By Angel Cardozo1 (Access this report in Spanish.)
In the spring of 2014, under the presidency of José “Pepe” Mujica, Law 19,286[2] was born in Uruguay, which with great triumph codified the Code of Medical Ethics (the Code) into law. Doctors celebrated this law since finally, there were clear rules for their actions even under challenging situations.
In its provisions, the law clarifies the much-debated topic of euthanasia. In its fourth chapter, “Specific Ethical Problems,” the second section speaks about the end of human life, and the Code establishes in article 46 that “active euthanasia, understood as the action or omission that accelerates or causes the death of a patient, is contrary to the profession’s ethics.”
Later, the Code establishes that in terminally ill patients, doctors must continue caring for the patient with the same responsibility and dedication. The objective of a doctor’s medical action is to alleviate the physical and moral suffering of the patient, helping him to die with dignity, according to the patient’s values.
This law ended with the discussion of the well-known “mercy death,” and it was clear to all Uruguayans that a doctor should not kill a person no matter how much a patient begged. This law also states that no doctor can be asked to hasten or cause death since that would not be euthanasia but homicide.
Years passed, and this medical ethic guided the actions of all Uruguayan medicine until 2018. That year the accountant Fernando Sureda was diagnosed with “amyotrophic lateral sclerosis” (ALS or Lou Gehrig’s Disease), the disease suffered by the physicist Stephen Hawking.
As a result of this diagnosis, the accountant Sureda wanted to end his life, but no one euthanized him due to medical ethics. So, a movement for legal euthanasia began.
He began to become visible in the media with the speech that since he had a dignified life (he was a leader and linked to the Uruguayan Soccer Association), he also deserved an equally dignified death. Thus, Sureda did not want to reach the point of not being able to move or swallow, and to avoid this situation he preferred to die before this point.
This speech also took him to unions and medical associations, managing to host a dialogue on “Euthanasia in Uruguay: ethical, healthcare and legal issues,”[3] co-organized by the Uruguayan Medical Union.
This activism also took him to the political sphere and found a place in the Colorado Party, a political group with a track record on the ideals promoted by the accountant Sureda.
In this regard, the Colorado deputy, Ope Pasquet, embraced the accountant Sureda’s movement, and in August 2022, he introduced a bill that sought to permit euthanasia.
In previous years, two other bills were introduced, but they did not move in the legislature because other critical issues were on the political agenda. In this post-pandemic 2022, there were also issues of relevance to the country. Still, Deputy Pasquet sought the support of other parliamentarians and political sectors to obtain their vote.
The bill reads, “Any mentally fit adult, who suffers from one or more illnesses or chronic, incurable and irreversible health conditions that seriously impair their quality of life, and which cause unbearable suffering, has the right to request, under the procedure established in this law, euthanasia so that their death occurs painlessly, peacefully, and with dignity.”
As can be seen, the bill has broad language and allows even a mental illness to qualify a person for euthanasia.
Thankfully, different delegations in Parliament have made the approval of this bill contingent upon approval of another bill, which had been presented in November 2021, and whose purpose is to guarantee the right to receive palliative care. Thus, the palliative care bill would apply to all people with severe, progressive and/or advanced diseases, covering the physical, psychological, social and spiritual dimensions, in accordance with the duties of health professionals and the health system.
The political actors decided to move forward with the euthanasia bill presented in August 2022, but abandoned the palliative care bill.
It took only two months to approve the euthanasia bill in the Deputies chamber, and by December of the same year, it already had the Senate committee’s reports, so it was ready to be approved.[4]
At the same time, the palliative care bill was approved by the Chamber of Deputies on December 14, 2021, but it remains on the desks of the Chamber of Senators without being dealt with.[5]
Now, if we keep in mind that the deputies are representatives of society and must “represent” their will, then could it be that Uruguay wants to permit euthanasia?
Various polls say that more than half of the population agrees with permitting euthanasia. But another compelling factor is affecting the political agenda, and, namely, it is the philosophical ideology of the Colorado Party.
At the beginning of the 20th century, the constitutional presidents of the country, the Colorados José Batlle y Ordóñez (for two terms), Claudio Williman and Feliciano Viera, who served from 1903 to 1919, were responsible for promulgating the divorce law (1907), eliminating religious teachings in schools (1909) and adding no-fault divorce (1912). In 1911 they established a prohibition for the military to participate in religious ceremonies, and in 1919 they changed the names of the religious festivities, and for this reason, in Uruguay, Holy Week is called tourism week; the Day of the Virgin—December 8—is the day of the beaches; and December 25, family day.
This shows that ideological reasons cause the acceleration of a bill (of euthanasia) and the stagnation of another (of palliative care).
And the Uruguayans, what do they want? This question was answered by the accountant Fernando Sureda himself. In November 2019, in full activism for legal euthanasia, while he was attending his routine medical consultations, he was suggested to contact Dr. Eric Benito, a Spanish oncologist and palliative care provider.
The accountant Sureda sent him an introductory video, telling him verbatim: “It is an honor that you have treated me, but I will tell you that I am the person best prepared to die and you, those in palliative care, do not have an answer to know what to do with me.”[6]
This is how the relationship between Sureda and his palliative care specialist began. It lasted until September 3, 2020 when Sureda died due to his illness. Despite his defense of euthanasia, he passed away without the need to undergo it because, thanks to Dr. Benito, he understood the dignity of dying and being cared for by loved ones.
Given this testimony, we can see, as Dr. Rita Rufo, president of the Uruguayan Society of Medicine and Palliative Care, says, that during the monitoring of a terminal patient, which often lasts for years, the important thing is to educate, teaching them to bear illness and pain. She also affirmed that she would be sending the wrong message if she maintained that the only peaceful way to die is by causing death, because it is not like that; there is also a dignified way to bear pain.[7]
Footnotes
[1] PhD in Law and Social Science. Solicitor and Notary, graduated from the University of the Republic of Uruguay.
[2] Full text of the standard available at: https://asuo.org.uy/wpcontent/uploads/2020/04/Codigo_de_Etica.pdf
[3] Uruguay, Medical Union of Uruguay. (July 31, 2019). Youtube. Retrieved from https://www.youtube.com/watch?v=WTWgW2_2gXk
[4] Legislative history available at: https://parlamento.gub.uy/documentosyleyes/ficha-asunto/155832/tramite
[5] Legislative history available at: https://parlamento.gub.uy/documentosyleyes/ficha-asunto/152965/tramite
[6] https://ladiaria.com.uy/salud/articulo/2022/11/enric-benito-el-debate-entre-eutanasia-y-cuidados-paliativos-es-falso-pero-no-se-empieza-la- construction-of-a-house-through-the-roof/
[7] Journalistic note available at: https://www.cronicas.com.uy/sociedad/debate-por-eutanasia-se-esta-dando-el-mensaje-equivocado-advirtio-especialista/
