DECRIMINALISATION is the abolition of criminal penalties in relation to a particular action. Since being under deliberation for some time, earlier this year the use of less than two ounces of ganja was decriminalised in Jamaica. Seventeen years ago, Colombia decriminalised euthanasia, stating that a “dignified death” is a fundamental right.

Euthanasia is the painless ending of the life of a patient suffering from an incurable and severely painful disease or who is in an irreversible coma. Decisions made in one jurisdiction can have a global reach and effect, as the increasing interdependence and connectedness of countries, along with an ever-expanding amount of global concerns and the virtually instantaneous nature of telecommunications, are blurring the distinction between domestic issues and foreign matters.

THE REALITY OF GLOBALISATION

In April of this year in Colombia, the Health Ministry issued a decree to regulate the use of euthanasia by health policy administrators. This came 17 years after their Constitutional Court decriminalised euthanasia, and was seen in the global community as a bold decision that placed that country on a short list of those that now have mechanisms defending the right of people to decide for themselves when to die, within a specific legal framework. These countries include the Netherlands, Belgium, Luxembourg, Switzerland, Argentina, Canada, and the states of Oregon, Washington and Vermont in the United States.

However, despite euthanasia now being legal in Colombia, when faced with individual patients suffering from an incurable disease like terminal cancer, doctors still hesitate on how to implement the Health Ministry’s relevant protocol.

In Bogota, a 79-year-old patient, after five years of cancer that required a range of painful treatments that destroyed parts of his face, wrote down on a piece of paper that he no longer wanted to live, and that his family supported his decision to be put to death. This patient would have been the first patient to undergo euthanasia under the new protocol that the Health Ministry had issued to regulate assisted death.

However, only 30 minutes before being carried out, his appointment with death was cancelled at the cancer clinic where he was being treated. The treating physician had agreed that the patient had an advanced illness that produced constant suffering, and so he no longer had any treatment options and further the patient’s request for euthanasia had been “coherent”. Within a week, the clinic announced that the euthanasia procedure was back on schedule, but that the patient’s family had asked that the date and time be kept private.

COMMITTEE TO DETERMINE

A scientific committee was formed to examine the patient’s case and pronounced that the Health Ministry’s stipulations were ambiguous and “full of gaps”, and that the patient did not meet the requirements for receiving euthanasia. The committee used three arguments to defend its position. Firstly, they said the patient had received all the palliative care that could control his pain. Secondly, he was very functional and the ministry’s regulations said the patient should be totally dependent. Finally, the committee opined that the patient’s death was not imminent.

The committee also stated that the normative standard was for the diagnosed patient who was about to die, although this term was very ambiguous. It said, in this particular case, the patient would not be dying soon. These doubts led to the cancellation of the appointment that had already been approved by the cancer clinic for the patient, and so the patient reportedly resorted to the courts to protect his right to die with dignity.

A constitutional law expert and head of a legal research centre in that country opined that the new regulations did not specify that the patient must be lying helpless in bed or dependent on others to exercise his right. He said that the regulation clearly stated that any patient with a terminal illness who was expected to die soon, could apply for euthanasia. However, while the idea of “dying soon” may have multiple interpretations, the expert said that medical committees examining patients’ cases could determine whether or not the remaining time entailed dignified conditions.

ON THE VERGE OF DYING

The legal expert also said that the ministry’s regulations did not obligate patients to receive palliative treatments, only that he or she must know that the option exists. The expert also stated that doctors implementing euthanasia should be aware that the new protocol was created to regulate two rulings of the Constitutional Court, which were broadly intended to defend and ensure respect for a patient’s autonomy in deciding on his or her own life.

Others pointed out that euthanasia has no use if a person is dying slowly, but is beneficial where the patient is suffering greatly, no curative treatments exist, and it is known that the patient will die within a short time. They said physicians should have enough elements to determine whether a person’s request to die is legitimate, and all issues should be explored. If it is to be done, it must accord to the patient’s wishes with his or her family’s participation in making the decision.

What is your opinion on this matter?

Derrick Aarons MD, PhD is a consultant bioethicist/family physician, a specialist in ethical issues in medicine, the life sciences and research, and is the Ethicist at the Caribbean Public Health Agency – CARPHA. (The views expressed here are not written on behalf of CARPHA)