What is your opinion of the bill that is being processed in Congress and that would regulate euthanasia in Colombia?
I believe that in 25 it is the most complete and ambitious bill that we have discussed as a society. Bills on this subject always sink. In the last 25 years there have been several. The latest data we have is from 9 different initiatives. We have had a legislative journey that goes from Piedad Córdoba in the Liberal Party in the 1990s, through Gina Parody, Germán Vargas Lleras and the recent efforts of former representative Juan Fernando Reyes Kuri and, currently, congressman Juan Carlos Losada.
Why do you say that it is the most complete?
Because it allows us as a society to have a serious discussion about medically assisted death. According to the latest figures from Invamer in the Colombia Opina survey, discussions on dignified and medically assisted death enjoy favorability in public opinion of over 70 percent. It is a good time to give this conversation.
The project talks about medically assisted death and you have requested that medically assisted suicide be included. What is the difference between these two situations?
There are no differences. It is like an umbrella, which is medically assisted death, and within this umbrella there are two mechanisms: euthanasia and medically assisted suicide. In the first of these mechanisms, it is the medical professional who causes death, that is, the person goes to a medical institution or the doctor goes home and this professional administers the drug that causes death. In euthanasia death is caused by a third party.
What about physician-assisted suicide?
In this case, that third party delivers the medicines to the person, of course in a protected, safe way and it is the same person who takes them. That is, the person causes his death. The only difference between one and the other is who causes death: in the case of euthanasia it is the doctor and in medically assisted suicide it is the same person, but with the support of the health system.
According to figures from your law office, how many people have requested accompaniment in these processes?
Since 2015 and as of August 31 of this year, we have 316 procedures reported. In that period the number has multiplied. In 2015, 4 cases were reported and in 2022, 93. This responds to a greater knowledge of actions to die with dignity. In any case, it is far from being massive. About 8 procedures are done per month throughout the country. This is done mainly in Bogotá and Medellín, where close to 80 percent are concentrated.
And without law, how do you go about developing these procedures?
People request the procedure at the medical centers where they are treated. The doctors treating each person have one day to take the case to a committee, which has ten business days to approve or deny the procedure. The request, in principle, should last about eleven days. Sometimes it lasts longer or sometimes less, but in principle that is the term. Normally people receive the request, but there are times when they do not and then they have to go to guardianship. What the medical center does is check if it meets the requirements and if it does, the procedure is authorized. And there are cases where not.
And what would have to be done to include physician-assisted suicide in the euthanasia bill that is being processed in Congress?
The adjustment is extremely simple to do, what happens is that in Colombian society it is much easier to talk about euthanasia, which is a difficult concept with stigmas, but to which we have become accustomed, than medically assisted suicide, with which the same does not happen. This mechanism carries additional stigmas that are difficult to address and process socially. It is a conversation that we are yet to have.
What requirements would a person have to meet to access this mechanism?
Not all people will be able to access, because they do not meet the requirements. If I, for example, have depression, I am in a moment of crisis and I have suicidal ideas, medically assisted death is not for me, but access to mental health services. There will be other cases in which it does: I have schizophrenia, for example, and I have lived with it for 40 years, I have undergone all the possible treatments and medically they do not work and I want to end my life. I probably meet the requirements. Or I have Alzheimer’s and I’m diagnosed early and I don’t want to wait for my life to deteriorate. I might as well.
There is another modality and it is when families decide to disconnect a person, but the doctor or clinic is opposed. What is it and how should it be regulated?
This is technically called the adequacy of the therapeutic effort, which is part of the right to die with dignity. It is the possibility of rejecting treatments or procedures that at some point in life are considered unnecessary or disproportionate. These decisions happen every day, particularly with people who are in intensive care, for example. However, people lack mechanisms to achieve an effective response.
What does this mean?
That this is defined or decided more or less informally within hospital settings and there are times when requests are processed, but it is also possible that there is a doctor or clinic that does not. The challenge here and in the face of the bill is that just as people make the request for medically assisted death with stipulated times, it is also applied to the adequacy of the therapeutic effort.