest court interpreted the rewritten liberal constitution of 1991 as granting that right. But for more than 15 years no hospital or official agency was willing to participate. One physician, Gustavo Quintana, who died recently, became known as “doctor death” for providing euthanasia to an estimated 400 patients.

In 2014 the constitutional court ordered the government to provide guidelines to hospitals and insurers. Since 2015, according to official figures, 178 Colombians have died by euthanasia, all of them, until now, with terminal diagnoses.

The practice has popular support, with 72.5% agreeing in a recent poll that euthanasia should be accessible to those experiencing “intense physical or psychological suffering, due to a bodily injury or illness that is grave and incurable.”

In a video sent to media before his death, Victor Escobar said, “We reached the goal for patients like me, who aren’t terminal but degenerative. To win this battle opens the doors for the other patients who come after me and who, right now, want a dignified death.”

Sepúlveda was able to reschedule her death for this weekend after convincing a lower court in October that her disease was incurable and likely to worsen. The court found that the health provider’s last minute refusal was unreasonable, in a ruling that was not appealed.

The Laboratory of Economic, Social and Cultural Rights (DescLAB), a law firm which has represented Sepúlveda and other patients seeking access to euthanasia, said after her death, “Martha’s legacy is built on the life stories and cases that over 29 years have reached the constitutional court and have allowed Colombia to be one of the few countries in the world where death with dignity and euthanasia are a right of citizens.”

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