Euthanasia – Specialists discuss the right to decide on one’s own life in the face of untreatable illnesses

The recent death of human rights activist Cecilia Heyder, who was terminally ill and had fought for years for the right to a dignified death, has reignited the debate on the need for a euthanasia law in Chile. Specialists from the faculties of Medicine, Law and Philosophy at the University of Chile agree on the urgency of a regulatory framework that would allow people in situations of extreme suffering and untreatable illness to decide about their own lives.

Chile is one of the few countries in the world where euthanasia is completely prohibited. To move forward on this issue, the Government announced that it would give urgency to the Bill that establishes the right to euthanasia, regulates the conditions for its exercise, and modifies the Penal Code accordingly (bulletin no. 11745-11), which was introduced in 2018, approved by the Chamber of Deputies and is now waiting to be tabled in the Senate. “We are committed to the right to palliative care and to a dignified death,” said President Gabriel Boric at the Public Account 2022.

For Professor Miguel Kottow, an academic at the Faculty of Medicine of the University of Chile, who has been working on this issue for decades and has presented debates on the subject in Congress, he believes that “we are taking too long”. Along these lines, he adds, “I insist on what I have been saying for years, that euthanasia is going to have to come, yes or yes, and that certain conditions have to be attached to it. That is to say, there has to be euthanasia, but there have to be certain prior rules – apart from the technical regulation, which comes after the law – first we would have to discuss who could opt for it if euthanasia were accepted in principle, and for me that means fulfilling certain conditions”.

“First of all, to be in a physical situation, not a psychological one, of non-palatable suffering, or not palatable. In other words, exchanging euthanasia for palliative treatment does not work. You can even refuse palliative treatment, which is no joke. So, what the most advanced countries do is that they give you the option: if you want to go into palliative or euthanasia. If you want to go into palliative care, that doesn’t mean that you can’t have euthanasia later on. But in any case, there has to be intractable suffering,” says Dr Kottow.

In addition, there has to be a repeated and insistent declaration that euthanasia is wanted and that it is authorised directly, because it is an urgent situation and that urgency has to be represented in the regulation, he says. “Because there are plans to set up committees in different parts of the country, and no. Euthanasia has to be a matter of urgency. Euthanasia has to be active, quick, timely, nothing like ‘in a fortnight we are going to see your case’, that person is suffering,” says the academic from the Faculty of Medicine.

For Raúl Villarroel, dean of the Faculty of Philosophy and Humanities at the University of Chile, the discussion on euthanasia confronts us with a situation that we had never managed in a correct way, but rather we had tried to ignore as a society. “The criteria for dealing with death had been established on the basis of religious convictions. But as society is becoming more and more secular and plural from the point of view of options and beliefs, the possibility then arises of reclaiming the right to die with dignity, as it has been called, and which consists, in a certain way, in giving course to a legal initiative that allows the concept that the dying can decide on the end of their life in a free, voluntary and sovereign manner. Understanding that a dignified death would be a right that people have,” explains Professor Villarroel.

In the legal sphere, meanwhile, Antonio Bascuñán, an academic from the Department of Criminal Sciences at the Faculty of Law of the University of Chile, says that the first priority is to provide health benefits that prevent death, “to those who want to heal and survive, which we reasonably assume is the desire of everyone as a general rule”. The second, he adds, is to provide palliative care for the terminally ill who wish to prolong their lives. The third, meanwhile, is to allow the terminally ill and those affected by severe and irrecoverable incapacity to decide about their death, to allow third parties to advise and assist them, and to guarantee access to lethal intervention. And the fourth, finally, “to decriminalise in general the inducement, assistance and failure to prevent suicide that is carried out by a free and mature decision of the person who wants to die”.

What is needed to move forward?
Internationally, euthanasia is legal in countries such as Belgium, the Netherlands, Colombia, Luxembourg, Canada and some US states, where patients have the right to request assisted dying under certain conditions. In these nations, euthanasia has become an option for those suffering from terminal or incurable illnesses that prevent them from having an acceptable quality of life. This week Portugal joined the list, which decriminalised this medical procedure, a law that comes into force on Thursday 18 May.

“Now, the rejection of euthanasia is totally anti-cultural, in all the countries and states where it is being discussed, it is argued in favour, they have just approved it in Portugal. We are all going there, and this absolute refusal or saying that with palliative systems it is not necessary is false for several reasons, among others, because we do not have a good palliative system, added to a deficient health system. And where they do have them, like in Belgium, for example, people prefer euthanasia,” says Dr Kottow.

The medical school academic also recalls that the National Bioethics Commission was approved more than a decade ago, and still does not exist. “It would be an instrument in which not only politicians, but also the people can express themselves. It seems that they don’t want us to have it,” he says.

The Dean of Philosophy, meanwhile, mentions that in recent times there has been a somewhat Byzantine discussion, because although all the conditions exist for a legal precept to be established that would allow it, the discussion has stagnated “in relation to a series of interests that have prevailed and that have to do fundamentally with the convictions held by groups of people in this society, which we could even consider as perhaps even minority groups. And, perhaps, everything exists as a kind of majority aspiration because there is legislation in this respect”, he comments.

Professor Villarroel concludes that, in any case, the option of a dignified death cannot be dismissed. “It cannot be taken off the discussion table at this time under any circumstances, under any conviction, and it is the duty of any country to set about the task of legislating in this respect, perhaps complementing it with other instances, with other alternatives, such as palliative medicine, but not only that, nor preventing people from being able to decide freely about their lives.

Redacción Chile