Euthanasia in Uruguay: its risks and consequences from a bioethical perspective

After the euthanasia law was approved in the Uruguayan Senate on October 15, doctor and university professor Diego Velasco Suárez, a reference for the Prudencia Uruguay professional group, offered an analysis of the law from the point of view of bioethics.

The law, which obtained 20 positive votes, allows any person over 18 years of age who “suffers from one or more chronic, incurable and irreversible pathologies or health conditions that seriously impair their quality of life, causing suffering that is unbearable”, to have access to euthanasia.

In dialogue with Radio Mariawhen reviewing the path that the bill took until it was approved, doctor Velasco Suárez pointed out that in 2020 “it began with something more minimalist, which was to treat euthanasia from the point of view of making it no longer a crime.”

That first text, promoted by the Colorado Party deputy, Ope Pasquet, exposed euthanasia as an expression of individual freedom. But the proposal changed: “The Frente Amplio proposed another very different project, because what was established there is that the State is the one that must provide, the one that has the duty to offer euthanasia to certain people.”

In this way, “the State no longer only fails to protect the right to life, but also causes death, offers death (…) It is an institutional violation of the first human right, which is the right to life,” he stated.

This law repeals article 46 of the Code of Medical Ethics, in which euthanasia was prohibited, and thus establishes a new professional function, the doctor said.

“A new profession is established, properly, because until now in Uruguay the death penalty was prohibited and no one had the duty to kill,” he said. What is done, he explained, “is to change an already existing profession for doctors and establish this duty to cause death,” he added, also added to “the duty to judge, according to this law, that a person has lost the right to life.”

A highly regressive law

In this context, Velasco Suárez expressed his concern about the breadth of the causes that enable euthanasia in Uruguay. As can be deduced from the law, “the concept of incurable disease is all chronic pathologies. Anyone who has a chronic pathology that causes suffering that they consider unbearable will be included in this,” he warned, detailing that the concept “health conditions” includes all congenital and acquired disabilities, and even old age.

Furthermore, he considers that this law generates a form of institutionalized discrimination: “It is a law that discriminates in the first right, in the right to life, based on illness, old age, disability and social and economic condition. So, it is a highly regressive law,” he stated, and noted: “It draws a lot of attention that an entire political sector that considers itself progressive is promoting this.”

He also questions the notion of “impaired quality of life” as a requirement: “Who has a worse quality of life, the rich or the poor? The one who is alone or the one who has good social and family support?”

On the other hand, he denounced the lack of minimum guarantees and the use of the “signature upon request,” that is, the possibility of another person signing on behalf of the applicant: “An enormous possibility is being enabled because people who are hospitalized or who have an incurable illness—needless to say if it is a terminal illness—it is easy to say ‘no, I couldn’t sign’, ‘but did you ask for it?’, ‘yes, yes, I did.’ ‘he asked’. How did you ask for it? And well, there doesn’t have to be any record, any proof,” he said.

In the law “there is no valid guarantee because this is not a right. There cannot be a right to death when the right that exists is the opposite right, which is the right to life,” he stressed.

Strengthen palliative care

In contrast, he raised the need to strengthen the palliative care service in Uruguay, which has existed in the health system since 2012, but whose coverage is limited. “In fact, this service is not universal, it does not reach everyone, it is not of quality and it is not comprehensive,” he denounced.

The Palliative Care Society, the doctor indicated, had promoted a specific law that sought to guarantee comprehensive and timely care. However, “when there was a week left to go to the plenary session of the Chamber of Deputies, the project was modified by the same people who had already drafted the euthanasia bill.”

In that modification “they removed the end-of-life chapter,” which turned it into “a palliative care law without end-of-life care, which is absurd.”

The rejection of that law, says Velasco Suárez, revealed a fundamental contradiction: “Everything they had been saying about being compatible and complementary, they erased it with their elbow and did not want it to be included in the project that was presented to the vote,” he warned.

“If one offers quality palliative care, the desire to hasten death is overcome in 95 or 98% of cases,” he said. “existential suffering is never addressed by offering death,” he summarized.

For Velasco Suárez, the consequences of this law can be serious, because “once a law is approved, in a country that is very morally relativistic, good and bad is what the law says.”

In that sense, he warned about the cultural impact of presenting euthanasia as a right: “Something that is destroying the bases of social coexistence and of law and ethics is going to become the most natural thing, which is that we are all worth the same, all human beings are equal in dignity and human rights.”

“God does not lose battles if one does things for Him. What cannot be done is abandon that battle that is cultural and at this moment it will be more important to focus on providing information about what the law says and what palliative care can do,” he concluded.