Psychologist specializing in bereavement, National Cancer Institute, Mexico City, Mexico
I have looked in detail at the results of the IAHPC Assisted Dying Practices and Euthanasia Survey. These results show legitimate concern regarding the challenges that palliative care development and consolidation face amid the increasing global debate on the legalization of assisted dying. Nonetheless, 49% of respondents support the legalization of assisted dying; yet, of these, 56% consider it should be used narrowly for exceptional cases alone. I would like to build on this information and contribute an interdisciplinary perspective to the debate. A course on assisted dying, as part of the End-of-Life Studies MSc program at the University of Glasgow, has given me a new lens through which to examine these complex topics.
I believe that palliative care has much to offer any patient with chronic and irreversible medical conditions. However, in Mexico, as in many other countries, the demand far exceeds the services available. Furthermore, I believe that palliative care does not have all the answers for those experiencing unbearable suffering. At the same time, it is true that the issues concerning the legalization and implementation of assisted dying are incredibly complex. Gerson et al.1 identified the multidimensional challenges inherent in the relationship between assisted dying and palliative care, and the impact that this may have on patients, families, and health professionals involved. Nonetheless, the authors also present evidence of the successful coexistence of assisted dying and palliative care in Belgium.
Dr. Asunción Álvarez del Río, a Mexican researcher at the Autonomous National University (UNAM), president of the College of Bioethics in Mexico, and president of the World Federation of Right to Die Societies, told me in an interview that Mexico is moving forward with assisted dying legalization. Mexico, like other legislatures in similar circumstances, may benefit from the experiences of those countries that have legislated in its favor. Mroz et al.2 provided an overall review of the different models of assisted dying around the world and their evolution. They also provided insights into how to implement the regulatory framework once assisted dying becomes legal. It is important to note that the terms euthanasia and suicide have been banned almost entirely from the debate. Instead, medical aid in dying or assisted dying are the preferred terms used globally. This may help lessen the general public confusion between concepts.
Changes in human history often occur after protracted socio-cultural shifts in understanding. This seems to be the case for assisted dying the world over. I consider it important to base this debate in human rights. To find common ground upon which to generate agreement, personal biases and beliefs need to be respected yet kept out of the debate. This topic easily conflates ethical, philosophical, medical, and religious aspects that require all those involved to delve deeper into the challenges that assisted dying may represent for the populations—especially for the sick and for the vulnerable.