Euthenasia a la Colombiana

Brittany Maynard. (Photo: CNN)

Colombia's progressive 1991 Constitution differentiated between simple homicide and something called 'homicide out of pity': killing intended to end another person's intense suffering.

In the late '90s, someone filed a lawsuit to end that distinction, arguing that murder is murder, even if motivated by compassion for another's suffering. But in its 1997 decision, the plaintiff lost. The court not only reaffirmed the 1991 Constitution, but went further: it depenalized killing out of compassion as long as the 'victim' was suffering intensely from a "grave, incurable illness."

The court also instructed the legislature to regulate the practice of euthanasia. However, because of opposition from the Catholic Church and other conservative groups which want euthanasia completely banned, the court has never legislated about the subject.

As a result, euthanasia is legal in Colombia, but has few rules: No minimum life expectancy; no requirement for opinions from multiple doctors: no consent degree requirements from the patient and relatives.

All of which sounds like a recipe for disaster: Legal battles between relatives for inheritances; murder charges against doctors; accusations from the church.

Dr. Gustavo Quintana, Colombia's Dr. Kevorkian, in 2011.

Yet, for the past 18 years, the practice of euthenasia in Colombia seems to have gone about as 'smoothly' as could be hoped. At least, in my nine years living here, I haven't heard of any problems.

The case of Brittany Maynard, who killed herself in Oregon, U.S.A. this weekend to escape a painful death from an incurable brain tumor, brought worldwide attention to euthanasia (even tho what she did was actually assisted suicide).

In part because of the lack of regulation, no good numbers exist about euthanasia in Colombia. One Bogotá doctor, Gustavo Quintana, talks publicly about the fact that he's carried out more than 150 euthanasias. When I spoke with him several years ago, he told me that he'd experienced no direct attacks from the Catholic Church. Undoubtedly, many other doctors perform euthanasia but don't talk about it.

While some religious critics would call each case of euthanasia a murder and a tragedy, to me each case represents the prevention of suffering for the patient and his or her family, (as well as family savings preserved, to be better invested in education or health care which can do more than just prolong suffering).

The Catholic Church and others hold that only God can take away life. But humans give and take life all the time. And, if God had really made human life priceless, then why does He (or She) take it away so arbitrarily - as in the case of the dozen coal miners trapped in a flooded coal mine this weekend. And, for that matter, why did God afflict Brittany Maynard with a deadly brain tumor in the first place?

Colombia is one of only three nations in the world, along with Belgium and Holland, which allow euthanasia. It's a tragedy that more nations do not respect this basic right and allow the sick and suffering and their families to find a dignified end.

In the wake of Maynard's assisted suicide, Colombian legislators are talking once again about regulating the practice of euthanasia here. Maybe that would make the practice safer, but perhaps it would only complicate the lives of doctors and patients.

By Mike Ceaser, of Bogotá Bike Tours

Colombia's Dr. Kevorkian

Colombia's Dr. Death? Quintana shows off a plant growing behind his office. 

Euthanasia and assisted suicide have received lots of media coverage and controversy in recent weeks, due to the death of Dr. James Kevorkian and the release of a video showing the assisted suicide of a British millionare.

But in here Colombia, one of the few places in the world where euthanasia is legal, at least one doctor has been practicing it for decades with little controversy.

Dr. Gustavo Quintana is an enthusiastic man of 64, whom I met in his small office in a nondestript building on Seventh Ave., above a hair salon and next door to an indoor rock climbing gym.


Quintana might not fit the image of someone who some critics call 'Dr. Death.' Rather, at 64, after two heart attacks, he's full of life, energetic and enthusiastic; a divorced father of four who is building a relationship with his girlfriend.

Quintana unapologetically defends euthanasia, which he carries out along with his practices of general medicine and gerontology, the treatment of aging. He says he's carried out euthanasia 83 times - a procedure he considers completely compatible with the Hippocratic Oath, which instructs: 'Do no harm.'

"In order to do it, I have to love my patients," Quintana says.

Other Colombian doctors also probably perform euthanasia, Quintana believes, but they don't talk about it as he does.

Quintana's interest in euthanasia began after an auto accident which almost left him quadripelegic. He decided then that he preferred death to a limited life. His patients suffer mostly from cancer, diabetes and degenerative neuromuscular conditions, he said, but have also included a few people in their 40s, whose lives had become unbearable. One was a woman whose diabetes had destroyed her kidneys and her eyesight and was going to require the amputation of her feet. Blind and unable to walk, the woman, who lived alone, faced an impossible challenge in traveling to her regular dialysis treatments.

Quintana says his euthanasia procedure is peaceful and painless, consisting of three medications, which put the patient to sleep, sedate them and then stop the heart. They are the same medications used to apply the death penalty in the U.S., Quintana said - ironic in Colombia, where the death penalty does not exist. The process lasts 10 to 15 minutes, he said.

Call him Dr. Death - he doesn't mind.

Altho Quintana has not faced criticism from religious leaders, being known as a euthanologist has brought him troubles. One time, he was denied a visa to England, because, he says, of his euthanasia practice. Another time he says the FARC guerrillas lured him into their territory with a false call for medical assistance and then held him there for several days before releasing him. He believes that a sick guerrilla leader had wanted to be euthanized, but the man died before Quintana arrived. (If the doctor's speculation is accurate, it's not much of an endorsement of the guerrillas' courage in the face of the same death they routinely dish out to soldiers and civilians.)

And in a university conference, someone once compared Quintana to a hired assassin.

Quintana says: "I told them 'an assassin is someone who kills a person who wants to live.'"

To this blogger, legalizing euthanasia is pretty close to a no-brainer. If you or I encounter someone lying on the sidewalk suffering terribly we've got a moral obligation to help relieve their pain. Why should it be any different for a doctor whose patient is suffering from a terminal illness? Add to that the tremendous financial burdens on the patient's family and society, and the moral obligation to offer euthanasia seems overwhelming.

But the great majority of societies prohibit both active euthanasia and assisted suicide (altho you can be sure that they're often practiced secretly). In contrast, other polemical practices, including prostitution, abortion and same-sex marriage, have been legalized in many countries.

"It's because we're very uncomfortable dealing with death," Quintana says.

To me, the moralists' arguments are self-contradictory. If the religious argument that 'God provides life, so only God can take it away,' is to be accepted, then why aren't the moralists also fighting to ban smoking, air polllution, drunk driving, rock climbing and the many other ways we humans cut short our own lives. And, why do conservative Bible thumpers, at least in the U.S., generally support capital punishment?

And following their reasoning about God's intentions to its logical opposition, believers should also oppose medical treatment, since it evidently interfere's with God's intention that the person suffer and perhaps die. 

A smoker commiting unassisted suicide. Why is lighting up legal?

But some of Dr. Quintana's reasoning also leaves me uncomfortable. Faced, for example, with the hypothetical case of a young, depressed person who came to him seeking euthanasia, Quintana says he would consider it.

Quintana says he's persuaded some patients bent on being euthanized to delay. But what right, he asks, does he have to question a patient's motives?

But depression is increasingly treatable, and I've heard of many cases of people who tried to commit suicide, failed, regretted trying and went on to live full lives.

Still, Quintana adds, it's very difficult to change people's minds.

"How can I convince a person who wants to die of my desire to live?" he asks.

To me, Quintana's non-judgementalness also creates potential for a slippery slope, especially when he talks about "every person's right to decide to what point to accept their own decadence." But our athletic skills peak in our twenties and we spend the rest of our lives in some sort of decadence.

Despite being highly Catholic and generally conservative, Colombia is one of the few nations to permit active euthanasia thanks to its progressive 1991 Constitution, which changed Colombia from a Catholic to a secular nation. In 1997, the Constitutional Court ruled that euthanasia did not violate the Constitution's clause endorsing a right to life. The court also called on Congress to regulate the practice of euthanasia, something which has never been done.

To protect the right to euthanasia in Colombia, I think the practice should be regulated, requiring, say, the agreement of two doctors and a psychiatrist that the person is terminally ill and has only a short time left to live and made an independent choice to die. Otherwise, a single highly-publicized case in which children fighting over an inheritance accuse each other of encouraging grandmother to have herself killed could motivate Colombia's Congress to outlaw the practice.

Colombian law also does not restrict the practicing of euthanasia to Colombian citizens or residents. Quintana says he's never had a foreign euthanasia patient, but that one time an American nurse proposed flying down planeloads of terminally ill North Americans to undergo euthanasia here. She'd charge each of them thousands of dollars and divide it with Quintana. Quintana didn't want to commercialize his work and so rejected the offer. But other doctors might not have the same scruples. And, while it could be a blessing for many suffering foreigners, such an scheme would most likely bring about a total euthanasia ban in Colombia.

For his part, Quintana plans to continue unapologetically performing euthanasia as long as he's able. And when his own time approaches, he plans to have his own euthanasia filmed for posterity.

After that, will some other courageous doctor take up his mission?


Dr. Quintana's website is: http://euthanasia-col.com/index.php/contactenos.html

The Foundation for the Right to Die With Dignity.

By Mike Ceaser, of Bogotá Bike Tours

Abortion Ban in Colombia?

The Santa Ana Church, amidst abortion clinics.

Colombia became one of the more progressive nations in Latin America for abortion rights thanks to a 2006 high court decision legalizing the practice in certain cases. But now, a Conservative Party senator wants to set the clock back - and condemn more girls and women to suffering and even death - by banning abortion in all cases.

The legislation appears unlikely to pass, since most Colombians appear to support the current exceptions, which depenalize abortion when a pregnancy results from rape or incenst, threatens a woman's life or the fetus is severely deformed. The government is even considering including the day-after pill in public health programs, altho its supporters don't consider it abortive.

The high court depenalized abortion in certain cases because dangerous pregnancies and illegal abortions were killing many women and girls - as they still do. According to a 2005 study, before abortion was legalized, 23% of Colombian women reported having had an abortion and illicit abortions caused 16% of maternal deaths.

A clinic offers ultrasounds, and perhaps other services.



Even since the court decision, only a few hundred women have taken advantage of each of the legal exceptions, in a nation of 45 million people. That's probably due to lack of education, the social stigma against abortion in a highly Catholic nation and resistance by doctors and hospitals to performing abortions, even when a woman has a legal right to the procedure. The low numbers also suggest that the procedure is not being abused, but rather that many women are being denied their right to the procedure and either carrying  dangerous pregnancies to term or undergoing illicit abortions.



There is even an area of Bogotá's Teusaquillo neighborhood that's known for illegal abortions. Ironically, these clinics, which advertise services for pregnant women, surround a venerable Catholic church.

Before the 2006 court decision, I visited several of these clinics with a friend who told the doctors that she needed an abortion. Each clinic offered her an abortion, for different costs. When my friend expressed concern about dangers to her health, one (apparent) doctor reassured her that 'Lots of women come here and have one abortion after another, with no problems.' In fact, my friend had had an abortion in one of those clinics, with no complications. But that's not always true. In one case, a woman having an abortion in a clinic near the church started hemorraging. The clinic's staff were afraid they'd get themselves in trouble if they took her to a hospital, and so they just called her family to come pick her up. But by the time her relatives arrived, the woman had died.

That's what happened and continues happening in Colombia, where law and reality often do not coincide.

'Center for Orientation for Women,' across
the street from the Santa Ana Church.

In a nation in which children start having sex in their early teens and where machismo and alcohol mean lots of unintended pregnancies, abortions will continue happening whether they're permitted or not. Right to life arguments are principled and deserve respect, altho I disagree with them. But abortion bans prevent few abortions, while pushing many girls and women into dangerous illegal clinics. Lgalized abortion can hopefully be regulated and made safe. But when abortion (or prostituion or drug dealing) is prohibited it goes on anyway, just clandestine and unregulated.

The same piece of legislation would also outlaw euthanasia, which is now permitted in Colombia by dint of not being banned. In my way of seeing it, euthanasia should also be permitted, to save victims of fatal diseases months or years of pointless suffering, and their loved ones months or years of misery, anguish and huge expenses.

Here's an entry about abortion protesters.

By Mike Ceaser, of Bogotá Bike Tours